{"id":17233655,"date":"2026-03-24T09:31:21","date_gmt":"2026-03-24T09:31:21","guid":{"rendered":"https:\/\/ambrelia.com\/?page_id=17233655"},"modified":"2026-03-26T15:13:01","modified_gmt":"2026-03-26T15:13:01","slug":"finalisez-votre-dossier-en-quelques-minutes","status":"publish","type":"page","link":"https:\/\/ambrelia.com\/fr\/finalisez-votre-dossier-en-quelques-minutes\/","title":{"rendered":"Questionnaire hospisafe &amp; lifesafe"},"content":{"rendered":"<p>[et_pb_section fb_built=\u00a0\u00bb1&Prime; _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb custom_padding=\u00a0\u00bb||3px|||\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_row _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb custom_padding=\u00a0\u00bb||1px|||\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_text _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb header_text_color=\u00a0\u00bb#1359D3&Prime; global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<h1>Finalisez votre dossier en quelques minutes<\/h1>\n<p>[\/et_pb_text][et_pb_text _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<p data-start=\"322\" data-end=\"481\">Afin de finaliser la mise en place de votre couverture, nous avons besoin de recueillir certaines informations obligatoires dans le cadre du devoir de conseil.<\/p>\n<p data-start=\"483\" data-end=\"680\">Ce questionnaire nous permet de mieux comprendre votre situation, d\u2019adapter les garanties \u00e0 vos besoins et de garantir la conformit\u00e9 de votre souscription aux exigences r\u00e9glementaires (DDA \/ ACPR).<\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<p data-section-id=\"x2fm5a\" data-start=\"687\" data-end=\"715\"><strong>Informations pratiques<\/strong><\/p>\n<p data-start=\"716\" data-end=\"867\">\u23f1\ufe0f Dur\u00e9e : environ 3 \u00e0 5 minutes<br data-start=\"748\" data-end=\"751\" \/>\ud83d\udd12 Vos informations sont strictement confidentielles et utilis\u00e9es uniquement dans le cadre de votre accompagnement<\/p>\n<p data-start=\"869\" data-end=\"992\">Nous vous invitons \u00e0 compl\u00e9ter ce formulaire avec attention afin de finaliser votre dossier dans les meilleures conditions.<\/p>\n<p>[\/et_pb_text][et_pb_text _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb header_3_text_color=\u00a0\u00bb#0039A3&Prime; header_4_text_color=\u00a0\u00bb#1359D3&Prime; custom_margin=\u00a0\u00bb||17px|||\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<h4 data-start=\"1277\" data-end=\"1323\">Merci de remplir les informations ci-dessous :<\/h4>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][et_pb_row _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb custom_padding=\u00a0\u00bb3px|||||\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_column type=\u00a0\u00bb4_4&Prime; _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb][et_pb_code _builder_version=\u00a0\u00bb4.27.4&Prime; _module_preset=\u00a0\u00bbdefault\u00a0\u00bb global_colors_info=\u00a0\u00bb{}\u00a0\u00bb]<\/p>\n<style><!-- [et_pb_line_break_holder] -->*{box-sizing:border-box;margin:0;padding:0}<!-- [et_pb_line_break_holder] -->:root{--blue:#1457B8;--orange:#F5A623;--lightblue:#f0f5ff;--border:#dde4f0;--gray:#5a6477;--text:#1a1f2e}<!-- 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-->.contrat-btn:hover{border-color:var(--blue);background:var(--lightblue)}<!-- [et_pb_line_break_holder] -->.contrat-btn.selected{border-color:var(--blue);background:var(--lightblue);box-shadow:0 0 0 3px rgba(20,87,184,.1)}<!-- [et_pb_line_break_holder] -->.contrat-btn .ct-icon{font-size:22px;margin-bottom:4px}<!-- [et_pb_line_break_holder] -->.contrat-btn .ct-name{font-size:14px;font-weight:800;color:var(--blue)}<!-- [et_pb_line_break_holder] -->.contrat-btn .ct-sub{font-size:11px;color:var(--gray);margin-top:2px}<!-- [et_pb_line_break_holder] -->.dual-notice{display:none;background:#e8f5e9;border:1px solid #a5d6a7;border-radius:8px;padding:10px 14px;font-size:12.5px;color:#2e7d32;margin-top:8px}<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->\/* CHECKS *\/<!-- [et_pb_line_break_holder] -->.check-list{display:flex;flex-direction:column;gap:11px}<!-- [et_pb_line_break_holder] -->.check-item{display:flex;align-items:flex-start;gap:11px;cursor:pointer}<!-- 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-->.error-msg{color:#c0392b;font-size:11.5px;margin-top:4px;display:none}<!-- [et_pb_line_break_holder] -->.field.error input,.field.error select,.field.error textarea{border-color:#e74c3c}<!-- [et_pb_line_break_holder] -->.field.error .error-msg{display:block}<!-- [et_pb_line_break_holder] -->.global-error{display:none;background:#fde8e8;border:1px solid #f5c6c6;border-radius:8px;padding:11px 16px;font-size:12.5px;color:#c0392b;margin-bottom:12px}<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->\/* SUBMIT *\/<!-- [et_pb_line_break_holder] -->.submit-card{background:linear-gradient(135deg,var(--blue) 0%,#1a6fd4 100%);border-radius:14px;padding:22px 26px;margin-bottom:14px;border:none}<!-- [et_pb_line_break_holder] -->.btn-submit{width:100%;padding:14px;background:#fff;color:var(--blue);border:none;border-radius:10px;font-size:15px;font-weight:800;cursor:pointer;transition:all .2s;letter-spacing:.2px}<!-- [et_pb_line_break_holder] -->.btn-submit:hover{background:var(--lightblue)}<!-- [et_pb_line_break_holder] -->.btn-submit:disabled{opacity:.6;cursor:not-allowed}<!-- [et_pb_line_break_holder] -->#uploadStatus{display:none;text-align:center;margin-top:12px;font-size:12.5px;color:#fff;font-weight:600}<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->\/* SUCCESS *\/<!-- [et_pb_line_break_holder] -->.success-screen{display:none;text-align:center;padding:32px 24px}<!-- [et_pb_line_break_holder] -->.success-icon{width:64px;height:64px;background:#e8f5e9;border-radius:50%;display:flex;align-items:center;justify-content:center;font-size:30px;margin:0 auto 14px}<!-- [et_pb_line_break_holder] -->.success-title{font-size:21px;font-weight:800;color:var(--blue);margin-bottom:6px}<!-- [et_pb_line_break_holder] -->.success-body{font-size:13.5px;color:var(--gray);line-height:1.65;margin-bottom:20px}<!-- [et_pb_line_break_holder] -->.link-box{background:var(--lightblue);border:1px solid #c5d5f5;border-radius:10px;padding:12px 16px;font-size:12.5px;margin:12px 0;text-align:left;word-break:break-all}<!-- [et_pb_line_break_holder] -->.link-box a{color:var(--blue);font-weight:600}<!-- [et_pb_line_break_holder] -->.btn-mail{display:inline-block;padding:12px 24px;border-radius:9px;font-size:13.5px;font-weight:700;cursor:pointer;margin:5px;text-decoration:none;background:var(--blue);color:#fff;border:none}<!-- [et_pb_line_break_holder] -->.btn-dl{display:inline-block;padding:12px 24px;border-radius:9px;font-size:13.5px;font-weight:700;cursor:pointer;margin:5px;background:var(--lightblue);color:var(--blue);border:1.5px solid #c5d5f5}<!-- [et_pb_line_break_holder] -->.btn-new{background:none;border:1.5px solid var(--border);color:var(--gray);padding:9px 22px;border-radius:8px;font-size:12.5px;cursor:pointer;margin-top:14px}<!-- [et_pb_line_break_holder] -->.mention{font-size:10.5px;color:#aaa;text-align:center;margin-top:18px;line-height:1.7}<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->\/* WARN BOX *\/<!-- [et_pb_line_break_holder] -->.warn-box{background:#fffbf0;border-left:4px solid var(--orange);border-radius:0 8px 8px 0;padding:11px 14px;font-size:12px;color:#6b4c10;margin-top:10px;line-height:1.6}<!-- [et_pb_line_break_holder] --><\/style>\n<p><!-- [et_pb_line_break_holder] --><script src=\"https:\/\/cdnjs.cloudflare.com\/ajax\/libs\/jspdf\/2.5.1\/jspdf.umd.min.js\"><\/script><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"page\"><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><!-- HEADER --><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"header\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"logo-wrap\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"logo-arc\"><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"logo-text\">Ambrelia<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"logo-tag\">We cover Anyone, Anywhere<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"doc-title\">Fiche de Devoir de Conseil<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"doc-sub\">Contrats Hospi Safe &#038; Life Safe \u2014 Allianz<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"badges\"><!-- [et_pb_line_break_holder] --><span class=\"badge badge-date\" id=\"dateBadge\"><\/span><!-- [et_pb_line_break_holder] --><span class=\"badge badge-acpr\">\u2713 Conforme DDA \/ ACPR<\/span><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><\/p>\n<div id=\"formArea\"><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><!-- 1. DISTRIBUTEUR --><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"card\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"section-title\"><span class=\"section-num\">1<\/span> Identit\u00e9 du distributeur<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"info-box\"><!-- [et_pb_line_break_holder] --><strong>Nom :<\/strong> Kevin Elbaz \u00a0\u00b7\u00a0 <strong>Soci\u00e9t\u00e9 :<\/strong> Ambrelia<!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><strong>Statut :<\/strong> Courtier en assurance \u2014 Mandataire d&rsquo;Allianz<!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><strong>N\u00b0 ORIAS :<\/strong> <span class=\"orias-val\">11 064 575<\/span><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><strong>Email :<\/strong> kevin.elbaz@ambrelia.com<!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><strong>R\u00e9mun\u00e9ration :<\/strong> Commission sur la prime vers\u00e9e par Allianz<!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><strong>Conflit d&rsquo;int\u00e9r\u00eats :<\/strong> En tant que mandataire d&rsquo;Allianz, le courtier repr\u00e9sente l&rsquo;assureur pour ces contrats.<!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><!-- 2. CLIENT --><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"card\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"section-title\"><span class=\"section-num\">2<\/span> Informations du client<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"grid2\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"field\" id=\"f-nom\"><label>Nom <span class=\"req\">*<\/span><\/label><input type=\"text\" id=\"nom\" placeholder=\"Dupont\"><\/p>\n<div class=\"error-msg\">Champ requis<\/div>\n<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"field\" id=\"f-prenom\"><label>Pr\u00e9nom <span class=\"req\">*<\/span><\/label><input type=\"text\" id=\"prenom\" placeholder=\"Marie\"><\/p>\n<div class=\"error-msg\">Champ requis<\/div>\n<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"grid2\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"field\" id=\"f-ddn\"><label>Date de naissance <span class=\"req\">*<\/span><\/label><input type=\"date\" id=\"ddn\"><\/p>\n<div class=\"error-msg\">Champ requis<\/div>\n<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"field\" id=\"f-marital\"><label>Statut marital <span class=\"req\">*<\/span><\/label><!-- [et_pb_line_break_holder] --><select id=\"marital\"><option value=\"\">\u2014 S\u00e9lectionner \u2014<\/option><option>C\u00e9libataire<\/option><option>Mari\u00e9(e)<\/option><option>Pacs\u00e9(e)<\/option><option>Divorc\u00e9(e)<\/option><option>Veuf \/ Veuve<\/option><\/select><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"error-msg\">Champ requis<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"grid2\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"field\"><label>Nombre d&rsquo;enfants \u00e0 charge<\/label><input type=\"number\" id=\"nbEnfants\" min=\"0\" max=\"15\" value=\"0\" oninput=\"updateChildren(this.value)\"><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"field\" id=\"f-employeur\"><label>Employeur \/ Organisation <span class=\"req\">*<\/span><\/label><input type=\"text\" id=\"employeur\" placeholder=\"Commission Europ\u00e9enne\"><\/p>\n<div class=\"error-msg\">Champ requis<\/div>\n<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"children-list\" id=\"childrenList\"><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"grid2\" style=\"margin-top:4px\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"field\" id=\"f-adresse\"><label>Adresse postale <span class=\"req\">*<\/span><\/label><input type=\"text\" id=\"adresse\" placeholder=\"12 rue de la Paix, 75001 Paris\"><\/p>\n<div class=\"error-msg\">Champ requis<\/div>\n<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"field\" id=\"f-email\"><label>Adresse e-mail <span class=\"req\">*<\/span><\/label><input type=\"email\" id=\"emailClient\" placeholder=\"client@organisation.eu\"><\/p>\n<div class=\"error-msg\">E-mail valide requis<\/div>\n<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><!-- 3. BESOINS --><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"card\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"section-title\"><span class=\"section-num\">3<\/span> Analyse des besoins <span class=\"section-tag\">DDA Art. L.521-4<\/span><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"field\" id=\"f-couverture\"><!-- [et_pb_line_break_holder] --><label>Couverture existante ? <span class=\"req\">*<\/span><\/label><!-- [et_pb_line_break_holder] --><select id=\"couverture\"><!-- [et_pb_line_break_holder] --><option value=\"\">\u2014 S\u00e9lectionner \u2014<\/option><!-- [et_pb_line_break_holder] --><option value=\"non\">Non, aucune couverture existante<\/option><!-- [et_pb_line_break_holder] --><option value=\"partielle\">Oui, couverture partielle (compl\u00e9mentaire souhait\u00e9e)<\/option><!-- [et_pb_line_break_holder] --><option value=\"autre\">Oui, couverture existante (remplacement ou compl\u00e9ment)<\/option><!-- [et_pb_line_break_holder] --><\/select><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"error-msg\">Champ requis<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"field\"><!-- [et_pb_line_break_holder] --><label>Besoins exprim\u00e9s par le client<\/label><!-- [et_pb_line_break_holder] --><textarea id=\"besoins\" placeholder=\"Ex : couverture hospitalisation pour la famille, protection d\u00e9c\u00e8s\/invalidit\u00e9, couverture \u00e0 l'international...\"><\/textarea><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"field\" id=\"f-adequation\"><!-- [et_pb_line_break_holder] --><label>Motif d&rsquo;ad\u00e9quation <span class=\"req\">*<\/span><\/label><!-- [et_pb_line_break_holder] --><textarea id=\"adequation\" placeholder=\"Pourquoi ce(s) contrat(s) r\u00e9pond(ent) aux besoins exprim\u00e9s...\"><\/textarea><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"error-msg\">Champ requis<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><!-- 4. CONTRATS --><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"card\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"section-title\"><span class=\"section-num\">4<\/span> Contrat(s) souscrit(s) <span class=\"req\">*<\/span><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"contrat-group\" id=\"contratGroup\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"contrat-btn\" onclick=\"toggleContrat(this)\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"ct-icon\">\ud83c\udfe5<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"ct-name\">Hospi Safe<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"ct-sub\">Allianz \u00b7 Hospitalisation<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"contrat-btn\" onclick=\"toggleContrat(this)\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"ct-icon\">\ud83d\udee1\ufe0f<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"ct-name\">Life Safe<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"ct-sub\">Allianz \u00b7 Pr\u00e9voyance \/ D\u00e9c\u00e8s<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"dual-notice\" id=\"dualNotice\">\u2139\ufe0f Souscription coupl\u00e9e Hospi Safe + Life Safe. Le client reconna\u00eet avoir \u00e9t\u00e9 inform\u00e9 des garanties et du co\u00fbt de chaque contrat s\u00e9par\u00e9ment.<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"error-msg\" id=\"contratError\">Veuillez s\u00e9lectionner au moins un contrat<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><!-- 5. DOCUMENTS --><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"card\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"section-title\"><span class=\"section-num\">5<\/span> Documents pr\u00e9contractuels remis <span class=\"section-tag\">DDA Art. L.521-3<\/span><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"check-list\"><!-- [et_pb_line_break_holder] --><label class=\"check-item\"><input type=\"checkbox\" class=\"decl\" id=\"doc1\"><\/p>\n<div class=\"check-box\"><\/div>\n<p><span class=\"check-text\">La <strong>fiche IPID<\/strong> m&rsquo;a \u00e9t\u00e9 remise avant souscription. <span class=\"check-tag\">IPID<\/span><\/span><\/label><!-- [et_pb_line_break_holder] --><label class=\"check-item\"><input type=\"checkbox\" class=\"decl\" id=\"doc2\"><\/p>\n<div class=\"check-box\"><\/div>\n<p><span class=\"check-text\">Les <strong>Conditions G\u00e9n\u00e9rales et Particuli\u00e8res<\/strong> m&rsquo;ont \u00e9t\u00e9 communiqu\u00e9es. <span class=\"check-tag\">CG\/CP<\/span><\/span><\/label><!-- [et_pb_line_break_holder] --><label class=\"check-item\"><input type=\"checkbox\" class=\"decl\" id=\"doc3\"><\/p>\n<div class=\"check-box\"><\/div>\n<p><span class=\"check-text\">Un <strong>lien de souscription<\/strong> m&rsquo;a \u00e9t\u00e9 adress\u00e9 par e-mail. <span class=\"check-tag\">Souscription<\/span><\/span><\/label><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><!-- 6. DECLARATIONS --><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"card\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"section-title\"><span class=\"section-num\">6<\/span> D\u00e9clarations du client<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"check-list\"><!-- [et_pb_line_break_holder] --><label class=\"check-item\"><input type=\"checkbox\" class=\"decl\" id=\"d1\"><\/p>\n<div class=\"check-box\"><\/div>\n<p><span class=\"check-text\">J&rsquo;ai \u00e9t\u00e9 inform\u00e9(e) et conseill\u00e9(e) par <strong>M. Kevin Elbaz<\/strong> (Ambrelia), mandataire d&rsquo;Allianz. <span class=\"check-tag\">L.521-1<\/span><\/span><\/label><!-- [et_pb_line_break_holder] --><label class=\"check-item\"><input type=\"checkbox\" class=\"decl\" id=\"d2\"><\/p>\n<div class=\"check-box\"><\/div>\n<p><span class=\"check-text\">Je comprends que ce contrat s&rsquo;inscrit dans le <strong>programme de couverture des Commissions Europ\u00e9ennes<\/strong>.<\/span><\/label><!-- [et_pb_line_break_holder] --><label class=\"check-item\"><input type=\"checkbox\" class=\"decl\" id=\"d3\"><\/p>\n<div class=\"check-box\"><\/div>\n<p><span class=\"check-text\">J&rsquo;ai \u00e9t\u00e9 inform\u00e9(e) de la <strong>r\u00e9mun\u00e9ration par commission<\/strong> du courtier. <span class=\"check-tag\">L.521-2<\/span><\/span><\/label><!-- [et_pb_line_break_holder] --><label class=\"check-item\"><input type=\"checkbox\" class=\"decl\" id=\"d4\"><\/p>\n<div class=\"check-box\"><\/div>\n<p><span class=\"check-text\">J&rsquo;ai re\u00e7u les informations sur <strong>garanties, exclusions, plafonds<\/strong> et conditions g\u00e9n\u00e9rales.<\/span><\/label><!-- [et_pb_line_break_holder] --><label class=\"check-item\"><input type=\"checkbox\" class=\"decl\" id=\"d5\"><\/p>\n<div class=\"check-box\"><\/div>\n<p><span class=\"check-text\">J&rsquo;ai \u00e9t\u00e9 inform\u00e9(e) de ma <strong>facult\u00e9 de renonciation<\/strong> et des modalit\u00e9s de r\u00e9siliation.<\/span><\/label><!-- [et_pb_line_break_holder] --><label class=\"check-item\"><input type=\"checkbox\" class=\"decl\" id=\"d6\"><\/p>\n<div class=\"check-box\"><\/div>\n<p><span class=\"check-text\">J&rsquo;ai pu <strong>poser toutes mes questions<\/strong> et obtenir des r\u00e9ponses satisfaisantes.<\/span><\/label><!-- [et_pb_line_break_holder] --><label class=\"check-item\"><input type=\"checkbox\" class=\"decl\" id=\"d7\"><\/p>\n<div class=\"check-box\"><\/div>\n<p><span class=\"check-text\">Les <strong>informations personnelles<\/strong> renseign\u00e9es sont exactes et compl\u00e8tes.<\/span><\/label><!-- [et_pb_line_break_holder] --><label class=\"check-item\" id=\"dualCheck\" style=\"display:none\"><input type=\"checkbox\" class=\"decl\" id=\"d8\"><\/p>\n<div class=\"check-box\"><\/div>\n<p><span class=\"check-text\"><strong>[Double souscription]<\/strong> J&rsquo;ai \u00e9t\u00e9 inform\u00e9(e) s\u00e9par\u00e9ment des garanties et co\u00fbts de chaque contrat. <span class=\"check-tag\">Double contrat<\/span><\/span><\/label><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"error-msg\" id=\"declError\" style=\"margin-top:12px\">Toutes les d\u00e9clarations doivent \u00eatre coch\u00e9es<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><!-- 7. SIGNATURE --><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"card\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"section-title\"><span class=\"section-num\">7<\/span> Signature \u00e9lectronique<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"grid2\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"field\" id=\"f-sigNom\"><label>Nom complet (confirmation) <span class=\"req\">*<\/span><\/label><input type=\"text\" id=\"sigNom\" placeholder=\"Marie Dupont\"><\/p>\n<div class=\"error-msg\">Champ requis<\/div>\n<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"field\"><label>Date<\/label><input type=\"text\" id=\"sigDate\" readonly><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"warn-box\">En soumettant ce formulaire, le client atteste de l&rsquo;exactitude des informations saisies et confirme avoir re\u00e7u le conseil pr\u00e9alable \u00e0 toute souscription, conform\u00e9ment aux articles L.521-1 et suivants du Code des assurances.<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"global-error\" id=\"globalError\">Veuillez corriger les erreurs ci-dessous avant de soumettre.<\/div>\n<p><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"submit-card\"><!-- [et_pb_line_break_holder] --><button class=\"btn-submit\" id=\"btnSubmit\" onclick=\"submitForm()\">Valider et g\u00e9n\u00e9rer le PDF \u2192<\/button><!-- [et_pb_line_break_holder] --><\/p>\n<div id=\"uploadStatus\">\u23f3 G\u00e9n\u00e9ration et upload du PDF en cours\u2026<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- \/formArea --><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><!-- SUCCESS --><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"card success-screen\" id=\"successScreen\"><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"success-icon\">\u2705<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"success-title\">Formulaire valid\u00e9 !<\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"success-body\" id=\"successBody\"><\/div>\n<p><!-- [et_pb_line_break_holder] --><\/p>\n<div><!-- [et_pb_line_break_holder] --><a class=\"btn-mail\" id=\"mailLink\" href=\"#\" onclick=\"return checkMailLink(this)\">\u2709 Ouvrir la messagerie<\/a><!-- [et_pb_line_break_holder] --><button class=\"btn-dl\" onclick=\"downloadPDF()\">\u2b07 T\u00e9l\u00e9charger le PDF<\/button><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --><!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] --><button class=\"btn-new\" onclick=\"resetForm()\">+ Nouveau formulaire<\/button><!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><\/p>\n<div class=\"mention\"><!-- [et_pb_line_break_holder] -->  Document g\u00e9n\u00e9r\u00e9 via Ambrelia \u2014 Fiche Devoir de Conseil conforme DDA \/ ACPR<!\u2013- [et_pb_br_holder] -\u2013><!-- [et_pb_line_break_holder] -->  R\u00e9f. l\u00e9gale : Art. L.521-1 \u00e0 L.521-6 du Code des assurances \u2014 Directive (UE) 2016\/97<!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><\/div>\n<p><!-- \/page --><!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] --><script><!-- [et_pb_line_break_holder] -->const pad=n=>String(n).padStart(2,'0');<!-- [et_pb_line_break_holder] -->const TODAY=new Date();<!-- [et_pb_line_break_holder] -->const fmtDate=d=>`${pad(d.getDate())}\/${pad(d.getMonth()+1)}\/${d.getFullYear()}`;<!-- [et_pb_line_break_holder] -->document.getElementById('dateBadge').textContent='\ud83d\udcc5 '+fmtDate(TODAY);<!-- [et_pb_line_break_holder] -->document.getElementById('sigDate').value=fmtDate(TODAY);<!-- [et_pb_line_break_holder] -->let _pdfData=null;<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->function updateChildren(n){<!-- [et_pb_line_break_holder] -->  n=Math.max(0,Math.min(15,parseInt(n)||0));<!-- [et_pb_line_break_holder] -->  const list=document.getElementById('childrenList');<!-- [et_pb_line_break_holder] -->  while(list.children.length>n)list.removeChild(list.lastChild);<!-- [et_pb_line_break_holder] -->  while(list.children.length<n){<!-- [et_pb_line_break_holder] -->    const i=list.children.length;<!-- [et_pb_line_break_holder] -->    const row=document.createElement('div');<!-- [et_pb_line_break_holder] -->    row.className='child-row';<!-- [et_pb_line_break_holder] -->    row.innerHTML=`<\/p>\n<div class=\"field\"><label>Enfant ${i+1} \u2014 Pr\u00e9nom<\/label><input type=\"text\" placeholder=\"Pr\u00e9nom\"><\/div>\n<div class=\"field\"><label>\u00c2ge<\/label><input type=\"number\" min=\"0\" max=\"25\" placeholder=\"ans\"><\/div>\n<p>`;<!-- [et_pb_line_break_holder] -->    list.appendChild(row);<!-- [et_pb_line_break_holder] -->  }<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->function toggleContrat(el){<!-- [et_pb_line_break_holder] -->  el.classList.toggle('selected');<!-- [et_pb_line_break_holder] -->  const sel=getContrats();<!-- [et_pb_line_break_holder] -->  const dual=sel.length===2;<!-- [et_pb_line_break_holder] -->  document.getElementById('dualNotice').style.display=dual?'block':'none';<!-- [et_pb_line_break_holder] -->  document.getElementById('dualCheck').style.display=dual?'flex':'none';<!-- [et_pb_line_break_holder] -->  if(!dual)document.getElementById('d8').checked=false;<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->function getContrats(){return[...document.querySelectorAll('#contratGroup .contrat-btn.selected')].map(e=>e.querySelector('.ct-name').textContent);}<!-- [et_pb_line_break_holder] -->function req(id){const f=document.getElementById('f-'+id),v=document.getElementById(id).value.trim();if(!v){f.classList.add('error');return false;}f.classList.remove('error');return true;}<!-- [et_pb_line_break_holder] -->function validate(){<!-- [et_pb_line_break_holder] -->  let ok=true;<!-- [et_pb_line_break_holder] -->  ['nom','prenom','ddn','marital','employeur','adresse','couverture','adequation'].forEach(id=>{if(!req(id))ok=false;});<!-- [et_pb_line_break_holder] -->  const ef=document.getElementById('f-email'),ev=document.getElementById('emailClient').value.trim();<!-- [et_pb_line_break_holder] -->  if(!ev||!\/^[^\\s@]+@[^\\s@]+\\.[^\\s@]+$\/.test(ev)){ef.classList.add('error');ok=false;}else ef.classList.remove('error');<!-- [et_pb_line_break_holder] -->  if(!req('sigNom'))ok=false;<!-- [et_pb_line_break_holder] -->  const c=getContrats();<!-- [et_pb_line_break_holder] -->  document.getElementById('contratError').style.display=c.length?'none':'block';<!-- [et_pb_line_break_holder] -->  if(!c.length)ok=false;<!-- [et_pb_line_break_holder] -->  const allDecl=[...document.querySelectorAll('.decl')].filter(d=>d.closest('label').style.display!=='none').every(d=>d.checked);<!-- [et_pb_line_break_holder] -->  document.getElementById('declError').style.display=allDecl?'none':'block';<!-- [et_pb_line_break_holder] -->  if(!allDecl)ok=false;<!-- [et_pb_line_break_holder] -->  document.getElementById('globalError').style.display=ok?'none':'block';<!-- [et_pb_line_break_holder] -->  return ok;<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] -->function getChildren(){return[...document.querySelectorAll('#childrenList .child-row')].map((r,i)=>{const ins=r.querySelectorAll('input');return`Enfant ${i+1}: ${ins[0].value||'\u2014'}, ${ins[1].value||'?'} ans`;});}<!-- [et_pb_line_break_holder] -->function v(id){return document.getElementById(id).value.trim();}<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->\/\/ \u2500\u2500 PDF \u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500\u2500<!-- [et_pb_line_break_holder] -->function buildPDF(){<!-- [et_pb_line_break_holder] -->  const{jsPDF}=window.jspdf;<!-- [et_pb_line_break_holder] -->  const doc=new jsPDF({unit:'mm',format:'a4'});<!-- [et_pb_line_break_holder] -->  const W=210,ML=12,MR=12,CW=W-ML-MR;<!-- [et_pb_line_break_holder] -->  const BLUE=[20,87,184],ORANGE=[245,166,35],LGRAY=[245,247,252],MGRAY=[90,100,119],WHITE=[255,255,255];<!-- [et_pb_line_break_holder] -->  let y=0;<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  \/* \u2500\u2500 HEADER BAND \u2500\u2500 *\/<!-- [et_pb_line_break_holder] -->  doc.setFillColor(...BLUE);<!-- [et_pb_line_break_holder] -->  doc.rect(0,0,W,34,'F');<!-- [et_pb_line_break_holder] -->  \/\/ Arc orange<!-- [et_pb_line_break_holder] -->  doc.setDrawColor(...ORANGE);<!-- [et_pb_line_break_holder] -->  doc.setLineWidth(2.5);<!-- [et_pb_line_break_holder] -->  doc.ellipse(W\/2,34,9,5,'S');<!-- [et_pb_line_break_holder] -->  \/\/ Titre<!-- [et_pb_line_break_holder] -->  doc.setTextColor(...WHITE);<!-- [et_pb_line_break_holder] -->  doc.setFont('helvetica','bold');<!-- [et_pb_line_break_holder] -->  doc.setFontSize(19);<!-- [et_pb_line_break_holder] -->  doc.text('Ambrelia',W\/2,12,{align:'center'});<!-- [et_pb_line_break_holder] -->  doc.setFontSize(7.5);<!-- [et_pb_line_break_holder] -->  doc.setFont('helvetica','normal');<!-- [et_pb_line_break_holder] -->  doc.text('We cover Anyone, Anywhere',W\/2,18,{align:'center'});<!-- [et_pb_line_break_holder] -->  doc.setFontSize(10);<!-- [et_pb_line_break_holder] -->  doc.setFont('helvetica','bold');<!-- [et_pb_line_break_holder] -->  doc.text('FICHE DE DEVOIR DE CONSEIL \u2014 DDA \/ ACPR',W\/2,25.5,{align:'center'});<!-- [et_pb_line_break_holder] -->  doc.setFontSize(7);<!-- [et_pb_line_break_holder] -->  doc.setFont('helvetica','normal');<!-- [et_pb_line_break_holder] -->  const contrats=getContrats().join(' + ')||'\u2014';<!-- [et_pb_line_break_holder] -->  doc.text(`Contrats : ${contrats}  \u00b7  Allianz  \u00b7  Date : ${fmtDate(TODAY)}`,W\/2,30.5,{align:'center'});<!-- [et_pb_line_break_holder] -->  y=40;<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  \/* helpers *\/<!-- [et_pb_line_break_holder] -->  const sectionH=(num,title,tag='')=>{<!-- [et_pb_line_break_holder] -->    doc.setFillColor(...LGRAY);<!-- [et_pb_line_break_holder] -->    doc.roundedRect(ML,y-3,CW,8,2,2,'F');<!-- [et_pb_line_break_holder] -->    doc.setFillColor(...BLUE);<!-- [et_pb_line_break_holder] -->    doc.circle(ML+4,y+1,2.5,'F');<!-- [et_pb_line_break_holder] -->    doc.setTextColor(...WHITE);<!-- [et_pb_line_break_holder] -->    doc.setFont('helvetica','bold');<!-- [et_pb_line_break_holder] -->    doc.setFontSize(7);<!-- [et_pb_line_break_holder] -->    doc.text(num,ML+4,y+1.6,{align:'center'});<!-- [et_pb_line_break_holder] -->    doc.setTextColor(...BLUE);<!-- [et_pb_line_break_holder] -->    doc.setFontSize(8);<!-- [et_pb_line_break_holder] -->    doc.text(title.toUpperCase(),ML+9,y+1.8);<!-- [et_pb_line_break_holder] -->    if(tag){doc.setFontSize(6.5);doc.setTextColor(90,100,119);doc.text(tag,W-MR,y+1.8,{align:'right'});}<!-- [et_pb_line_break_holder] -->    y+=9;<!-- [et_pb_line_break_holder] -->  };<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  const row2=(label,val,x=ML,w=CW)=>{<!-- [et_pb_line_break_holder] -->    const lw=38;<!-- [et_pb_line_break_holder] -->    doc.setFont('helvetica','bold');doc.setFontSize(7);doc.setTextColor(...MGRAY);<!-- [et_pb_line_break_holder] -->    doc.text(label,x,y);<!-- [et_pb_line_break_holder] -->    doc.setFont('helvetica','normal');doc.setTextColor(30,30,30);<!-- [et_pb_line_break_holder] -->    const lines=doc.splitTextToSize(String(val||'\u2014'),w-lw-1);<!-- [et_pb_line_break_holder] -->    doc.text(lines,x+lw,y);<!-- [et_pb_line_break_holder] -->    y+=4.5*lines.length;<!-- [et_pb_line_break_holder] -->  };<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  const multiline=(label,val)=>{<!-- [et_pb_line_break_holder] -->    doc.setFont('helvetica','bold');doc.setFontSize(7);doc.setTextColor(...MGRAY);<!-- [et_pb_line_break_holder] -->    doc.text(label,ML,y);y+=4;<!-- [et_pb_line_break_holder] -->    doc.setFont('helvetica','normal');doc.setTextColor(30,30,30);<!-- [et_pb_line_break_holder] -->    const lines=doc.splitTextToSize(val||'\u2014',CW);<!-- [et_pb_line_break_holder] -->    doc.text(lines,ML,y);y+=4*lines.length+1;<!-- [et_pb_line_break_holder] -->  };<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  const chk=(txt)=>{<!-- [et_pb_line_break_holder] -->    doc.setFontSize(7);doc.setTextColor(...BLUE);doc.setFont('helvetica','bold');<!-- [et_pb_line_break_holder] -->    doc.text('\u2611',ML,y);<!-- [et_pb_line_break_holder] -->    doc.setFont('helvetica','normal');doc.setTextColor(30,30,30);<!-- [et_pb_line_break_holder] -->    const lines=doc.splitTextToSize(txt,CW-7);<!-- [et_pb_line_break_holder] -->    doc.text(lines,ML+6,y);<!-- [et_pb_line_break_holder] -->    y+=4*lines.length+0.5;<!-- [et_pb_line_break_holder] -->  };<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  \/* \u2500\u2500 COL LAYOUT \u2500\u2500 *\/<!-- [et_pb_line_break_holder] -->  \/* LEFT col x=ML w=88, RIGHT col x=ML+94 w=88 *\/<!-- [et_pb_line_break_holder] -->  const LC=ML, RC=ML+CW\/2+3, HW=CW\/2-3;<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  \/* \u2500\u2500 1. DISTRIBUTEUR + 2. CLIENT \u2014 c\u00f4te \u00e0 c\u00f4te \u2500\u2500 *\/<!-- [et_pb_line_break_holder] -->  sectionH('1','Identit\u00e9 du distributeur');<!-- [et_pb_line_break_holder] -->  const yAfterS1=y;<!-- [et_pb_line_break_holder] -->  \/\/ col gauche : distributeur<!-- [et_pb_line_break_holder] -->  doc.setFont('helvetica','normal');doc.setFontSize(7);doc.setTextColor(30,30,30);<!-- [et_pb_line_break_holder] -->  const distLines=[<!-- [et_pb_line_break_holder] -->    ['Nom \/ Soci\u00e9t\u00e9 :','Kevin Elbaz \u2014 Ambrelia'],<!-- [et_pb_line_break_holder] -->    ['Statut :','Courtier mandat\u00e9 Allianz'],<!-- [et_pb_line_break_holder] -->    ['N\u00b0 ORIAS :','11 064 575'],<!-- [et_pb_line_break_holder] -->    ['Email :','kevin.elbaz@ambrelia.com'],<!-- [et_pb_line_break_holder] -->    ['R\u00e9mun\u00e9ration :','Commission sur prime Allianz'],<!-- [et_pb_line_break_holder] -->  ];<!-- [et_pb_line_break_holder] -->  let yL=yAfterS1;<!-- [et_pb_line_break_holder] -->  distLines.forEach(([lbl,val])=>{<!-- [et_pb_line_break_holder] -->    doc.setFont('helvetica','bold');doc.setFontSize(7);doc.setTextColor(...MGRAY);<!-- [et_pb_line_break_holder] -->    doc.text(lbl,LC,yL);<!-- [et_pb_line_break_holder] -->    doc.setFont('helvetica','normal');doc.setTextColor(30,30,30);<!-- [et_pb_line_break_holder] -->    doc.text(val,LC+32,yL);<!-- [et_pb_line_break_holder] -->    yL+=4.5;<!-- [et_pb_line_break_holder] -->  });<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  \/\/ col droite : client<!-- [et_pb_line_break_holder] -->  doc.setFont('helvetica','bold');doc.setFontSize(7);doc.setTextColor(...BLUE);<!-- [et_pb_line_break_holder] -->  doc.text('CLIENT',RC,yAfterS1-1);<!-- [et_pb_line_break_holder] -->  let yR=yAfterS1;<!-- [et_pb_line_break_holder] -->  const nb=parseInt(v('nbEnfants'))||0;<!-- [et_pb_line_break_holder] -->  const clientLines=[<!-- [et_pb_line_break_holder] -->    ['Nom \/ Pr\u00e9nom :',`${v('nom')} ${v('prenom')}`],<!-- [et_pb_line_break_holder] -->    ['Date de naissance :',v('ddn')],<!-- [et_pb_line_break_holder] -->    ['Statut marital :',v('marital')],<!-- [et_pb_line_break_holder] -->    ['Enfants \u00e0 charge :',String(nb)],<!-- [et_pb_line_break_holder] -->    ['Employeur :',v('employeur')],<!-- [et_pb_line_break_holder] -->    ['Adresse :',v('adresse')],<!-- [et_pb_line_break_holder] -->    ['E-mail :',v('emailClient')],<!-- [et_pb_line_break_holder] -->  ];<!-- [et_pb_line_break_holder] -->  clientLines.forEach(([lbl,val])=>{<!-- [et_pb_line_break_holder] -->    doc.setFont('helvetica','bold');doc.setFontSize(7);doc.setTextColor(...MGRAY);<!-- [et_pb_line_break_holder] -->    doc.text(lbl,RC,yR);<!-- [et_pb_line_break_holder] -->    doc.setFont('helvetica','normal');doc.setTextColor(30,30,30);<!-- [et_pb_line_break_holder] -->    const lines=doc.splitTextToSize(val||'\u2014',HW-28);<!-- [et_pb_line_break_holder] -->    doc.text(lines,RC+28,yR);<!-- [et_pb_line_break_holder] -->    yR+=4.5*lines.length;<!-- [et_pb_line_break_holder] -->  });<!-- [et_pb_line_break_holder] -->  getChildren().forEach((c,i)=>{<!-- [et_pb_line_break_holder] -->    doc.setFont('helvetica','normal');doc.setFontSize(7);doc.setTextColor(30,30,30);<!-- [et_pb_line_break_holder] -->    doc.text(`  \u00b7 ${c}`,RC+28,yR);yR+=4;<!-- [et_pb_line_break_holder] -->  });<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  y=Math.max(yL,yR)+2;<!-- [et_pb_line_break_holder] -->  doc.setDrawColor(...LGRAY);doc.setLineWidth(0.3);<!-- [et_pb_line_break_holder] -->  doc.line(ML,y,ML+CW,y);y+=3;<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  \/* \u2500\u2500 3. BESOINS \u2500\u2500 *\/<!-- [et_pb_line_break_holder] -->  sectionH('3','Analyse des besoins','DDA Art. L.521-4');<!-- [et_pb_line_break_holder] -->  const couv=document.getElementById('couverture');<!-- [et_pb_line_break_holder] -->  row2('Couverture existante :',couv.options[couv.selectedIndex].text);<!-- [et_pb_line_break_holder] -->  multiline('Besoins exprim\u00e9s :',document.getElementById('besoins').value||'Non renseign\u00e9');<!-- [et_pb_line_break_holder] -->  multiline(\"Motif d'ad\u00e9quation :\",v('adequation'));<!-- [et_pb_line_break_holder] -->  y+=1;<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  \/* \u2500\u2500 4+5 CONTRATS + DOCS \u2014 c\u00f4te \u00e0 c\u00f4te \u2500\u2500 *\/<!-- [et_pb_line_break_holder] -->  sectionH('4+5','Contrats souscrits & Documents remis');<!-- [et_pb_line_break_holder] -->  let yC=y;<!-- [et_pb_line_break_holder] -->  \/\/ contrats gauche<!-- [et_pb_line_break_holder] -->  doc.setFont('helvetica','bold');doc.setFontSize(8);doc.setTextColor(...BLUE);<!-- [et_pb_line_break_holder] -->  doc.text(contrats,LC,yC);yC+=5;<!-- [et_pb_line_break_holder] -->  if(getContrats().length===2){<!-- [et_pb_line_break_holder] -->    doc.setFont('helvetica','italic');doc.setFontSize(6.5);doc.setTextColor(46,125,50);<!-- [et_pb_line_break_holder] -->    doc.text('Souscription coupl\u00e9e \u2014 client inform\u00e9 s\u00e9par\u00e9ment',LC,yC);yC+=5;<!-- [et_pb_line_break_holder] -->  }<!-- [et_pb_line_break_holder] -->  \/\/ docs droite<!-- [et_pb_line_break_holder] -->  let yD=y;<!-- [et_pb_line_break_holder] -->  ['Fiche IPID remise avant souscription','Conditions G\u00e9n\u00e9rales communiqu\u00e9es','Lien de souscription envoy\u00e9 par e-mail'].forEach(txt=>{<!-- [et_pb_line_break_holder] -->    doc.setFontSize(7);doc.setTextColor(...BLUE);doc.setFont('helvetica','bold');<!-- [et_pb_line_break_holder] -->    doc.text('\u2611',RC,yD);<!-- [et_pb_line_break_holder] -->    doc.setFont('helvetica','normal');doc.setTextColor(30,30,30);<!-- [et_pb_line_break_holder] -->    doc.text(txt,RC+6,yD);yD+=4.5;<!-- [et_pb_line_break_holder] -->  });<!-- [et_pb_line_break_holder] -->  y=Math.max(yC,yD)+2;<!-- [et_pb_line_break_holder] -->  doc.setDrawColor(...LGRAY);doc.setLineWidth(0.3);<!-- [et_pb_line_break_holder] -->  doc.line(ML,y,ML+CW,y);y+=3;<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  \/* \u2500\u2500 6. D\u00c9CLARATIONS \u2500\u2500 *\/<!-- [et_pb_line_break_holder] -->  sectionH('6','D\u00e9clarations du client \u2014 Devoir de conseil');<!-- [et_pb_line_break_holder] -->  const decls=[<!-- [et_pb_line_break_holder] -->    'Inform\u00e9(e) et conseill\u00e9(e) par M. Kevin Elbaz, courtier mandat\u00e9 Allianz (DDA L.521-1)',<!-- [et_pb_line_break_holder] -->    'Souscription dans le cadre du programme des Commissions Europ\u00e9ennes',<!-- [et_pb_line_break_holder] -->    'Inform\u00e9(e) de la r\u00e9mun\u00e9ration par commission du courtier (DDA L.521-2)',<!-- [et_pb_line_break_holder] -->    'Inform\u00e9(e) des garanties, exclusions, plafonds et conditions g\u00e9n\u00e9rales',<!-- [et_pb_line_break_holder] -->    \"Inform\u00e9(e) de la facult\u00e9 de renonciation et des modalit\u00e9s de r\u00e9siliation\",<!-- [et_pb_line_break_holder] -->    'Questions pos\u00e9es et r\u00e9ponses satisfaisantes re\u00e7ues avant la souscription',<!-- [et_pb_line_break_holder] -->    'Informations personnelles exactes, compl\u00e8tes et assum\u00e9es',<!-- [et_pb_line_break_holder] -->  ];<!-- [et_pb_line_break_holder] -->  if(getContrats().length===2) decls.push('Double souscription confirm\u00e9e en toute connaissance de cause');<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  \/\/ 2 colonnes<!-- [et_pb_line_break_holder] -->  const half=Math.ceil(decls.length\/2);<!-- [et_pb_line_break_holder] -->  let yD1=y,yD2=y;<!-- [et_pb_line_break_holder] -->  decls.forEach((d,i)=>{<!-- [et_pb_line_break_holder] -->    if(i<half){<!-- [et_pb_line_break_holder] -->      doc.setFontSize(7);doc.setTextColor(...BLUE);doc.setFont('helvetica','bold');<!-- [et_pb_line_break_holder] -->      doc.text('\u2611',LC,yD1);<!-- [et_pb_line_break_holder] -->      doc.setFont('helvetica','normal');doc.setTextColor(30,30,30);<!-- [et_pb_line_break_holder] -->      const lines=doc.splitTextToSize(d,HW-6);<!-- [et_pb_line_break_holder] -->      doc.text(lines,LC+6,yD1);yD1+=4*lines.length+0.5;<!-- [et_pb_line_break_holder] -->    } else {<!-- [et_pb_line_break_holder] -->      doc.setFontSize(7);doc.setTextColor(...BLUE);doc.setFont('helvetica','bold');<!-- [et_pb_line_break_holder] -->      doc.text('\u2611',RC,yD2);<!-- [et_pb_line_break_holder] -->      doc.setFont('helvetica','normal');doc.setTextColor(30,30,30);<!-- [et_pb_line_break_holder] -->      const lines=doc.splitTextToSize(d,HW-6);<!-- [et_pb_line_break_holder] -->      doc.text(lines,RC+6,yD2);yD2+=4*lines.length+0.5;<!-- [et_pb_line_break_holder] -->    }<!-- [et_pb_line_break_holder] -->  });<!-- [et_pb_line_break_holder] -->  y=Math.max(yD1,yD2)+3;<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  \/* \u2500\u2500 7. SIGNATURE \u2500\u2500 *\/<!-- [et_pb_line_break_holder] -->  sectionH('7','Signature \u00e9lectronique du client');<!-- [et_pb_line_break_holder] -->  row2('Nom (confirmation) :',v('sigNom'));<!-- [et_pb_line_break_holder] -->  row2('Date :',fmtDate(TODAY));<!-- [et_pb_line_break_holder] -->  y+=1;<!-- [et_pb_line_break_holder] -->  doc.setFontSize(6.5);doc.setTextColor(...MGRAY);doc.setFont('helvetica','italic');<!-- [et_pb_line_break_holder] -->  const mention=\"En soumettant ce formulaire, le client atteste de l'exactitude des informations saisies et confirme avoir recu le conseil prealable a toute souscription conformement aux articles L.521-1 et suivants du Code des assurances.\";<!-- [et_pb_line_break_holder] -->  const ml=doc.splitTextToSize(mention,CW);<!-- [et_pb_line_break_holder] -->  doc.text(ml,ML,y);<!-- [et_pb_line_break_holder] -->  y+=4*ml.length+2;<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  \/* \u2500\u2500 FOOTER \u2500\u2500 *\/<!-- [et_pb_line_break_holder] -->  doc.setFillColor(...BLUE);<!-- [et_pb_line_break_holder] -->  doc.rect(0,285,W,12,'F');<!-- [et_pb_line_break_holder] -->  doc.setTextColor(...WHITE);doc.setFontSize(6.5);doc.setFont('helvetica','normal');<!-- [et_pb_line_break_holder] -->  doc.text('Ambrelia \u2014 ORIAS 11 064 575 \u2014 kevin.elbaz@ambrelia.com',ML,291);<!-- [et_pb_line_break_holder] -->  doc.text('Art. L.521-1 \u00e0 L.521-6 Code des assurances \u2014 Directive (UE) 2016\/97',W-MR,291,{align:'right'});<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->  return doc;<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->async function uploadPDF(pdfDoc,filename){<!-- [et_pb_line_break_holder] -->  const blob=pdfDoc.output('blob');<!-- [et_pb_line_break_holder] -->  const srvRes=await fetch('https:\/\/api.gofile.io\/servers');<!-- [et_pb_line_break_holder] -->  if(!srvRes.ok)throw new Error('Serveur indisponible');<!-- [et_pb_line_break_holder] -->  const srvData=await srvRes.json();<!-- [et_pb_line_break_holder] -->  if(srvData.status!=='ok')throw new Error('Erreur serveur gofile');<!-- [et_pb_line_break_holder] -->  const server=srvData.data.servers[0].name;<!-- [et_pb_line_break_holder] -->  const formData=new FormData();<!-- [et_pb_line_break_holder] -->  formData.append('file',blob,filename);<!-- [et_pb_line_break_holder] -->  const upRes=await fetch(`https:\/\/${server}.gofile.io\/contents\/uploadfile`,{method:'POST',body:formData});<!-- [et_pb_line_break_holder] -->  if(!upRes.ok)throw new Error('Upload \u00e9chou\u00e9');<!-- [et_pb_line_break_holder] -->  const upData=await upRes.json();<!-- [et_pb_line_break_holder] -->  if(upData.status!=='ok')throw new Error('Erreur upload : '+upData.status);<!-- [et_pb_line_break_holder] -->  return upData.data.downloadPage;<!-- [et_pb_line_break_holder] -->}<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->function downloadPDF(){if(_pdfData)_pdfData.save(`Devoir_Conseil_${v('nom')}_${v('prenom')}_${fmtDate(TODAY).replace(\/\\\/\/g,'-')}.pdf`);}<!-- [et_pb_line_break_holder] --> <!-- [et_pb_line_break_holder] -->async function submitForm(){<!-- [et_pb_line_break_holder] -->  if(!validate()){const fe=document.querySelector('.field.error input,.field.error select,.field.error 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afin de finaliser votre dossier et r\u00e9pondre \u00e0 vos \u00e9ventuelles questions.<\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Finalisez votre dossier en quelques minutesAfin de finaliser la mise en place de votre couverture, nous avons besoin de recueillir certaines informations obligatoires dans le cadre du devoir de conseil. Ce questionnaire nous permet de mieux comprendre votre situation, d\u2019adapter les garanties \u00e0 vos besoins et de garantir la conformit\u00e9 de votre souscription aux exigences [&hellip;]<\/p>\n","protected":false},"author":26,"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":"<!-- wp:paragraph {\"fontSize\":\"medium\"} -->\n<p class=\"has-medium-font-size\">Afin de finaliser la mise en place de votre couverture, nous avons besoin de recueillir certaines informations obligatoires dans le cadre du devoir de conseil.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"fontSize\":\"medium\"} -->\n<p class=\"has-medium-font-size\">Ce questionnaire nous permet de mieux comprendre votre situation, d\u2019adapter les garanties \u00e0 vos besoins et de garantir la conformit\u00e9 de votre souscription aux exigences r\u00e9glementaires (DDA \/ ACPR).<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading {\"level\":3} -->\n<h3 class=\"wp-block-heading\">Informations pratiques<\/h3>\n<!-- \/wp:heading -->\n\n<!-- wp:paragraph {\"fontSize\":\"medium\"} -->\n<p class=\"has-medium-font-size\">\u23f1\ufe0f Dur\u00e9e : environ 3 \u00e0 5 minutes<br>\ud83d\udd12 Vos informations sont strictement confidentielles et utilis\u00e9es uniquement dans le cadre de votre accompagnement<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:paragraph {\"fontSize\":\"medium\"} -->\n<p class=\"has-medium-font-size\">Nous vous invitons \u00e0 compl\u00e9ter ce formulaire avec attention afin de finaliser votre dossier dans les meilleures conditions.<\/p>\n<!-- \/wp:paragraph -->\n\n<!-- wp:heading -->\n<h2 class=\"wp-block-heading\">Merci de remplir les informations ci-dessous :<\/h2>\n<!-- \/wp:heading -->\n\n<!-- wp:code -->\n<pre class=\"wp-block-code\"><code><\/code><\/pre>\n<!-- \/wp:code -->","_et_gb_content_width":"","footnotes":""},"dipi_cpt_category":[],"class_list":["post-17233655","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Questionnaire hospisafe &amp; 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