{"id":2842,"date":"2022-11-08T03:28:52","date_gmt":"2022-11-08T03:28:52","guid":{"rendered":"https:\/\/loremfunerals.com\/usa-cne\/?page_id=2842"},"modified":"2023-05-11T23:09:53","modified_gmt":"2023-05-11T23:09:53","slug":"cremations","status":"publish","type":"page","link":"https:\/\/loremfunerals.com\/usa-cremation\/cremations\/","title":{"rendered":"Cremation Wizard"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"2842\" class=\"elementor elementor-2842\">\n\t\t\t\t\t\t<div class=\"elementor-inner\">\n\t\t\t\t<div class=\"elementor-section-wrap\">\n\t\t\t\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-dbe02bf elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"dbe02bf\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;video&quot;,&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_video_link&quot;:&quot;https:\\\/\\\/firebasestorage.googleapis.com\\\/v0\\\/b\\\/fcrm-e17b0.appspot.com\\\/o\\\/_storage%2Fteam%2F-KyTV-ZKdQjZKoMCOf8Y%2F1683836123762-Copie%20de%20Vid%C3%A9o%20test%20(1).webm?alt=media&amp;token=979b95ce-5feb-4bc9-aaa5-3c6b7238bdd2&quot;}\">\n\t\t\t\t\t\t\t\t<div class=\"elementor-background-video-container elementor-hidden-phone\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t<video class=\"elementor-background-video-hosted elementor-html5-video\" autoplay muted playsinline loop><\/video>\n\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-5a0d35f\" data-id=\"5a0d35f\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-b3dffe6 elementor-widget elementor-widget-spacer\" data-id=\"b3dffe6\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f6f7fc3 elementor-widget elementor-widget-heading\" data-id=\"f6f7fc3\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">Cremation<\/h1>\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7b44007 elementor-widget elementor-widget-spacer\" data-id=\"7b44007\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-ef2fac3 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"ef2fac3\" data-element_type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t\t\t<div class=\"elementor-row\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-b2aa37a\" data-id=\"b2aa37a\" data-element_type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-column-wrap elementor-element-populated\">\n\t\t\t\t\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-d2e7511 elementor-widget elementor-widget-shortcode\" data-id=\"d2e7511\" data-element_type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-shortcode\">\n\n\n\n\n\n\n\n\n\n\n<!-- This file should primarily consist of HTML with a little bit of PHP. -->\n<div class=\"firehawk-crm firehawk-crm-style\">\n  \n  <div id=\"firehawk-crm-form-6a2d4e5648c60\"  class=\"firehawk-crm-form borderless\"  data-api-url=\"\/v2\/webforms\/funerals\/create-devito-cremation\"  >\n\n        \n          \n\n    <div class=\"firehawk-crm-form-page active   \" data-index=\"0\"  data-page-id=\"your-details\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element form-heading col-sm-12 \" data-field-id=\"heading_your-details\" >\n                        <h3 class=\"form-title\"  data-name=\"Your Details\"><span class=\"content\">Your Details<\/span><\/h3>\n                    <\/div>\n  \n          \n          \n                <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-auto col-lg-auto \" data-field-id=\"applicantTitle\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Title\">Title<\/label>\n              <\/div>\n                                      <div class=\"btn-group\">\n                                                                                                        <label class=\"btn-default btn-light primary btn segment-button segment-applicantTitle\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"applicantTitle\" data-segment-value=\"Mr\">\n                        <input type=\"checkbox\"  name=\"applicantTitle\" id=\"applicantTitle_0\"  value=\"Mr\" \/>\n                        <span>Mr<\/span>\n                      <\/label>\n                                                                                                              <label class=\"btn-default btn-light primary btn segment-button segment-applicantTitle\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"applicantTitle\" data-segment-value=\"Miss\">\n                        <input type=\"checkbox\"  name=\"applicantTitle\" id=\"applicantTitle_1\"  value=\"Miss\" \/>\n                        <span>Miss<\/span>\n                      <\/label>\n                                                                                                              <label class=\"btn-default btn-light primary btn segment-button segment-applicantTitle\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"applicantTitle\" data-segment-value=\"Mrs\">\n                        <input type=\"checkbox\"  name=\"applicantTitle\" id=\"applicantTitle_2\"  value=\"Mrs\" \/>\n                        <span>Mrs<\/span>\n                      <\/label>\n                                                                                                              <label class=\"btn-default btn-light primary btn segment-button segment-applicantTitle\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"applicantTitle\" data-segment-value=\"Ms\">\n                        <input type=\"checkbox\"  name=\"applicantTitle\" id=\"applicantTitle_3\"  value=\"Ms\" \/>\n                        <span>Ms<\/span>\n                      <\/label>\n                                                                      <\/div>\n          <small class=\"form-text text-danger d-none error-label\"><\/small>\n                    <\/div>\n  \n          \n          \n                <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"applicantFirstName\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"First name\">First name<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"applicantFirstName\" id=\"applicantFirstName\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"applicantFamilyName\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Last name\">Last name<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"applicantFamilyName\" id=\"applicantFamilyName\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n                <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"applicantPhone\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Phone number\">Phone number<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"applicantPhone\" id=\"applicantPhone\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"applicantEmail\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Email address\">Email address<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"applicantEmail\" id=\"applicantEmail\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n                <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-auto col-lg-auto \" data-field-id=\"applicantContactPreferred\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"How would you like us to contact you?\">How would you like us to contact you?<\/label>\n              <\/div>\n                                      <div class=\"btn-group\">\n                                                                                                        <label class=\"btn-default btn-light primary btn segment-button segment-applicantContactPreferred\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"applicantContactPreferred\" data-segment-value=\"Phone\">\n                        <input type=\"checkbox\"  name=\"applicantContactPreferred\" id=\"applicantContactPreferred_0\"  value=\"Phone\" \/>\n                        <span>Phone<\/span>\n                      <\/label>\n                                                                                                              <label class=\"btn-default btn-light primary btn segment-button segment-applicantContactPreferred\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"applicantContactPreferred\" data-segment-value=\"Email\">\n                        <input type=\"checkbox\"  name=\"applicantContactPreferred\" id=\"applicantContactPreferred_1\"  value=\"Email\" \/>\n                        <span>Email<\/span>\n                      <\/label>\n                                                                                                              <label class=\"btn-default btn-light primary btn segment-button segment-applicantContactPreferred\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"applicantContactPreferred\" data-segment-value=\"SMS\">\n                        <input type=\"checkbox\"  name=\"applicantContactPreferred\" id=\"applicantContactPreferred_2\"  value=\"SMS\" \/>\n                        <span>SMS<\/span>\n                      <\/label>\n                                                                      <\/div>\n          <small class=\"form-text text-danger d-none error-label\"><\/small>\n                    <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n                      <\/div>\n                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n            \n            <button class=\"btn-default btn-primary primary btn next-button\"  >\n              <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next            <\/button>\n          <\/div>\n                  <\/div>\n              <\/form>\n    <\/div>\n      \n\n    <div class=\"firehawk-crm-form-page    \" data-index=\"1\"  data-page-id=\"loved-one-details\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element form-heading col-sm-12 \" data-field-id=\"heading_last-details\" >\n                        <h3 class=\"form-title\"  data-name=\"Your Loved One&#039;s Details\"><span class=\"content\">Your Loved One's Details<\/span><\/h3>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-4 col-lg-4 \" data-field-id=\"clientFirstGivenName\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"First name\">First name<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"clientFirstGivenName\" id=\"clientFirstGivenName\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-4 col-lg-4 \" data-field-id=\"clientOtherGivenNames\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Middle name\">Middle name<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"clientOtherGivenNames\" id=\"clientOtherGivenNames\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-4 col-lg-4 \" data-field-id=\"clientFamilyName\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Last name\">Last name<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"clientFamilyName\" id=\"clientFamilyName\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-4 col-lg-4 \" data-field-id=\"clientKnownAs\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Known As (other than legal name)\">Known As (other than legal name)<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"clientKnownAs\" id=\"clientKnownAs\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-4 \" data-field-id=\"clientDateOfBirth\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Date of Birth\">Date of Birth<\/label>\n              <\/div>\n            \n              <input class=\"form-control input-masked date-input\" type=\"text\" autocomplete=\"false\" data-datemin=\"\"  data-mask-format=\"mm\/dd\/yyyy\" data-mask-placeholder=\"\" data-mask-alias=\"datetime\" name=\"clientDateOfBirth\" id=\"clientDateOfBirth\"  \/>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n      \n\n            <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-4 \" data-field-id=\"clientDateOfDeath\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Date of Death\">Date of Death<\/label>\n              <\/div>\n            \n              <input class=\"form-control input-masked date-input\" type=\"text\" autocomplete=\"false\" data-datemin=\"\"  data-mask-format=\"mm\/dd\/yyyy\" data-mask-placeholder=\"\" data-mask-alias=\"datetime\" name=\"clientDateOfDeath\" id=\"clientDateOfDeath\"  \/>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n      \n\n            <\/div>\n  \n          \n          \n                <div class=\"row col-sm-12\">\n    <\/div>\n    <div data-relation='[{&quot;action&quot;:&quot;COPY&quot;,&quot;calculation&quot;:{&quot;equation&quot;:&quot;[clientDateOfBirth]-[clientDateOfDeath]&quot;,&quot;type&quot;:&quot;date&quot;,&quot;units&quot;:&quot;years&quot;},&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;clientDateOfBirth&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;null&quot;},{&quot;id&quot;:&quot;clientDateOfDeath&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;null&quot;}]},{&quot;action&quot;:&quot;HIDE&quot;,&quot;connective&quot;:&quot;OR&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;clientDateOfDeath&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;null&quot;},{&quot;id&quot;:&quot;clientDateOfBirth&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;null&quot;}]}]' data-sectionparent=\"0\"     class=\"form-element col-12 col-md-2 \" data-field-id=\"clientAgeAtDeath\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Age (Yrs)\">Age (Yrs)<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"clientAgeAtDeath\" id=\"clientAgeAtDeath\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;COPY&quot;,&quot;calculation&quot;:{&quot;equation&quot;:&quot;[clientDateOfBirth]-[clientDateOfDeath]&quot;,&quot;hide&quot;:[&quot;years&quot;],&quot;type&quot;:&quot;date&quot;,&quot;units&quot;:&quot;months&quot;},&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;clientDateOfBirth&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;null&quot;},{&quot;id&quot;:&quot;clientDateOfDeath&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;null&quot;}]},{&quot;action&quot;:&quot;HIDE&quot;,&quot;connective&quot;:&quot;OR&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;clientDateOfDeath&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;null&quot;},{&quot;id&quot;:&quot;clientDateOfBirth&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;null&quot;}]}]' data-sectionparent=\"0\"     class=\"form-element col-12 col-md-2 \" data-field-id=\"clientAgeAtDeathMonths\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Age (Mths)\">Age (Mths)<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"clientAgeAtDeathMonths\" id=\"clientAgeAtDeathMonths\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;COPY&quot;,&quot;calculation&quot;:{&quot;equation&quot;:&quot;[clientDateOfBirth]-[clientDateOfDeath]&quot;,&quot;hide&quot;:[&quot;years&quot;,&quot;months&quot;],&quot;type&quot;:&quot;date&quot;,&quot;units&quot;:&quot;days&quot;},&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;clientDateOfBirth&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;null&quot;},{&quot;id&quot;:&quot;clientDateOfDeath&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;null&quot;}]},{&quot;action&quot;:&quot;HIDE&quot;,&quot;connective&quot;:&quot;OR&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;clientDateOfDeath&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;null&quot;},{&quot;id&quot;:&quot;clientDateOfBirth&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;null&quot;}]}]' data-sectionparent=\"0\"     class=\"form-element col-12 col-md-2 \" data-field-id=\"clientAgeAtDeathDays\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Age (Days)\">Age (Days)<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"clientAgeAtDeathDays\" id=\"clientAgeAtDeathDays\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n                <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 checkbox-group checkbox-group-first \" data-field-id=\"clientIsVeteran\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Check all that apply\">Check all that apply<\/label>\n              <\/div>\n                                  <div class=\"checkbox-list\" id=\"clientIsVeteran\">\n                                                                                        <div class=\"checkbox-list-item  checkbox-list-item-clientIsVeteran\" tabindex=\"0\" data-multiple=\"false\" data-item-id=\"clientIsVeteran\" data-item-value=\"Yes\">\n                    <input type=\"checkbox\" name=\"clientIsVeteran\" id=\"clientIsVeteran_0\"\n                      value=\"Yes\"   \/>\n                    <div class=\"checkbox-icon\"><i class=\"far fa fa-regular fa-check check-icon\"><\/i><\/div>\n                    <div class=\"content\" >\n                      <span class=\"label\">They were a veteran<\/span>                    <\/div>\n                  <\/div>\n                                                            <\/div>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n                  <\/div>\n  \n          \n          \n                <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 checkbox-group checkbox-group-last \" data-field-id=\"cremationBatteryPoweredDevicePresentOrRemoved\" >\n                                      <div class=\"checkbox-list\" id=\"cremationBatteryPoweredDevicePresentOrRemoved\">\n                                                                                        <div class=\"checkbox-list-item  checkbox-list-item-cremationBatteryPoweredDevicePresentOrRemoved\" tabindex=\"0\" data-multiple=\"false\" data-item-id=\"cremationBatteryPoweredDevicePresentOrRemoved\" data-item-value=\"Yes\">\n                    <input type=\"checkbox\" name=\"cremationBatteryPoweredDevicePresentOrRemoved\" id=\"cremationBatteryPoweredDevicePresentOrRemoved_0\"\n                      value=\"Yes\"   \/>\n                    <div class=\"checkbox-icon\"><i class=\"far fa fa-regular fa-check check-icon\"><\/i><\/div>\n                    <div class=\"content\" >\n                      <span class=\"label\">They have a pacemaker<\/span>                    <\/div>\n                  <\/div>\n                                                            <\/div>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n                  <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n            <input type=\"button\" class=\"btn-default btn-primary primary btn back-button w-auto\" value=\"Back\" \/>          <\/div>\n                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n            \n            <button class=\"btn-default btn-primary primary btn next-button\"  >\n              <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next            <\/button>\n          <\/div>\n                  <\/div>\n              <\/form>\n    <\/div>\n      \n\n    <div class=\"firehawk-crm-form-page    \" data-index=\"2\"  data-page-id=\"loved-one-birth-details\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element form-heading col-sm-12 \" data-field-id=\"heading_last-details\" >\n                        <h3 class=\"form-title\" data-merge-name='[[clientFirstGivenName:plural]] Birth Details' data-name=\"Your Loved One&#039;s Birth Details\"><span class=\"content\">Your Loved One's Birth Details<\/span><\/h3>\n                  <h5 class=\"form-subtitle\" data-merge-name='Please provide the location of where [[clientFirstGivenName]] was born.' data-name=\"Please provide the location of where your loved one was born.\"><span class=\"content\">Please provide the location of where your loved one was born.<\/span><\/h5>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-4 col-lg-4 \" data-field-id=\"birthCity\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"City\">City<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"birthCity\" id=\"birthCity\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-4 col-lg-4 \" data-field-id=\"birthState\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"State\">State<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"birthState\" id=\"birthState\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-4 col-lg-4 \" data-field-id=\"birthCountry\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Country\">Country<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"birthCountry\" id=\"birthCountry\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n            <input type=\"button\" class=\"btn-default btn-primary primary btn back-button w-auto\" value=\"Back\" \/>          <\/div>\n                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n            \n            <button class=\"btn-default btn-primary primary btn next-button\"  >\n              <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next            <\/button>\n          <\/div>\n                  <\/div>\n              <\/form>\n    <\/div>\n      \n\n    <div class=\"firehawk-crm-form-page    \" data-index=\"3\"  data-page-id=\"address-details\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element form-heading col-sm-12 \" data-field-id=\"heading_last-applicant-address\" >\n                        <h3 class=\"form-title\"  data-name=\"Your Address\"><span class=\"content\">Your Address<\/span><\/h3>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-sm-12 \" data-field-id=\"applicantAddress\" >\n                                <div class=\"firehawk-crm-form-address-picker \" id=\"applicantAddress\" name=\"applicantAddress\"  data-default-country=\"\"  data-country=\"\"  data-distance=\"\" data-category=\"\" data-save-result-field=\"\" data-geo-tags=\"\" data-invalid-label=\"\" >\n          <div class=\"address-picker\">\n          <\/div>\n        <\/div>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n            <\/div>\n  \n          \n          \n                <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-auto \" data-field-id=\"applicantCanMailAddress\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Can we send mail to this address?\">Can we send mail to this address?<\/label>\n              <\/div>\n                                      <div class=\"btn-group\">\n                                                                                                    <label class=\"btn-default  btn-light primary btn segment-button segment-applicantCanMailAddress\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"applicantCanMailAddress\" data-segment-value=\"Yes\"  >\n                      <input type=\"checkbox\" name=\"applicantCanMailAddress\" id=\"applicantCanMailAddress_0\"\n                        value=\"Yes\"   \/>\n                      <div class=\"content\" >\n                      <span class=\"label\">Yes<\/span>                      <\/div>\n                    <\/label>\n                                                                                                          <label class=\"btn-default  btn-light primary btn segment-button segment-applicantCanMailAddress\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"applicantCanMailAddress\" data-segment-value=\"No\"  >\n                      <input type=\"checkbox\" name=\"applicantCanMailAddress\" id=\"applicantCanMailAddress_1\"\n                        value=\"No\"   \/>\n                      <div class=\"content\" >\n                      <span class=\"label\">No<\/span>                      <\/div>\n                    <\/label>\n                                                                      <\/div>\n          <small class=\"form-text text-danger d-none error-label\"><\/small>\n                    <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n            <input type=\"button\" class=\"btn-default btn-primary primary btn back-button w-auto\" value=\"Back\" \/>          <\/div>\n                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n            \n            <button class=\"btn-default btn-primary primary btn next-button\"  >\n              <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next            <\/button>\n          <\/div>\n                  <\/div>\n              <\/form>\n    <\/div>\n      \n\n    <div class=\"firehawk-crm-form-page    \" data-index=\"4\"  data-page-id=\"deceased-location\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element form-heading col-sm-12 \" data-field-id=\"heading_centrelink-details\" >\n                        <h3 class=\"form-title\" data-merge-name='Where is [[clientFirstGivenName]] currently located?' data-name=\"Where is your loved one currently located?\"><span class=\"content\">Where is your loved one currently located?<\/span><\/h3>\n                  <h5 class=\"form-subtitle\"  data-name=\"We will arrange to bring them into our care.\"><span class=\"content\">We will arrange to bring them into our care.<\/span><\/h5>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-sm-12 \" data-field-id=\"firstCallTransferLocationOfDeceased\" >\n                                <div class=\"firehawk-crm-form-address-picker \" id=\"firstCallTransferLocationOfDeceased\" name=\"firstCallTransferLocationOfDeceased\"  data-default-country=\"\"  data-country=\"\"  data-distance=\"\" data-category=\"\" data-save-result-field=\"\" data-geo-tags=\"\" data-invalid-label=\"\" >\n          <div class=\"address-picker\">\n          <\/div>\n        <\/div>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n            <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"deceasedAddressLocationType\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Please check all the statements that apply\">Please check all the statements that apply<\/label>\n              <\/div>\n                                  <div class=\"checkbox-list\" id=\"deceasedAddressLocationType\">\n                                                                                        <div class=\"checkbox-list-item selected checkbox-list-item-deceasedAddressLocationType\" tabindex=\"0\" data-multiple=\"true\" data-item-id=\"deceasedAddressLocationType\" data-item-value=\"passed-away-address\">\n                    <input type=\"checkbox\" name=\"deceasedAddressLocationType\" id=\"deceasedAddressLocationType_0\"\n                    checked=\"checked\"  value=\"passed-away-address\"   \/>\n                    <div class=\"checkbox-icon\"><i class=\"far fa fa-regular fa-check check-icon\"><\/i><\/div>\n                    <div class=\"content\" >\n                      <span class=\"label\">They passed away at this address<\/span>                    <\/div>\n                  <\/div>\n                                                                                              <div class=\"checkbox-list-item  checkbox-list-item-deceasedAddressLocationType\" tabindex=\"0\" data-multiple=\"true\" data-item-id=\"deceasedAddressLocationType\" data-item-value=\"lived-at-address\">\n                    <input type=\"checkbox\" name=\"deceasedAddressLocationType\" id=\"deceasedAddressLocationType_1\"\n                      value=\"lived-at-address\"   \/>\n                    <div class=\"checkbox-icon\"><i class=\"far fa fa-regular fa-check check-icon\"><\/i><\/div>\n                    <div class=\"content\" >\n                      <span class=\"label\">They lived at this address<\/span>                    <\/div>\n                  <\/div>\n                                                            <\/div>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n                  <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n            <input type=\"button\" class=\"btn-default btn-primary primary btn back-button w-auto\" value=\"Back\" \/>          <\/div>\n                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n            \n            <button class=\"btn-default btn-primary primary btn next-button\"  >\n              <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next            <\/button>\n          <\/div>\n                  <\/div>\n              <\/form>\n    <\/div>\n      \n\n    <div class=\"firehawk-crm-form-page    \" data-index=\"5\" data-relation='[{\"action\":\"SHOW\",\"connective\":\"AND\",\"when\":[{\"id\":\"deceasedAddressLocationType\",\"operator\":\"!=\",\"value\":\"passed-away-address\"}]}]' data-page-id=\"deceased-pass-away-details\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element form-heading col-sm-12 \" data-field-id=\"heading_centrelink-details\" >\n                        <h3 class=\"form-title\" data-merge-name='[[clientFirstGivenName:plural]] Place of Passing' data-name=\"Your Loved One&#039;s Place of Passing\"><span class=\"content\">Your Loved One's Place of Passing<\/span><\/h3>\n                  <h5 class=\"form-subtitle\" data-merge-name='Please provide the address of where [[clientFirstGivenName]] passed away?' data-name=\"Please provide the address of where your loved one passed away?\"><span class=\"content\">Please provide the address of where your loved one passed away?<\/span><\/h5>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-sm-12 \" data-field-id=\"firstCallLocationOfDeceased\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"\"><\/label>\n              <\/div>\n                            <div class=\"firehawk-crm-form-address-picker \" id=\"firstCallLocationOfDeceased\" name=\"firstCallLocationOfDeceased\"  data-default-country=\"\"  data-country=\"\"  data-distance=\"\" data-category=\"\" data-save-result-field=\"\" data-geo-tags=\"\" data-invalid-label=\"\" >\n          <div class=\"address-picker\">\n          <\/div>\n        <\/div>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n            <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n            <input type=\"button\" class=\"btn-default btn-primary primary btn back-button w-auto\" value=\"Back\" \/>          <\/div>\n                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n            \n            <button class=\"btn-default btn-primary primary btn next-button\"  >\n              <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next            <\/button>\n          <\/div>\n                  <\/div>\n              <\/form>\n    <\/div>\n      \n\n    <div class=\"firehawk-crm-form-page    \" data-index=\"6\" data-relation='[{\"action\":\"SHOW\",\"connective\":\"AND\",\"when\":[{\"id\":\"deceasedAddressLocationType\",\"operator\":\"!=\",\"value\":\"lived-at-address\"}]}]' data-page-id=\"deceased-address\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element form-heading col-sm-12 \" data-field-id=\"heading_address-details\" >\n                        <h3 class=\"form-title\" data-merge-name='[[clientFirstGivenName:plural]] Last Residential Address' data-name=\"Your Loved One&#039;s Last Residential Address\"><span class=\"content\">Your Loved One's Last Residential Address<\/span><\/h3>\n                  <h5 class=\"form-subtitle\" data-merge-name='Please provide the address of the last place [[clientFirstGivenName]] lived at.' data-name=\"Please provide the address of the last place Your Loved One lived at.\"><span class=\"content\">Please provide the address of the last place Your Loved One lived at.<\/span><\/h5>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-sm-12 \" data-field-id=\"lastResidentialAddress\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"\"><\/label>\n              <\/div>\n                            <div class=\"firehawk-crm-form-address-picker \" id=\"lastResidentialAddress\" name=\"lastResidentialAddress\"  data-default-country=\"\"  data-country=\"\"  data-distance=\"\" data-category=\"\" data-save-result-field=\"\" data-geo-tags=\"\" data-invalid-label=\"\" >\n          <div class=\"address-picker\">\n          <\/div>\n        <\/div>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n            <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n            <input type=\"button\" class=\"btn-default btn-primary primary btn back-button w-auto\" value=\"Back\" \/>          <\/div>\n                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n            \n            <button class=\"btn-default btn-primary primary btn next-button\"  >\n              <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next            <\/button>\n          <\/div>\n                  <\/div>\n              <\/form>\n    <\/div>\n      \n\n    <div class=\"firehawk-crm-form-page    \" data-index=\"7\"  data-page-id=\"more-oved-one-details\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element form-heading col-sm-12 \" data-field-id=\"heading_last-details\" >\n                        <h3 class=\"form-title\" data-merge-name='We need a little more information about [[clientFirstGivenName]]' data-name=\"We need a little more information about your loved one\"><span class=\"content\">We need a little more information about your loved one<\/span><\/h3>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"clientEducation\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"What was their highest level of education?\">What was their highest level of education?<\/label>\n              <\/div>\n                            <div>\n                        <select class=\"form-control select2\" autocomplete=\"false\" data-template=\"\" data-placeholder=\"Please select\"  name=\"clientEducation\"  id=\"clientEducation\" >\n              <option value=\"\"><\/option>                                 <option value=\"8th Grade or Less\" >8th Grade or Less<\/option>\n                                                <option value=\"9-12th (no Diploma)\" >9-12th (no Diploma)<\/option>\n                                                <option value=\"HS Graduate or GED\" >HS Graduate or GED<\/option>\n                                                <option value=\"Some College (no Degree)\" >Some College (no Degree)<\/option>\n                                                <option value=\"Associate Degree\" >Associate Degree<\/option>\n                                                <option value=\"Bachelor's Degree\" >Bachelor's Degree<\/option>\n                                                <option value=\"Master's Degree\" >Master's Degree<\/option>\n                                                <option value=\"Doctorate or Pro Degree\" >Doctorate or Pro Degree<\/option>\n                                                      <\/select>\n            <small class=\"form-text text-danger d-none error-label\"><\/small>\n          <\/div>\n                    <\/div>\n  \n          \n          \n                <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"clientRace\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"What was their race?\">What was their race?<\/label>\n              <\/div>\n                            <div>\n                        <select class=\"form-control select2\" autocomplete=\"false\" data-template=\"\" data-placeholder=\"Please select\"  name=\"clientRace\"  id=\"clientRace\" >\n              <option value=\"\"><\/option>                                 <option value=\"White\" >White<\/option>\n                                                <option value=\"American Indian or Alaska Native\" >American Indian or Alaska Native<\/option>\n                                                <option value=\"Asian Indian\" >Asian Indian<\/option>\n                                                <option value=\"Bi-Racial\" >Bi-Racial<\/option>\n                                                <option value=\"Black\" >Black<\/option>\n                                                <option value=\"Chinese\" >Chinese<\/option>\n                                                <option value=\"Filipino\" >Filipino<\/option>\n                                                <option value=\"Guamanian\" >Guamanian<\/option>\n                                                <option value=\"Hawaiian\" >Hawaiian<\/option>\n                                                <option value=\"Indian\" >Indian<\/option>\n                                                <option value=\"Japanese\" >Japanese<\/option>\n                                                <option value=\"Korean\" >Korean<\/option>\n                                                <option value=\"Samoan\" >Samoan<\/option>\n                                                <option value=\"Vietnamese\" >Vietnamese<\/option>\n                                                <option value=\"Other Asian\" >Other Asian<\/option>\n                                                <option value=\"Other Pacific Islander\" >Other Pacific Islander<\/option>\n                                                <option value=\"Other\" >Other<\/option>\n                                                      <\/select>\n            <small class=\"form-text text-danger d-none error-label\"><\/small>\n          <\/div>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"clientIsHispanicOrigin\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Hispanic\">Hispanic<\/label>\n              <\/div>\n                                      <div class=\"btn-group\">\n                                                                                                        <label class=\"btn-default btn-light primary btn segment-button segment-clientIsHispanicOrigin\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"clientIsHispanicOrigin\" data-segment-value=\"Yes\">\n                        <input type=\"checkbox\"  name=\"clientIsHispanicOrigin\" id=\"clientIsHispanicOrigin_0\"  value=\"Yes\" \/>\n                        <span>Yes<\/span>\n                      <\/label>\n                                                                                                              <label class=\"btn-default btn-light primary btn segment-button segment-clientIsHispanicOrigin\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"clientIsHispanicOrigin\" data-segment-value=\"No\">\n                        <input type=\"checkbox\"  name=\"clientIsHispanicOrigin\" id=\"clientIsHispanicOrigin_1\"  value=\"No\" \/>\n                        <span>No<\/span>\n                      <\/label>\n                                                                      <\/div>\n          <small class=\"form-text text-danger d-none error-label\"><\/small>\n                    <\/div>\n  \n          \n          \n                <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"clientOccupation\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Occupation (Cannot be retired)\">Occupation (Cannot be retired)<\/label>\n                  <i class=\"fas fa-solid fa-circle-info info-tooltip text-muted\" data-bs-toggle=\"tooltip\" data-bs-placement=\"top\" title=\"Cannot be Retired\"><\/i>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"clientOccupation\" id=\"clientOccupation\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"clientOccupationIndustry\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Type of Industry\">Type of Industry<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"clientOccupationIndustry\" id=\"clientOccupationIndustry\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"clientSocialSecurityNo\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Social Security Number\">Social Security Number<\/label>\n              <\/div>\n                  <input class=\"form-control input-masked\" autocomplete=\"false\" type=\"text\" name=\"clientSocialSecurityNo\" id=\"clientSocialSecurityNo\"    data-mask-format=\"999-99-9999\" data-mask-alias=\"numeric\" data-mask-placeholder=\"000-00-0000\"          \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"clientUsualDoctor\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Primary Care Physician\">Primary Care Physician<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"clientUsualDoctor\" id=\"clientUsualDoctor\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n            <input type=\"button\" class=\"btn-default btn-primary primary btn back-button w-auto\" value=\"Back\" \/>          <\/div>\n                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n            \n            <button class=\"btn-default btn-primary primary btn next-button\"  >\n              <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next            <\/button>\n          <\/div>\n                  <\/div>\n              <\/form>\n    <\/div>\n      \n\n    <div class=\"firehawk-crm-form-page    \" data-index=\"8\" data-relation='[{\"action\":\"SHOW\",\"connective\":\"AND\",\"when\":[{\"id\":\"clientIsVeteran\",\"operator\":\"==\",\"value\":\"Yes\"}]}]' data-page-id=\"veteran-details\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element form-heading col-sm-12 \" data-field-id=\"heading_details\" >\n                        <h3 class=\"form-title\" data-merge-name='We thank [[clientFirstGivenName]] for their service' data-name=\"We thank your loved one for their service\"><span class=\"content\">We thank your loved one for their service<\/span><\/h3>\n                  <h5 class=\"form-subtitle\"  data-name=\"Please provide more information.\"><span class=\"content\">Please provide more information.<\/span><\/h5>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"3\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"serviceBranch\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Branch\">Branch<\/label>\n              <\/div>\n                            <div>\n                        <select class=\"form-control select2\" autocomplete=\"false\" data-template=\"\" data-placeholder=\"Select all that apply\" multiple name=\"serviceBranch\"  id=\"serviceBranch\" >\n                                              <option value=\"Army\" >Army<\/option>\n                                                <option value=\"Navy\" >Navy<\/option>\n                                                <option value=\"Air Force\" >Air Force<\/option>\n                                                <option value=\"Marine Corps\" >Marine Corps<\/option>\n                                                <option value=\"Merchant Marine\" >Merchant Marine<\/option>\n                                                <option value=\"Army Air Forces (WWII)\" >Army Air Forces (WWII)<\/option>\n                                                <option value=\"Coast Guard\" >Coast Guard<\/option>\n                                                <option value=\"Other\" >Other<\/option>\n                                                      <\/select>\n            <small class=\"form-text text-danger d-none error-label\"><\/small>\n          <\/div>\n                    <\/div>\n      <div class=\"col-sm-12\">\n    <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;serviceBranch&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Other&quot;}]}]' data-sectionparent=\"3\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"serviceBranchOther\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Other Branch\">Other Branch<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"serviceBranchOther\" id=\"serviceBranchOther\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n      <div class=\"col-sm-12\">\n    <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;show&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;clientIsVeteran&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Yes&quot;}]}]' data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"serviceNumber\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Service No\">Service No<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"serviceNumber\" id=\"serviceNumber\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;show&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;clientIsVeteran&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Yes&quot;}]}]' data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"Rank\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Rank\">Rank<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"Rank\" id=\"Rank\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n                <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 col-lg-6 \" data-field-id=\"serviceMilitaryEntryDate\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Entry to Millitary Date\">Entry to Millitary Date<\/label>\n              <\/div>\n            \n              <input class=\"form-control input-masked date-input\" type=\"text\" autocomplete=\"false\" data-datemin=\"\"  data-mask-format=\"yyyy\" data-mask-placeholder=\"\" data-mask-alias=\"datetime\" name=\"serviceMilitaryEntryDate\" id=\"serviceMilitaryEntryDate\"  \/>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n      \n\n            <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 col-lg-6 \" data-field-id=\"serviceMilitaryDischargeDate\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Discharge from Millitary Date\">Discharge from Millitary Date<\/label>\n              <\/div>\n            \n              <input class=\"form-control input-masked date-input\" type=\"text\" autocomplete=\"false\" data-datemin=\"\"  data-mask-format=\"yyyy\" data-mask-placeholder=\"\" data-mask-alias=\"datetime\" name=\"serviceMilitaryDischargeDate\" id=\"serviceMilitaryDischargeDate\"  \/>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n      \n\n            <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n            <input type=\"button\" class=\"btn-default btn-primary primary btn back-button w-auto\" value=\"Back\" \/>          <\/div>\n                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n            \n            <button class=\"btn-default btn-primary primary btn next-button\"  >\n              <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next            <\/button>\n          <\/div>\n                  <\/div>\n              <\/form>\n    <\/div>\n      \n\n    <div class=\"firehawk-crm-form-page    \" data-index=\"9\"  data-page-id=\"relationship\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element form-heading col-sm-12 \" data-field-id=\"heading_your-relationship\" >\n                        <h3 class=\"form-title\" data-merge-name='What was your relationship to [[clientFirstGivenName]]?' data-name=\"Your Relationship\"><span class=\"content\">Your Relationship<\/span><\/h3>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\" data-required='true'    class=\"form-element col-12 col-md-6 \" data-field-id=\"applicantRelationshipToClient\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"I&#039;m their\">I'm their <span class=\"required\">*<\/span><\/label>\n              <\/div>\n                            <div>\n                        <select class=\"form-control select2\" autocomplete=\"false\" data-template=\"\" data-placeholder=\"Select one\"  name=\"applicantRelationshipToClient\"  id=\"applicantRelationshipToClient\" >\n              <option value=\"\"><\/option>                                 <option value=\"Husband\" >Husband<\/option>\n                                                <option value=\"Wife\" >Wife<\/option>\n                                                <option value=\"Aunt\" >Aunt<\/option>\n                                                <option value=\"Brother\" >Brother<\/option>\n                                                <option value=\"Brother-in-Law\" >Brother-in-Law<\/option>\n                                                <option value=\"Cousin\" >Cousin<\/option>\n                                                <option value=\"Daughter\" >Daughter<\/option>\n                                                <option value=\"Daughter-in-Law\" >Daughter-in-Law<\/option>\n                                                <option value=\"De Facto\" >De Facto<\/option>\n                                                <option value=\"Director of Nursing\" >Director of Nursing<\/option>\n                                                <option value=\"Ex-Spouse\" >Ex-Spouse<\/option>\n                                                <option value=\"Executor\" >Executor<\/option>\n                                                <option value=\"Executrix\" >Executrix<\/option>\n                                                <option value=\"Father\" >Father<\/option>\n                                                <option value=\"Father-in-Law\" >Father-in-Law<\/option>\n                                                <option value=\"Foster Child\" >Foster Child<\/option>\n                                                <option value=\"Foster Mother\" >Foster Mother<\/option>\n                                                <option value=\"Friend\" >Friend<\/option>\n                                                <option value=\"Funeral Director\" >Funeral Director<\/option>\n                                                <option value=\"Goddaughter\" >Goddaughter<\/option>\n                                                <option value=\"Godfather\" >Godfather<\/option>\n                                                <option value=\"Godmother\" >Godmother<\/option>\n                                                <option value=\"Godson\" >Godson<\/option>\n                                                <option value=\"Granddaughter\" >Granddaughter<\/option>\n                                                <option value=\"Grandfather\" >Grandfather<\/option>\n                                                <option value=\"Grandmother\" >Grandmother<\/option>\n                                                <option value=\"Grandnephew\" >Grandnephew<\/option>\n                                                <option value=\"Grandneice\" >Grandneice<\/option>\n                                                <option value=\"Grandson\" >Grandson<\/option>\n                                                <option value=\"Great Nephew\" >Great Nephew<\/option>\n                                                <option value=\"Great Niece\" >Great Niece<\/option>\n                                                <option value=\"Great-Aunt\" >Great-Aunt<\/option>\n                                                <option value=\"Great-Granddaughter\" >Great-Granddaughter<\/option>\n                                                <option value=\"Great-Grandson\" >Great-Grandson<\/option>\n                                                <option value=\"Great-Uncle\" >Great-Uncle<\/option>\n                                                <option value=\"Guardian\" >Guardian<\/option>\n                                                <option value=\"Half Brother\" >Half Brother<\/option>\n                                                <option value=\"Half Sister\" >Half Sister<\/option>\n                                                <option value=\"Lawyer\/Solicitor\" >Lawyer\/Solicitor<\/option>\n                                                <option value=\"Mother\" >Mother<\/option>\n                                                <option value=\"Mother-in-Law\" >Mother-in-Law<\/option>\n                                                <option value=\"Nephew\" >Nephew<\/option>\n                                                <option value=\"Niece\" >Niece<\/option>\n                                                <option value=\"No Relation\" >No Relation<\/option>\n                                                <option value=\"Parent\" >Parent<\/option>\n                                                <option value=\"Second Cousin\" >Second Cousin<\/option>\n                                                <option value=\"Sister\" >Sister<\/option>\n                                                <option value=\"Sister-in-Law\" >Sister-in-Law<\/option>\n                                                <option value=\"Son\" >Son<\/option>\n                                                <option value=\"Son-in-Law\" >Son-in-Law<\/option>\n                                                <option value=\"Step Brother\" >Step Brother<\/option>\n                                                <option value=\"Step Daughter\" >Step Daughter<\/option>\n                                                <option value=\"Step Father\" >Step Father<\/option>\n                                                <option value=\"Step Mother\" >Step Mother<\/option>\n                                                <option value=\"Step Sister\" >Step Sister<\/option>\n                                                <option value=\"Step Son\" >Step Son<\/option>\n                                                <option value=\"Third Cousin\" >Third Cousin<\/option>\n                                                <option value=\"Uncle\" >Uncle<\/option>\n                                                <option value=\"Widow\" >Widow<\/option>\n                                                <option value=\"Widower\" >Widower<\/option>\n                                                <option value=\"Other\" >Other<\/option>\n                                                      <\/select>\n            <small class=\"form-text text-danger d-none error-label\"><\/small>\n          <\/div>\n                    <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;applicantRelationshipToClient&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Father&quot;}]}]'      class=\"form-element col-12 col-md-6 \" data-field-id=\"fatherPlaceOfBirth\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"What is your place of birth?\">What is your place of birth?<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"fatherPlaceOfBirth\" id=\"fatherPlaceOfBirth\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;applicantRelationshipToClient&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Mother&quot;}]}]'      class=\"form-element col-12 col-md-6 \" data-field-id=\"motherPlaceOfBirth\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"What is your place of birth?\">What is your place of birth?<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"motherPlaceOfBirth\" id=\"motherPlaceOfBirth\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n                <div class=\"row col-sm-12\">\n    <\/div>\n    <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;applicantRelationshipToClient&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Other&quot;}]}]' data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"applicantRelationshipToClientOther\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Other:\">Other:<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"applicantRelationshipToClientOther\" id=\"applicantRelationshipToClientOther\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"callerIs\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Please check all the statements that apply\">Please check all the statements that apply<\/label>\n              <\/div>\n                                  <div class=\"checkbox-list\" id=\"callerIs\">\n                                                                                        <div class=\"checkbox-list-item  checkbox-list-item-callerIs\" tabindex=\"0\" data-multiple=\"true\" data-item-id=\"callerIs\" data-item-value=\"Next of Kin\">\n                    <input type=\"checkbox\" name=\"callerIs\" id=\"callerIs_0\"\n                      value=\"Next of Kin\"   \/>\n                    <div class=\"checkbox-icon\"><i class=\"far fa fa-regular fa-check check-icon\"><\/i><\/div>\n                    <div class=\"content\" >\n                      <span class=\"label\">I am the next of kin<\/span>                    <\/div>\n                  <\/div>\n                                                                                              <div class=\"checkbox-list-item  checkbox-list-item-callerIs\" tabindex=\"0\" data-multiple=\"true\" data-item-id=\"callerIs\" data-item-value=\"Executor\">\n                    <input type=\"checkbox\" name=\"callerIs\" id=\"callerIs_1\"\n                      value=\"Executor\"   \/>\n                    <div class=\"checkbox-icon\"><i class=\"far fa fa-regular fa-check check-icon\"><\/i><\/div>\n                    <div class=\"content\" >\n                      <span class=\"label\">I am the executor of their will<\/span>                    <\/div>\n                  <\/div>\n                                                                                              <div class=\"checkbox-list-item  checkbox-list-item-callerIs\" tabindex=\"0\" data-multiple=\"true\" data-item-id=\"callerIs\" data-item-value=\"Account To\">\n                    <input type=\"checkbox\" name=\"callerIs\" id=\"callerIs_2\"\n                      value=\"Account To\"   \/>\n                    <div class=\"checkbox-icon\"><i class=\"far fa fa-regular fa-check check-icon\"><\/i><\/div>\n                    <div class=\"content\" >\n                      <span class=\"label\">I am the person you will send the invoice\/account to<\/span>                    <\/div>\n                  <\/div>\n                                                                                              <div class=\"checkbox-list-item  checkbox-list-item-callerIs\" tabindex=\"0\" data-multiple=\"true\" data-item-id=\"callerIs\" data-item-value=\"Death Certificate Recipient\">\n                    <input type=\"checkbox\" name=\"callerIs\" id=\"callerIs_3\"\n                      value=\"Death Certificate Recipient\"   \/>\n                    <div class=\"checkbox-icon\"><i class=\"far fa fa-regular fa-check check-icon\"><\/i><\/div>\n                    <div class=\"content\" >\n                      <span class=\"label\">I will receive the death certifcate<\/span>                    <\/div>\n                  <\/div>\n                                                            <\/div>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n                  <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n            <input type=\"button\" class=\"btn-default btn-primary primary btn back-button w-auto\" value=\"Back\" \/>          <\/div>\n                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n            \n            <button class=\"btn-default btn-primary primary btn next-button\"  >\n              <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next            <\/button>\n          <\/div>\n                  <\/div>\n              <\/form>\n    <\/div>\n      \n\n    <div class=\"firehawk-crm-form-page    \" data-index=\"10\"  data-page-id=\"love-ones-parents\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element form-heading col-sm-12 \" data-field-id=\"heading_your-relationship\" >\n                        <h3 class=\"form-title\" data-merge-name='[[clientFirstGivenName:plural]] Parents' data-name=\"Your Loved One&#039;s Parents\"><span class=\"content\">Your Loved One's Parents<\/span><\/h3>\n                  <h5 class=\"form-subtitle\" data-merge-name='Please give us a bit more information about [[clientFirstGivenName:plural]] parents' data-name=\"Please give us a bit more information about Your Loved One&#039;s parents\"><span class=\"content\">Please give us a bit more information about Your Loved One's parents<\/span><\/h5>\n                    <\/div>\n  \n          \n          \n                <div class=\"row col-sm-12\">\n    <\/div>\n    <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;applicantRelationshipToClient&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;Mother&quot;}]}]'      class=\"form-element col-12 col-md-6 \" data-field-id=\"motherFirstGivenName\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Mother - First Name\">Mother - First Name<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"motherFirstGivenName\" id=\"motherFirstGivenName\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;applicantRelationshipToClient&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;Mother&quot;}]}]'      class=\"form-element col-12 col-md-6 \" data-field-id=\"motherOtherGivenNames\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Mother - Middle name\">Mother - Middle name<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"motherOtherGivenNames\" id=\"motherOtherGivenNames\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;applicantRelationshipToClient&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;Mother&quot;}]}]'      class=\"form-element col-12 col-md-6 \" data-field-id=\"motherFamilyName\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Mother - Last Name\">Mother - Last Name<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"motherFamilyName\" id=\"motherFamilyName\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;applicantRelationshipToClient&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;Mother&quot;}]}]'      class=\"form-element col-12 col-md-6 \" data-field-id=\"motherSuffix\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Suffix\">Suffix<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"motherSuffix\" id=\"motherSuffix\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;applicantRelationshipToClient&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;Mother&quot;}]}]'      class=\"form-element col-12 col-md-6 \" data-field-id=\"motherPlaceOfBirth\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Place of Birth\">Place of Birth<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"motherPlaceOfBirth\" id=\"motherPlaceOfBirth\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;applicantRelationshipToClient&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;Mother&quot;}]}]' data-sectionparent=\"2\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"motherLifeStatus\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Life status\">Life status<\/label>\n              <\/div>\n                                      <div class=\"btn-group\">\n                                                                                                        <label class=\"btn-default btn-light primary btn segment-button segment-motherLifeStatus\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"motherLifeStatus\" data-segment-value=\"Living\">\n                        <input type=\"checkbox\"  name=\"motherLifeStatus\" id=\"motherLifeStatus_0\"  value=\"Living\" \/>\n                        <span>Living<\/span>\n                      <\/label>\n                                                                                                              <label class=\"btn-default btn-light primary btn segment-button segment-motherLifeStatus\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"motherLifeStatus\" data-segment-value=\"Deceased\">\n                        <input type=\"checkbox\"  name=\"motherLifeStatus\" id=\"motherLifeStatus_1\"  value=\"Deceased\" \/>\n                        <span>Deceased<\/span>\n                      <\/label>\n                                                                      <\/div>\n          <small class=\"form-text text-danger d-none error-label\"><\/small>\n                    <\/div>\n  \n          \n          \n                <div class=\"row col-sm-12\">\n    <\/div>\n    <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;applicantRelationshipToClient&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;Father&quot;}]}]'      class=\"form-element col-12 col-md-6 \" data-field-id=\"fatherFirstGivenName\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Father - First Name\">Father - First Name<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"fatherFirstGivenName\" id=\"fatherFirstGivenName\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;applicantRelationshipToClient&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;Father&quot;}]}]'      class=\"form-element col-12 col-md-6 \" data-field-id=\"fatherOtherGivenNames\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Father - Middle name\">Father - Middle name<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"fatherOtherGivenNames\" id=\"fatherOtherGivenNames\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;applicantRelationshipToClient&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;Father&quot;}]}]'      class=\"form-element col-12 col-md-6 \" data-field-id=\"fatherFamilyName\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Father - Last Name\">Father - Last Name<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"fatherFamilyName\" id=\"fatherFamilyName\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;applicantRelationshipToClient&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;Father&quot;}]}]'      class=\"form-element col-12 col-md-6 \" data-field-id=\"fatherSuffix\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Suffix\">Suffix<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"fatherSuffix\" id=\"fatherSuffix\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;applicantRelationshipToClient&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;Father&quot;}]}]'      class=\"form-element col-12 col-md-6 \" data-field-id=\"fatherPlaceOfBirth\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Place of Birth\">Place of Birth<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"fatherPlaceOfBirth\" id=\"fatherPlaceOfBirth\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;AND&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;applicantRelationshipToClient&quot;,&quot;operator&quot;:&quot;!=&quot;,&quot;value&quot;:&quot;Father&quot;}]}]' data-sectionparent=\"2\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"fatherLifeStatus\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Life status\">Life status<\/label>\n              <\/div>\n                                      <div class=\"btn-group\">\n                                                                                                        <label class=\"btn-default btn-light primary btn segment-button segment-fatherLifeStatus\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"fatherLifeStatus\" data-segment-value=\"Living\">\n                        <input type=\"checkbox\"  name=\"fatherLifeStatus\" id=\"fatherLifeStatus_0\"  value=\"Living\" \/>\n                        <span>Living<\/span>\n                      <\/label>\n                                                                                                              <label class=\"btn-default btn-light primary btn segment-button segment-fatherLifeStatus\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"fatherLifeStatus\" data-segment-value=\"Deceased\">\n                        <input type=\"checkbox\"  name=\"fatherLifeStatus\" id=\"fatherLifeStatus_1\"  value=\"Deceased\" \/>\n                        <span>Deceased<\/span>\n                      <\/label>\n                                                                      <\/div>\n          <small class=\"form-text text-danger d-none error-label\"><\/small>\n                    <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n            <input type=\"button\" class=\"btn-default btn-primary primary btn back-button w-auto\" value=\"Back\" \/>          <\/div>\n                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n            \n            <button class=\"btn-default btn-primary primary btn next-button\"  >\n              <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next            <\/button>\n          <\/div>\n                  <\/div>\n              <\/form>\n    <\/div>\n      \n\n    <div class=\"firehawk-crm-form-page    \" data-index=\"11\" data-relation='[{\"action\":\"SHOW\",\"connective\":\"AND\",\"when\":[{\"id\":\"callerIs\",\"operator\":\"!=\",\"value\":\"Next of Kin\"}]}]' data-page-id=\"nextofkin-details\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element form-heading col-sm-12 \" data-field-id=\"heading_your-details\" >\n                        <h3 class=\"form-title\"  data-name=\"Next of Kin Details\"><span class=\"content\">Next of Kin Details<\/span><\/h3>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"nextOfKinIs\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Please check all the statements that apply.\">Please check all the statements that apply.<\/label>\n              <\/div>\n                                  <div class=\"checkbox-list\" id=\"nextOfKinIs\">\n                                                                                        <div class=\"checkbox-list-item  checkbox-list-item-nextOfKinIs\" tabindex=\"0\" data-multiple=\"true\" data-item-id=\"nextOfKinIs\" data-item-value=\"Executor\">\n                    <input type=\"checkbox\" name=\"nextOfKinIs\" id=\"nextOfKinIs_0\"\n                      value=\"Executor\"   \/>\n                    <div class=\"checkbox-icon\"><i class=\"far fa fa-regular fa-check check-icon\"><\/i><\/div>\n                    <div class=\"content\" >\n                      <span class=\"label\">Next of kin is the executor of the will<\/span>                    <\/div>\n                  <\/div>\n                                                                                              <div class=\"checkbox-list-item  checkbox-list-item-nextOfKinIs\" tabindex=\"0\" data-multiple=\"true\" data-item-id=\"nextOfKinIs\" data-item-value=\"Account To\">\n                    <input type=\"checkbox\" name=\"nextOfKinIs\" id=\"nextOfKinIs_1\"\n                      value=\"Account To\"   \/>\n                    <div class=\"checkbox-icon\"><i class=\"far fa fa-regular fa-check check-icon\"><\/i><\/div>\n                    <div class=\"content\" >\n                      <span class=\"label\">Next of kin is the person you will send the invoice\/account to<\/span>                    <\/div>\n                  <\/div>\n                                                                                              <div class=\"checkbox-list-item  checkbox-list-item-nextOfKinIs\" tabindex=\"0\" data-multiple=\"true\" data-item-id=\"nextOfKinIs\" data-item-value=\"Death Certificate Recipient\">\n                    <input type=\"checkbox\" name=\"nextOfKinIs\" id=\"nextOfKinIs_2\"\n                      value=\"Death Certificate Recipient\"   \/>\n                    <div class=\"checkbox-icon\"><i class=\"far fa fa-regular fa-check check-icon\"><\/i><\/div>\n                    <div class=\"content\" >\n                      <span class=\"label\">Next of kin will receive the death certifcate<\/span>                    <\/div>\n                  <\/div>\n                                                            <\/div>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n                  <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"    data-groupkey=\"nextOfKinGroup\" data-group-position=\"\" data-group-path=nextOfKinGroup class=\"form-element col-12 col-md-auto col-lg-auto \" data-field-id=\"nextOfKinGroup\" >\n    <div class=\"row\">                <div  data-sectionparent=\"0\" data-required='true'    class=\"form-element col-12 col-md-6 \" data-field-id=\"nextOfKinGroup[0][relationshipToClient]\" data-parent-key=\"nextOfKinGroup[0]\">\n              <div class=\"label-con\">\n        <label class=\"control-label  \" data-merge-name='Relationship to [[clientFirstGivenName]]' data-name=\"Relationship to Loved One\">Relationship to Loved One <span class=\"required\">*<\/span><\/label>\n              <\/div>\n                            <div>\n                        <select class=\"form-control select2\" autocomplete=\"false\" data-template=\"\" data-placeholder=\"Select one\"  name=\"nextOfKinGroup[0][relationshipToClient]\"  id=\"nextOfKinGroup[0][relationshipToClient]\" >\n              <option value=\"\"><\/option>                                 <option value=\"Husband\" >Husband<\/option>\n                                                <option value=\"Wife\" >Wife<\/option>\n                                                <option value=\"Aunt\" >Aunt<\/option>\n                                                <option value=\"Brother\" >Brother<\/option>\n                                                <option value=\"Brother-in-Law\" >Brother-in-Law<\/option>\n                                                <option value=\"Cousin\" >Cousin<\/option>\n                                                <option value=\"Daughter\" >Daughter<\/option>\n                                                <option value=\"Daughter-in-Law\" >Daughter-in-Law<\/option>\n                                                <option value=\"De Facto\" >De Facto<\/option>\n                                                <option value=\"Director of Nursing\" >Director of Nursing<\/option>\n                                                <option value=\"Ex-Spouse\" >Ex-Spouse<\/option>\n                                                <option value=\"Executor\" >Executor<\/option>\n                                                <option value=\"Executrix\" >Executrix<\/option>\n                                                <option value=\"Father\" >Father<\/option>\n                                                <option value=\"Father-in-Law\" >Father-in-Law<\/option>\n                                                <option value=\"Foster Child\" >Foster Child<\/option>\n                                                <option value=\"Foster Mother\" >Foster Mother<\/option>\n                                                <option value=\"Friend\" >Friend<\/option>\n                                                <option value=\"Funeral Director\" >Funeral Director<\/option>\n                                                <option value=\"Goddaughter\" >Goddaughter<\/option>\n                                                <option value=\"Godfather\" >Godfather<\/option>\n                                                <option value=\"Godmother\" >Godmother<\/option>\n                                                <option value=\"Godson\" >Godson<\/option>\n                                                <option value=\"Granddaughter\" >Granddaughter<\/option>\n                                                <option value=\"Grandfather\" >Grandfather<\/option>\n                                                <option value=\"Grandmother\" >Grandmother<\/option>\n                                                <option value=\"Grandnephew\" >Grandnephew<\/option>\n                                                <option value=\"Grandneice\" >Grandneice<\/option>\n                                                <option value=\"Grandson\" >Grandson<\/option>\n                                                <option value=\"Great Nephew\" >Great Nephew<\/option>\n                                                <option value=\"Great Niece\" >Great Niece<\/option>\n                                                <option value=\"Great-Aunt\" >Great-Aunt<\/option>\n                                                <option value=\"Great-Granddaughter\" >Great-Granddaughter<\/option>\n                                                <option value=\"Great-Grandson\" >Great-Grandson<\/option>\n                                                <option value=\"Great-Uncle\" >Great-Uncle<\/option>\n                                                <option value=\"Guardian\" >Guardian<\/option>\n                                                <option value=\"Half Brother\" >Half Brother<\/option>\n                                                <option value=\"Half Sister\" >Half Sister<\/option>\n                                                <option value=\"Lawyer\/Solicitor\" >Lawyer\/Solicitor<\/option>\n                                                <option value=\"Mother\" >Mother<\/option>\n                                                <option value=\"Mother-in-Law\" >Mother-in-Law<\/option>\n                                                <option value=\"Nephew\" >Nephew<\/option>\n                                                <option value=\"Niece\" >Niece<\/option>\n                                                <option value=\"No Relation\" >No Relation<\/option>\n                                                <option value=\"Parent\" >Parent<\/option>\n                                                <option value=\"Second Cousin\" >Second Cousin<\/option>\n                                                <option value=\"Sister\" >Sister<\/option>\n                                                <option value=\"Sister-in-Law\" >Sister-in-Law<\/option>\n                                                <option value=\"Son\" >Son<\/option>\n                                                <option value=\"Son-in-Law\" >Son-in-Law<\/option>\n                                                <option value=\"Step Brother\" >Step Brother<\/option>\n                                                <option value=\"Step Daughter\" >Step Daughter<\/option>\n                                                <option value=\"Step Father\" >Step Father<\/option>\n                                                <option value=\"Step Mother\" >Step Mother<\/option>\n                                                <option value=\"Step Sister\" >Step Sister<\/option>\n                                                <option value=\"Step Son\" >Step Son<\/option>\n                                                <option value=\"Third Cousin\" >Third Cousin<\/option>\n                                                <option value=\"Uncle\" >Uncle<\/option>\n                                                <option value=\"Widow\" >Widow<\/option>\n                                                <option value=\"Widower\" >Widower<\/option>\n                                                <option value=\"Other\" >Other<\/option>\n                                                      <\/select>\n            <small class=\"form-text text-danger d-none error-label\"><\/small>\n          <\/div>\n                    <\/div>\n        <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-auto col-lg-auto \" data-field-id=\"nextOfKinGroup[0][title]\" data-parent-key=\"nextOfKinGroup[0]\">\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Title\">Title<\/label>\n              <\/div>\n                                      <div class=\"btn-group\">\n                                                                                                        <label class=\"btn-default btn-light primary btn segment-button segment-nextOfKinGroup-title\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"nextOfKinGroup-title\" data-segment-value=\"Mr\">\n                        <input type=\"checkbox\"  name=\"nextOfKinGroup[0][title]\" id=\"title_0\"  value=\"Mr\" \/>\n                        <span>Mr<\/span>\n                      <\/label>\n                                                                                                              <label class=\"btn-default btn-light primary btn segment-button segment-nextOfKinGroup-title\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"nextOfKinGroup-title\" data-segment-value=\"Miss\">\n                        <input type=\"checkbox\"  name=\"nextOfKinGroup[0][title]\" id=\"title_1\"  value=\"Miss\" \/>\n                        <span>Miss<\/span>\n                      <\/label>\n                                                                                                              <label class=\"btn-default btn-light primary btn segment-button segment-nextOfKinGroup-title\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"nextOfKinGroup-title\" data-segment-value=\"Mrs\">\n                        <input type=\"checkbox\"  name=\"nextOfKinGroup[0][title]\" id=\"title_2\"  value=\"Mrs\" \/>\n                        <span>Mrs<\/span>\n                      <\/label>\n                                                                                                              <label class=\"btn-default btn-light primary btn segment-button segment-nextOfKinGroup-title\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"nextOfKinGroup-title\" data-segment-value=\"Ms\">\n                        <input type=\"checkbox\"  name=\"nextOfKinGroup[0][title]\" id=\"title_3\"  value=\"Ms\" \/>\n                        <span>Ms<\/span>\n                      <\/label>\n                                                                      <\/div>\n          <small class=\"form-text text-danger d-none error-label\"><\/small>\n                    <\/div>\n        <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"nextOfKinGroup[0][firstName]\" data-parent-key=\"nextOfKinGroup[0]\">\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"First name\">First name<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"nextOfKinGroup[0][firstName]\" id=\"firstName\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n      <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"nextOfKinGroup[0][familyName]\" data-parent-key=\"nextOfKinGroup[0]\">\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Last name\">Last name<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"nextOfKinGroup[0][familyName]\" id=\"familyName\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n        <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"nextOfKinGroup[0][contactPhoneNumber]\" data-parent-key=\"nextOfKinGroup[0]\">\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Phone number\">Phone number<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"nextOfKinGroup[0][contactPhoneNumber]\" id=\"contactPhoneNumber\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n      <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"nextOfKinGroup[0][contactEmail]\" data-parent-key=\"nextOfKinGroup[0]\">\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Email address\">Email address<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"nextOfKinGroup[0][contactEmail]\" id=\"contactEmail\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n      <div  data-sectionparent=\"0\"     class=\"form-element col-sm-12 \" data-field-id=\"nextOfKinGroup[0][address]\" data-parent-key=\"nextOfKinGroup[0]\">\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Address\">Address<\/label>\n              <\/div>\n                            <div class=\"firehawk-crm-form-address-picker \" id=\"address\" name=\"nextOfKinGroup[0][address]\"  data-default-country=\"\"  data-country=\"\"  data-distance=\"\" data-category=\"\" data-save-result-field=\"\" data-geo-tags=\"\" data-invalid-label=\"\" >\n          <div class=\"address-picker\">\n          <\/div>\n        <\/div>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n            <\/div>\n  \n            <\/div>\n          <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n            <input type=\"button\" class=\"btn-default btn-primary primary btn back-button w-auto\" value=\"Back\" \/>          <\/div>\n                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n            \n            <button class=\"btn-default btn-primary primary btn next-button\"  >\n              <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next            <\/button>\n          <\/div>\n                  <\/div>\n              <\/form>\n    <\/div>\n      \n\n    <div class=\"firehawk-crm-form-page    \" data-index=\"12\" data-relation='[{\"action\":\"HIDE\",\"connective\":\"OR\",\"when\":[{\"id\":\"callerIs\",\"operator\":\"==\",\"value\":\"Executor\"},{\"id\":\"nextOfKinIs\",\"operator\":\"==\",\"value\":\"Executor\"}]}]' data-page-id=\"executor-details\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element form-heading col-sm-12 \" data-field-id=\"heading_details\" >\n                        <h3 class=\"form-title\"  data-name=\"Executor Details\"><span class=\"content\">Executor Details<\/span><\/h3>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"    data-groupkey=\"executor\" data-group-position=\"\" data-group-path=executor class=\"form-element col-12 col-md-auto col-lg-auto \" data-field-id=\"executor\" >\n    <div class=\"row\">                <div  data-sectionparent=\"0\" data-required='true'    class=\"form-element col-12 col-md-6 \" data-field-id=\"executor[0][relationshipToClient]\" data-parent-key=\"executor[0]\">\n              <div class=\"label-con\">\n        <label class=\"control-label  \" data-merge-name='Relationship to [[clientFirstGivenName]]' data-name=\"Relationship to Loved One\">Relationship to Loved One <span class=\"required\">*<\/span><\/label>\n              <\/div>\n                            <div>\n                        <select class=\"form-control select2\" autocomplete=\"false\" data-template=\"\" data-placeholder=\"Select one\"  name=\"executor[0][relationshipToClient]\"  id=\"executor[0][relationshipToClient]\" >\n              <option value=\"\"><\/option>                                 <option value=\"Husband\" >Husband<\/option>\n                                                <option value=\"Wife\" >Wife<\/option>\n                                                <option value=\"Aunt\" >Aunt<\/option>\n                                                <option value=\"Brother\" >Brother<\/option>\n                                                <option value=\"Brother-in-Law\" >Brother-in-Law<\/option>\n                                                <option value=\"Cousin\" >Cousin<\/option>\n                                                <option value=\"Daughter\" >Daughter<\/option>\n                                                <option value=\"Daughter-in-Law\" >Daughter-in-Law<\/option>\n                                                <option value=\"De Facto\" >De Facto<\/option>\n                                                <option value=\"Director of Nursing\" >Director of Nursing<\/option>\n                                                <option value=\"Ex-Spouse\" >Ex-Spouse<\/option>\n                                                <option value=\"Executor\" >Executor<\/option>\n                                                <option value=\"Executrix\" >Executrix<\/option>\n                                                <option value=\"Father\" >Father<\/option>\n                                                <option value=\"Father-in-Law\" >Father-in-Law<\/option>\n                                                <option value=\"Foster Child\" >Foster Child<\/option>\n                                                <option value=\"Foster Mother\" >Foster Mother<\/option>\n                                                <option value=\"Friend\" >Friend<\/option>\n                                                <option value=\"Funeral Director\" >Funeral Director<\/option>\n                                                <option value=\"Goddaughter\" >Goddaughter<\/option>\n                                                <option value=\"Godfather\" >Godfather<\/option>\n                                                <option value=\"Godmother\" >Godmother<\/option>\n                                                <option value=\"Godson\" >Godson<\/option>\n                                                <option value=\"Granddaughter\" >Granddaughter<\/option>\n                                                <option value=\"Grandfather\" >Grandfather<\/option>\n                                                <option value=\"Grandmother\" >Grandmother<\/option>\n                                                <option value=\"Grandnephew\" >Grandnephew<\/option>\n                                                <option value=\"Grandneice\" >Grandneice<\/option>\n                                                <option value=\"Grandson\" >Grandson<\/option>\n                                                <option value=\"Great Nephew\" >Great Nephew<\/option>\n                                                <option value=\"Great Niece\" >Great Niece<\/option>\n                                                <option value=\"Great-Aunt\" >Great-Aunt<\/option>\n                                                <option value=\"Great-Granddaughter\" >Great-Granddaughter<\/option>\n                                                <option value=\"Great-Grandson\" >Great-Grandson<\/option>\n                                                <option value=\"Great-Uncle\" >Great-Uncle<\/option>\n                                                <option value=\"Guardian\" >Guardian<\/option>\n                                                <option value=\"Half Brother\" >Half Brother<\/option>\n                                                <option value=\"Half Sister\" >Half Sister<\/option>\n                                                <option value=\"Lawyer\/Solicitor\" >Lawyer\/Solicitor<\/option>\n                                                <option value=\"Mother\" >Mother<\/option>\n                                                <option value=\"Mother-in-Law\" >Mother-in-Law<\/option>\n                                                <option value=\"Nephew\" >Nephew<\/option>\n                                                <option value=\"Niece\" >Niece<\/option>\n                                                <option value=\"No Relation\" >No Relation<\/option>\n                                                <option value=\"Parent\" >Parent<\/option>\n                                                <option value=\"Second Cousin\" >Second Cousin<\/option>\n                                                <option value=\"Sister\" >Sister<\/option>\n                                                <option value=\"Sister-in-Law\" >Sister-in-Law<\/option>\n                                                <option value=\"Son\" >Son<\/option>\n                                                <option value=\"Son-in-Law\" >Son-in-Law<\/option>\n                                                <option value=\"Step Brother\" >Step Brother<\/option>\n                                                <option value=\"Step Daughter\" >Step Daughter<\/option>\n                                                <option value=\"Step Father\" >Step Father<\/option>\n                                                <option value=\"Step Mother\" >Step Mother<\/option>\n                                                <option value=\"Step Sister\" >Step Sister<\/option>\n                                                <option value=\"Step Son\" >Step Son<\/option>\n                                                <option value=\"Third Cousin\" >Third Cousin<\/option>\n                                                <option value=\"Uncle\" >Uncle<\/option>\n                                                <option value=\"Widow\" >Widow<\/option>\n                                                <option value=\"Widower\" >Widower<\/option>\n                                                <option value=\"Other\" >Other<\/option>\n                                                      <\/select>\n            <small class=\"form-text text-danger d-none error-label\"><\/small>\n          <\/div>\n                    <\/div>\n        <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-auto col-lg-auto \" data-field-id=\"executor[0][title]\" data-parent-key=\"executor[0]\">\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Title\">Title<\/label>\n              <\/div>\n                                      <div class=\"btn-group\">\n                                                                                                        <label class=\"btn-default btn-light primary btn segment-button segment-executor-title\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"executor-title\" data-segment-value=\"Mr\">\n                        <input type=\"checkbox\"  name=\"executor[0][title]\" id=\"title_0\"  value=\"Mr\" \/>\n                        <span>Mr<\/span>\n                      <\/label>\n                                                                                                              <label class=\"btn-default btn-light primary btn segment-button segment-executor-title\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"executor-title\" data-segment-value=\"Miss\">\n                        <input type=\"checkbox\"  name=\"executor[0][title]\" id=\"title_1\"  value=\"Miss\" \/>\n                        <span>Miss<\/span>\n                      <\/label>\n                                                                                                              <label class=\"btn-default btn-light primary btn segment-button segment-executor-title\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"executor-title\" data-segment-value=\"Mrs\">\n                        <input type=\"checkbox\"  name=\"executor[0][title]\" id=\"title_2\"  value=\"Mrs\" \/>\n                        <span>Mrs<\/span>\n                      <\/label>\n                                                                                                              <label class=\"btn-default btn-light primary btn segment-button segment-executor-title\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"executor-title\" data-segment-value=\"Ms\">\n                        <input type=\"checkbox\"  name=\"executor[0][title]\" id=\"title_3\"  value=\"Ms\" \/>\n                        <span>Ms<\/span>\n                      <\/label>\n                                                                      <\/div>\n          <small class=\"form-text text-danger d-none error-label\"><\/small>\n                    <\/div>\n        <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"executor[0][firstName]\" data-parent-key=\"executor[0]\">\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"First name\">First name<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"executor[0][firstName]\" id=\"firstName\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n      <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"executor[0][familyName]\" data-parent-key=\"executor[0]\">\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Last name\">Last name<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"executor[0][familyName]\" id=\"familyName\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n        <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"executor[0][contactPhoneNumber]\" data-parent-key=\"executor[0]\">\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Phone number\">Phone number<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"executor[0][contactPhoneNumber]\" id=\"contactPhoneNumber\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n      <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 \" data-field-id=\"executor[0][contactEmail]\" data-parent-key=\"executor[0]\">\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Email address\">Email address<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"executor[0][contactEmail]\" id=\"contactEmail\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n      <div  data-sectionparent=\"0\"     class=\"form-element col-sm-12 \" data-field-id=\"executor[0][address]\" data-parent-key=\"executor[0]\">\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Address\">Address<\/label>\n              <\/div>\n                            <div class=\"firehawk-crm-form-address-picker \" id=\"address\" name=\"executor[0][address]\"  data-default-country=\"\"  data-country=\"\"  data-distance=\"\" data-category=\"\" data-save-result-field=\"\" data-geo-tags=\"\" data-invalid-label=\"\" >\n          <div class=\"address-picker\">\n          <\/div>\n        <\/div>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n            <\/div>\n  \n            <\/div>\n          <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n            <input type=\"button\" class=\"btn-default btn-primary primary btn back-button w-auto\" value=\"Back\" \/>          <\/div>\n                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n            \n            <button class=\"btn-default btn-primary primary btn next-button\"  >\n              <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next            <\/button>\n          <\/div>\n                  <\/div>\n              <\/form>\n    <\/div>\n      \n\n    <div class=\"firehawk-crm-form-page    \" data-index=\"13\"  data-page-id=\"packages\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-sm-12 \" data-field-id=\"heading_packages\" >\n                        <h3 class=\"form-title\"  data-name=\"Packages\"><span class=\"content\">Packages<\/span><\/h3>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 mb-0 \" data-field-id=\"cremationPackage\" >\n                          <div class=\"firehawk-crm-form-grid-picker\" id=\"cremationPackage\"  name=\"cremationPackage\"    data-layout=\"product-card\" data-columns=\"2\" data-api-es-index=\"stock\" data-api-es-route=\"stock\/list\/\" data-api-es-tagfilters=\"cremation-package\" data-qf-tags=\"\"  data-cart-item=\"true\"         >\n          <div class=\"grid\">\n            <div class=\"grid-item my-sizer-element\"><\/div>\n          <\/div>\n          <div class=\"firehawk-crm-pg\">\n          <\/div>\n        <\/div>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 \" data-field-id=\"_paragraph_content_1\" >\n                        <div class=\"fh-p-content\"  data-name=\"&lt;i&gt;Our charge for a direct cremation (without ceremony) or any attendant rites or ceremonies includes: basic services of funeral director and staff, a proportionate share of overhead costs, local removal of remains and transportation to crematory. If you want to arrange a direct cremation, you can use an alternative container. Alternative containers encase the body and can be made of materials like fiberboards or composition materials (with or without an outside covering). The alternative containers we use are wood and fiberboard.&lt;\/i&gt;\"><span class=\"content\"><i>Our charge for a direct cremation (without ceremony) or any attendant rites or ceremonies includes: basic services of funeral director and staff, a proportionate share of overhead costs, local removal of remains and transportation to crematory. If you want to arrange a direct cremation, you can use an alternative container. Alternative containers encase the body and can be made of materials like fiberboards or composition materials (with or without an outside covering). The alternative containers we use are wood and fiberboard.<\/i><\/span><\/div>\n            <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 \" data-field-id=\"_paragraph_content_3\" >\n                        <div class=\"fh-p-content\"  data-name=\"&lt;i&gt;*The state required medical examiner fee ($200) and crematory\/cremation fee ($425).&lt;\/i&gt;\"><span class=\"content\"><i>*The state required medical examiner fee ($200) and crematory\/cremation fee ($425).<\/i><\/span><\/div>\n            <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n            <input type=\"button\" class=\"btn-default btn-primary primary btn back-button w-auto\" value=\"Back\" \/>          <\/div>\n                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n            \n            <button class=\"btn-default btn-primary primary btn next-button\"  >\n              <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next            <\/button>\n          <\/div>\n                  <\/div>\n              <\/form>\n    <\/div>\n      \n\n    <div class=\"firehawk-crm-form-page    \" data-index=\"14\"  data-page-id=\"casket\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"1\"     class=\"form-element col-sm-12 \" data-field-id=\"heading_casket-selection\" >\n                        <h3 class=\"form-title\"  data-name=\"Select a  casket\"><span class=\"content\">Select a  casket<\/span><\/h3>\n                  <h5 class=\"form-subtitle\"  data-name=\"Your loved one will be placed in an alternative container (a casket is not needed for direct-cremation) as required by the crematory. Should you wish to upgrade this container to one of the below cremation-friendly alternatives we would be honored to do so.\"><span class=\"content\">Your loved one will be placed in an alternative container (a casket is not needed for direct-cremation) as required by the crematory. Should you wish to upgrade this container to one of the below cremation-friendly alternatives we would be honored to do so.<\/span><\/h5>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"1\"     class=\"form-element col-12 \" data-field-id=\"selectedCoffin\" >\n                          <div class=\"firehawk-crm-form-grid-picker\" id=\"selectedCoffin\"  name=\"selectedCoffin\" data-api-es-only-show-in-web='yes'     data-api-es-index=\"stock\" data-api-es-route=\"stock\/list\/\" data-api-es-tagfilters=\"coffin,casket\" data-qf-tags=\"\"  data-cart-item=\"true\"         >\n          <div class=\"grid\">\n            <div class=\"grid-item my-sizer-element\"><\/div>\n          <\/div>\n          <div class=\"firehawk-crm-pg\">\n          <\/div>\n        <\/div>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"1\"     class=\"form-element col-12 col-md-12 col-lg-12 \" data-field-id=\"clientOtherDetails\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Other details you want the Funeral Director to know\">Other details you want the Funeral Director to know<\/label>\n              <\/div>\n                    <textarea class=\"form-control\" autocomplete=\"false\" rows=\"5\" name=\"clientOtherDetails\" id=\"clientOtherDetails\" ><\/textarea>\n            <\/div>\n      <div class=\"col-sm-12\">\n    <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n            <input type=\"button\" class=\"btn-default btn-primary primary btn back-button w-auto\" value=\"Back\" \/>          <\/div>\n                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n            \n            <button class=\"btn-default btn-primary primary btn next-button\"  >\n              <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next            <\/button>\n          <\/div>\n                  <\/div>\n              <\/form>\n    <\/div>\n      \n\n    <div class=\"firehawk-crm-form-page    \" data-index=\"15\"  data-page-id=\"urn\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-sm-12 \" data-field-id=\"heading_urn-selection\" >\n                        <h3 class=\"form-title\"  data-name=\"Select an Urn\"><span class=\"content\">Select an Urn<\/span><\/h3>\n                  <h5 class=\"form-subtitle\"  data-name=\"Your loved ones cremains will be returned to you by our staff in a minimum container provided by the cemetery, or you have the option to upgrade to an urn from our selection below.\"><span class=\"content\">Your loved ones cremains will be returned to you by our staff in a minimum container provided by the cemetery, or you have the option to upgrade to an urn from our selection below.<\/span><\/h5>\n                    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 \" data-field-id=\"selectedUrnJewellery\" >\n                          <div class=\"firehawk-crm-form-grid-picker\" id=\"selectedUrnJewellery\"  name=\"selectedUrnJewellery\" data-api-es-only-show-in-web='yes'     data-api-es-index=\"stock\" data-api-es-route=\"stock\/list\/\" data-api-es-tagfilters=\"urn\" data-qf-tags=\"\"  data-cart-item=\"true\"         >\n          <div class=\"grid\">\n            <div class=\"grid-item my-sizer-element\"><\/div>\n          <\/div>\n          <div class=\"firehawk-crm-pg\">\n          <\/div>\n        <\/div>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n                    <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n            <input type=\"button\" class=\"btn-default btn-primary primary btn back-button w-auto\" value=\"Back\" \/>          <\/div>\n                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n            \n            <button class=\"btn-default btn-primary primary btn next-button\"  >\n              <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next            <\/button>\n          <\/div>\n                  <\/div>\n              <\/form>\n    <\/div>\n      \n\n    <div class=\"firehawk-crm-form-page    \" data-index=\"16\"  data-page-id=\"post-cremation\">\n      <form id=\"firehawk-crm-form-page-form\" class=\"firehawk-crm-form\">\n        <div class=\"row firehawk-crm-form-page-form-row\">\n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element form-heading col-sm-12 \" data-field-id=\"heading_ashes\" >\n                        <h3 class=\"form-title\"  data-name=\"Post Cremation\"><span class=\"content\">Post Cremation<\/span><\/h3>\n                    <\/div>\n  \n          \n          \n                <div class=\"row col-sm-12\">\n    <\/div>\n    <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-12 \" data-field-id=\"clientCertifiedDeathCertificate\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Do you require a copy of the death certificate? A cost of $15 applies for each copy.\">Do you require a copy of the death certificate? A cost of $15 applies for each copy.<\/label>\n              <\/div>\n                                      <div class=\"btn-group\">\n                                                                                                    <label class=\"btn-default  btn-light primary btn segment-button segment-clientCertifiedDeathCertificate\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"clientCertifiedDeathCertificate\" data-segment-value=\"Yes\"  >\n                      <input type=\"checkbox\" name=\"clientCertifiedDeathCertificate\" id=\"clientCertifiedDeathCertificate_0\"\n                        value=\"Yes\"   \/>\n                      <div class=\"content\" >\n                      <span class=\"label\">Yes<\/span>                      <\/div>\n                    <\/label>\n                                                                                                          <label class=\"btn-default  btn-primary primary btn segment-button segment-clientCertifiedDeathCertificate\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"clientCertifiedDeathCertificate\" data-segment-value=\"No\"  >\n                      <input type=\"checkbox\" name=\"clientCertifiedDeathCertificate\" id=\"clientCertifiedDeathCertificate_1\"\n                      checked=\"checked\"  value=\"No\"   \/>\n                      <div class=\"content\" >\n                      <span class=\"label\">No<\/span>                      <\/div>\n                    <\/label>\n                                                                      <\/div>\n          <small class=\"form-text text-danger d-none error-label\"><\/small>\n                    <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;OR&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;clientCertifiedDeathCertificate&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Yes&quot;}]}]' data-sectionparent=\"0\"     class=\"form-element col-12 col-md-4 \" data-field-id=\"certifiedDeathCertificateQuantity\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Number of copies of the death certificate required?\">Number of copies of the death certificate required?<\/label>\n              <\/div>\n                            <div>\n                        <select class=\"form-control select2\" autocomplete=\"false\" data-template=\"\" data-placeholder=\"Please select\"  name=\"certifiedDeathCertificateQuantity\"  id=\"certifiedDeathCertificateQuantity\" >\n              <option value=\"\"><\/option>                                   <option value=\"1\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"1\" >1<\/option>\n                                                  <option value=\"2\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"2\" >2<\/option>\n                                                  <option value=\"3\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"3\" >3<\/option>\n                                                  <option value=\"4\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"4\" >4<\/option>\n                                                  <option value=\"5\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"5\" >5<\/option>\n                                                  <option value=\"6\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"6\" >6<\/option>\n                                                  <option value=\"7\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"7\" >7<\/option>\n                                                  <option value=\"8\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"8\" >8<\/option>\n                                                  <option value=\"9\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"9\" >9<\/option>\n                                                  <option value=\"10\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"10\" >10<\/option>\n                                                  <option value=\"11\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"11\" >11<\/option>\n                                                  <option value=\"12\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"12\" >12<\/option>\n                                                  <option value=\"13\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"13\" >13<\/option>\n                                                  <option value=\"14\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"14\" >14<\/option>\n                                                  <option value=\"15\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"15\" >15<\/option>\n                                                  <option value=\"16\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"16\" >16<\/option>\n                                                  <option value=\"17\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"17\" >17<\/option>\n                                                  <option value=\"18\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"18\" >18<\/option>\n                                                  <option value=\"19\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"19\" >19<\/option>\n                                                  <option value=\"20\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"20\" >20<\/option>\n                                                  <option value=\"21\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"21\" >21<\/option>\n                                                  <option value=\"22\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"22\" >22<\/option>\n                                                  <option value=\"23\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"23\" >23<\/option>\n                                                  <option value=\"24\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"24\" >24<\/option>\n                                                  <option value=\"25\" data-woocommerceid=\"\" data-woocommercequantity=\"\"  data-cart-item=\"-McvK2m7NHJqX56vSStA\" data-cart-item-action=\"add\" data-cart-item-quantity=\"25\" >25<\/option>\n                                                      <\/select>\n            <small class=\"form-text text-danger d-none error-label\"><\/small>\n          <\/div>\n                    <\/div>\n      <div class=\"col-sm-12\">\n    <\/div>\n  \n          \n          \n              <div  data-sectionparent=\"0\"     class=\"form-element col-12 col-md-auto \" data-field-id=\"cremationCollectionType\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"After the cremation has taken place, how would you like to receive the ashes?\">After the cremation has taken place, how would you like to receive the ashes?<\/label>\n              <\/div>\n                                  <div class=\"checkbox-list\" id=\"cremationCollectionType\">\n                                                                                            <div class=\"checkbox-list-item  checkbox-list-item-cremationCollectionType\" tabindex=\"0\" data-multiple=\"false\" data-item-id=\"cremationCollectionType\" data-item-value=\"Pick Up at Funeral Home\">\n                      <input type=\"checkbox\"  name=\"cremationCollectionType\" id=\"cremationCollectionType_0\"  value=\"Pick Up at Funeral Home\" \/>\n                      <div class=\"checkbox-icon\"><i class=\"far fa fa-regular fa-check check-icon\"><\/i><\/div>\n                      <div class=\"content\">\n                        <span class=\"label\">Pick Up at Funeral Home<\/span>\n                      <\/div>\n                    <\/div>\n                                                                                                  <div class=\"checkbox-list-item  checkbox-list-item-cremationCollectionType\" tabindex=\"0\" data-multiple=\"false\" data-item-id=\"cremationCollectionType\" data-item-value=\"Mail - Set Charge\">\n                      <input type=\"checkbox\"  name=\"cremationCollectionType\" id=\"cremationCollectionType_1\"  value=\"Mail - Set Charge\" \/>\n                      <div class=\"checkbox-icon\"><i class=\"far fa fa-regular fa-check check-icon\"><\/i><\/div>\n                      <div class=\"content\">\n                        <span class=\"label\">Mail - Set Charge<\/span>\n                      <\/div>\n                    <\/div>\n                                                                                                  <div class=\"checkbox-list-item  checkbox-list-item-cremationCollectionType\" tabindex=\"0\" data-multiple=\"false\" data-item-id=\"cremationCollectionType\" data-item-value=\"Delivery\">\n                      <input type=\"checkbox\"  name=\"cremationCollectionType\" id=\"cremationCollectionType_2\"  value=\"Delivery\" \/>\n                      <div class=\"checkbox-icon\"><i class=\"far fa fa-regular fa-check check-icon\"><\/i><\/div>\n                      <div class=\"content\">\n                        <span class=\"label\">Delivery<\/span>\n                      <\/div>\n                    <\/div>\n                                                                                                  <div class=\"checkbox-list-item  checkbox-list-item-cremationCollectionType\" tabindex=\"0\" data-multiple=\"false\" data-item-id=\"cremationCollectionType\" data-item-value=\"Other\">\n                      <input type=\"checkbox\"  name=\"cremationCollectionType\" id=\"cremationCollectionType_3\"  value=\"Other\" \/>\n                      <div class=\"checkbox-icon\"><i class=\"far fa fa-regular fa-check check-icon\"><\/i><\/div>\n                      <div class=\"content\">\n                        <span class=\"label\">Other<\/span>\n                      <\/div>\n                    <\/div>\n                                                            <\/div>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n                  <\/div>\n      <div class=\"col-sm-12\">\n    <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;OR&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;cremationCollectionType&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Other&quot;}]}]' data-sectionparent=\"0\"     class=\"form-element col-12 col-md-auto \" data-field-id=\"cremationCollectionTypeOther\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Other\">Other<\/label>\n              <\/div>\n                  <input class=\"form-control \" autocomplete=\"false\" type=\"text\" name=\"cremationCollectionTypeOther\" id=\"cremationCollectionTypeOther\"                \/>\n      <small class=\"form-text text-danger d-none error-label\"><\/small>\n\n            <\/div>\n      <div class=\"col-sm-12\">\n    <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;OR&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;cremationCollectionType&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Mail - Set Charge&quot;},{&quot;id&quot;:&quot;cremationCollectionType&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Delivery&quot;}]}]' data-sectionparent=\"0\"     class=\"form-element col-12 col-md-6 col-lg-6 \" data-field-id=\"cremationCollectionDeliverTo\" >\n              <div class=\"label-con\">\n        <label class=\"control-label  \"  data-name=\"Delivery To\">Delivery To<\/label>\n              <\/div>\n                                      <div class=\"btn-group\">\n                                                                                                    <label class=\"btn-default  btn-light primary btn segment-button segment-cremationCollectionDeliverTo\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"cremationCollectionDeliverTo\" data-segment-value=\"Caller\"  >\n                      <input type=\"checkbox\" name=\"cremationCollectionDeliverTo\" id=\"cremationCollectionDeliverTo_0\"\n                        value=\"Caller\"   \/>\n                      <div class=\"content\" >\n                      <span class=\"label\">Caller<\/span>                      <\/div>\n                    <\/label>\n                                                                                                          <label class=\"btn-default  btn-light primary btn segment-button segment-cremationCollectionDeliverTo\" tabindex=\"0\" data-multiple=\"false\" data-segment-id=\"cremationCollectionDeliverTo\" data-segment-value=\"Other\"  >\n                      <input type=\"checkbox\" name=\"cremationCollectionDeliverTo\" id=\"cremationCollectionDeliverTo_1\"\n                        value=\"Other\"   \/>\n                      <div class=\"content\" >\n                      <span class=\"label\">Other<\/span>                      <\/div>\n                    <\/label>\n                                                                      <\/div>\n          <small class=\"form-text text-danger d-none error-label\"><\/small>\n                    <\/div>\n      <div class=\"col-sm-12\">\n    <\/div>\n  \n          \n          \n              <div data-relation='[{&quot;action&quot;:&quot;SHOW&quot;,&quot;connective&quot;:&quot;OR&quot;,&quot;when&quot;:[{&quot;id&quot;:&quot;cremationCollectionDeliverTo&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Other&quot;}]}]' data-sectionparent=\"0\"     class=\"form-element col-sm-12 \" data-field-id=\"cremationCollectionDeliverToOther\" >\n                                <div class=\"firehawk-crm-form-address-picker \" id=\"cremationCollectionDeliverToOther\" name=\"cremationCollectionDeliverToOther\"  data-default-country=\"\"  data-country=\"\"  data-distance=\"\" data-category=\"\" data-save-result-field=\"\" data-geo-tags=\"\" data-invalid-label=\"\" >\n          <div class=\"address-picker\">\n          <\/div>\n        <\/div>\n        <small class=\"form-text text-danger d-none error-label\"><\/small>\n            <\/div>\n  \n                  <\/div>\n                        <div class=\"row firehawk-crm-form-footer-buttons\">\n          <div class=\"col-auto col-sm-6 me-auto\">\n            <input type=\"button\" class=\"btn-default btn-primary primary btn back-button w-auto\" value=\"Back\" \/>          <\/div>\n                                    <div class=\"col-auto col-sm-6\" style=\"text-align: right\">\n                \n                <button class=\"btn-default btn-primary primary btn conf-next-button\" >\n                  <span class=\"spinner-border spinner-border-sm d-none\" role=\"status\" aria-hidden=\"true\"><\/span> Next                <\/button>\n              <\/div>\n                              <\/div>\n              <\/form>\n    <\/div>\n\n<div class=\"firehawk-crm-form-page confirmation-page \" data-index=\"17\">\n  <div class=\"confirmation-container\">\n    <div class=\"confirmation-header\">\n      <h4>Cremation<\/h4>\n    <\/div>\n\n    <div class=\"grid-container\">\n                      \n                                                           <div class=\"grid-col\" id=\"confirm-page-your-details\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\"  data-name=\"Your Details\"><span class=\"content\">Your Details<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"applicantTitle\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Title\"><span class=\"content\">Title<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"applicantTitle\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"applicantFirstName\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"First name\"><span class=\"content\">First name<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"applicantFirstName\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"applicantFamilyName\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Last name\"><span class=\"content\">Last name<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"applicantFamilyName\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"applicantPhone\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Phone number\"><span class=\"content\">Phone number<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"applicantPhone\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"applicantEmail\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Email address\"><span class=\"content\">Email address<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"applicantEmail\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"applicantContactPreferred\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"How would you like us to contact you?\"><span class=\"content\">How would you like us to contact you?<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"applicantContactPreferred\"><\/span>\n    <\/div>\n                <\/div>\n                            \n                                                           <div class=\"grid-col\" id=\"confirm-page-loved-one-details\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\"  data-name=\"Your loved ones details\"><span class=\"content\">Your loved ones details<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"clientFirstGivenName\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"First name\"><span class=\"content\">First name<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientFirstGivenName\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"clientOtherGivenNames\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Middle name\"><span class=\"content\">Middle name<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientOtherGivenNames\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"clientFamilyName\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Last name\"><span class=\"content\">Last name<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientFamilyName\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"clientKnownAs\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Known As (other than legal name)\"><span class=\"content\">Known As (other than legal name)<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientKnownAs\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"date\" data-field-id=\"clientDateOfBirth\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Date of Birth\"><span class=\"content\">Date of Birth<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientDateOfBirth\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"date\" data-field-id=\"clientDateOfDeath\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Date of Death\"><span class=\"content\">Date of Death<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientDateOfDeath\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"clientAgeAtDeath\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Age (Yrs)\"><span class=\"content\">Age (Yrs)<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientAgeAtDeath\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"clientAgeAtDeathMonths\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Age (Mths)\"><span class=\"content\">Age (Mths)<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientAgeAtDeathMonths\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"clientAgeAtDeathDays\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Age (Days)\"><span class=\"content\">Age (Days)<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientAgeAtDeathDays\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"clientIsVeteran\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Check all that apply\"><span class=\"content\">Check all that apply<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientIsVeteran\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"cremationBatteryPoweredDevicePresentOrRemoved\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"\"><span class=\"content\"><\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"cremationBatteryPoweredDevicePresentOrRemoved\"><\/span>\n    <\/div>\n                <\/div>\n                            \n                                                           <div class=\"grid-col\" id=\"confirm-page-loved-one-birth-details\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\" data-merge-name='[[clientFirstGivenName:plural]] Birth Details' data-name=\"Your loved ones birth details\"><span class=\"content\">Your loved ones birth details<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"birthCity\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"City\"><span class=\"content\">City<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"birthCity\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"birthState\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"State\"><span class=\"content\">State<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"birthState\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"birthCountry\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Country\"><span class=\"content\">Country<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"birthCountry\"><\/span>\n    <\/div>\n                <\/div>\n                            \n                                                           <div class=\"grid-col\" id=\"confirm-page-address-details\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\"  data-name=\"Your Address\"><span class=\"content\">Your Address<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"address-picker\" data-field-id=\"applicantAddress\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Where are you located?\"><span class=\"content\">Where are you located?<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"applicantAddress\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"applicantCanMailAddress\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Can we send mail to this address?\"><span class=\"content\">Can we send mail to this address?<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"applicantCanMailAddress\"><\/span>\n    <\/div>\n                <\/div>\n                            \n                                                           <div class=\"grid-col\" id=\"confirm-page-deceased-location\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\" data-merge-name='Where is [[clientFirstGivenName]] currently located?' data-name=\" Where is your loved on currently located\"><span class=\"content\"> Where is your loved on currently located<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"address-picker\" data-field-id=\"firstCallTransferLocationOfDeceased\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Where are they located?\"><span class=\"content\">Where are they located?<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"firstCallTransferLocationOfDeceased\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"deceasedAddressLocationType\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Please check all the statements that apply\"><span class=\"content\">Please check all the statements that apply<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"deceasedAddressLocationType\"><\/span>\n    <\/div>\n                <\/div>\n                            \n                                                           <div class=\"grid-col\" id=\"confirm-page-deceased-pass-away-details\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\" data-merge-name='[[clientFirstGivenName:plural]] Place of Passing' data-name=\" Where did your loved one pass away\"><span class=\"content\"> Where did your loved one pass away<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"address-picker\" data-field-id=\"firstCallLocationOfDeceased\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"\"><span class=\"content\"><\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"firstCallLocationOfDeceased\"><\/span>\n    <\/div>\n                <\/div>\n                            \n                                                           <div class=\"grid-col\" id=\"confirm-page-deceased-address\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\" data-merge-name='[[clientFirstGivenName:plural]] Last Residential Address' data-name=\"Your Loved One&#039;s Address Details\"><span class=\"content\">Your Loved One's Address Details<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"address-picker\" data-field-id=\"lastResidentialAddress\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"\"><span class=\"content\"><\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"lastResidentialAddress\"><\/span>\n    <\/div>\n                <\/div>\n                            \n                                                           <div class=\"grid-col\" id=\"confirm-page-more-oved-one-details\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\" data-merge-name='We need a little more information about [[clientFirstGivenName]]' data-name=\"Your loved ones details\"><span class=\"content\">Your loved ones details<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"clientEducation\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"What was their highest level of education?\"><span class=\"content\">What was their highest level of education?<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientEducation\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"clientRace\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"What was their race?\"><span class=\"content\">What was their race?<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientRace\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"clientIsHispanicOrigin\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Hispanic\"><span class=\"content\">Hispanic<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientIsHispanicOrigin\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"clientOccupation\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Occupation (Cannot be retired)\"><span class=\"content\">Occupation (Cannot be retired)<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientOccupation\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"clientOccupationIndustry\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Type of Industry\"><span class=\"content\">Type of Industry<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientOccupationIndustry\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"clientSocialSecurityNo\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Social Security Number\"><span class=\"content\">Social Security Number<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientSocialSecurityNo\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"clientUsualDoctor\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Primary Care Physician\"><span class=\"content\">Primary Care Physician<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientUsualDoctor\"><\/span>\n    <\/div>\n                <\/div>\n                            \n                                                           <div class=\"grid-col\" id=\"confirm-page-veteran-details\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\" data-merge-name='We thank [[clientFirstGivenName]] for their service' data-name=\"Veteran details\"><span class=\"content\">Veteran details<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                                               <\/div>                <div class=\"grid-col\" id=\"confirm-page-veteran-details\">\n              \n                      \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"serviceBranch\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Branch\"><span class=\"content\">Branch<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"serviceBranch\"><\/span>\n    <\/div>\n                                               <\/div>                <div class=\"grid-col\" id=\"confirm-page-veteran-details\">\n              \n                      \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"serviceBranchOther\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Other Branch\"><span class=\"content\">Other Branch<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"serviceBranchOther\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"serviceNumber\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Service No\"><span class=\"content\">Service No<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"serviceNumber\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"Rank\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Rank\"><span class=\"content\">Rank<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"Rank\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"date\" data-field-id=\"serviceMilitaryEntryDate\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Entry to Millitary Date\"><span class=\"content\">Entry to Millitary Date<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"serviceMilitaryEntryDate\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"date\" data-field-id=\"serviceMilitaryDischargeDate\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Discharge from Millitary Date\"><span class=\"content\">Discharge from Millitary Date<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"serviceMilitaryDischargeDate\"><\/span>\n    <\/div>\n                <\/div>\n                            \n                                                           <div class=\"grid-col\" id=\"confirm-page-relationship\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\" data-merge-name='What was your relationship to [[clientFirstGivenName]]?' data-name=\"Your relationship\"><span class=\"content\">Your relationship<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"applicantRelationshipToClient\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"I'm their\"><span class=\"content\">I'm their<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"applicantRelationshipToClient\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"fatherPlaceOfBirth\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"What is your place of birth?\"><span class=\"content\">What is your place of birth?<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"fatherPlaceOfBirth\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"motherPlaceOfBirth\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"What is your place of birth?\"><span class=\"content\">What is your place of birth?<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"motherPlaceOfBirth\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"applicantRelationshipToClientOther\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Other:\"><span class=\"content\">Other:<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"applicantRelationshipToClientOther\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"callerIs\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Please check all the statements that apply\"><span class=\"content\">Please check all the statements that apply<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"callerIs\"><\/span>\n    <\/div>\n                <\/div>\n                            \n                                                           <div class=\"grid-col\" id=\"confirm-page-love-ones-parents\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\" data-merge-name='[[clientFirstGivenName:plural]] Parents' data-name=\"Your loved ones parents\"><span class=\"content\">Your loved ones parents<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"motherFirstGivenName\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Mother - First Name\"><span class=\"content\">Mother - First Name<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"motherFirstGivenName\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"motherOtherGivenNames\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Mother - Middle name\"><span class=\"content\">Mother - Middle name<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"motherOtherGivenNames\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"motherFamilyName\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Mother - Last Name\"><span class=\"content\">Mother - Last Name<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"motherFamilyName\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"motherSuffix\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Suffix\"><span class=\"content\">Suffix<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"motherSuffix\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"motherPlaceOfBirth\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Place of Birth\"><span class=\"content\">Place of Birth<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"motherPlaceOfBirth\"><\/span>\n    <\/div>\n                                               <\/div>                <div class=\"grid-col\" id=\"confirm-page-love-ones-parents\">\n              \n                      \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"motherLifeStatus\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Life status\"><span class=\"content\">Life status<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"motherLifeStatus\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"fatherFirstGivenName\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Father - First Name\"><span class=\"content\">Father - First Name<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"fatherFirstGivenName\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"fatherOtherGivenNames\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Father - Middle name\"><span class=\"content\">Father - Middle name<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"fatherOtherGivenNames\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"fatherFamilyName\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Father - Last Name\"><span class=\"content\">Father - Last Name<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"fatherFamilyName\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"fatherSuffix\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Suffix\"><span class=\"content\">Suffix<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"fatherSuffix\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"fatherPlaceOfBirth\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Place of Birth\"><span class=\"content\">Place of Birth<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"fatherPlaceOfBirth\"><\/span>\n    <\/div>\n                                               <\/div>                <div class=\"grid-col\" id=\"confirm-page-love-ones-parents\">\n              \n                      \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"fatherLifeStatus\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Life status\"><span class=\"content\">Life status<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"fatherLifeStatus\"><\/span>\n    <\/div>\n                <\/div>\n                            \n                                                           <div class=\"grid-col\" id=\"confirm-page-nextofkin-details\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\"  data-name=\"Next of kin details\"><span class=\"content\">Next of kin details<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"nextOfKinIs\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Please check all the statements that apply.\"><span class=\"content\">Please check all the statements that apply.<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"nextOfKinIs\"><\/span>\n    <\/div>\n                    \n                <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"nextOfKinGroup[0][relationshipToClient]\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\" data-merge-name='Relationship to [[clientFirstGivenName]]' data-name=\"Relationship to Loved One\"><span class=\"content\">Relationship to Loved One<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"nextOfKinGroup[0][relationshipToClient]\"><\/span>\n    <\/div>\n      <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"nextOfKinGroup[0][title]\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Title\"><span class=\"content\">Title<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"nextOfKinGroup[0][title]\"><\/span>\n    <\/div>\n      <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"nextOfKinGroup[0][firstName]\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"First name\"><span class=\"content\">First name<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"nextOfKinGroup[0][firstName]\"><\/span>\n    <\/div>\n      <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"nextOfKinGroup[0][familyName]\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Last name\"><span class=\"content\">Last name<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"nextOfKinGroup[0][familyName]\"><\/span>\n    <\/div>\n      <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"nextOfKinGroup[0][contactPhoneNumber]\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Phone number\"><span class=\"content\">Phone number<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"nextOfKinGroup[0][contactPhoneNumber]\"><\/span>\n    <\/div>\n      <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"nextOfKinGroup[0][contactEmail]\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Email address\"><span class=\"content\">Email address<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"nextOfKinGroup[0][contactEmail]\"><\/span>\n    <\/div>\n      <div class=\"confirmation-field\" data-fieldtype=\"address-picker\" data-field-id=\"nextOfKinGroup[0][address]\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Address\"><span class=\"content\">Address<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"nextOfKinGroup[0][address]\"><\/span>\n    <\/div>\n                    <\/div>\n                            \n                                                           <div class=\"grid-col\" id=\"confirm-page-executor-details\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\"  data-name=\"Executor details\"><span class=\"content\">Executor details<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                    \n                <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"executor[0][relationshipToClient]\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\" data-merge-name='Relationship to [[clientFirstGivenName]]' data-name=\"Relationship to Loved One\"><span class=\"content\">Relationship to Loved One<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"executor[0][relationshipToClient]\"><\/span>\n    <\/div>\n      <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"executor[0][title]\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Title\"><span class=\"content\">Title<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"executor[0][title]\"><\/span>\n    <\/div>\n      <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"executor[0][firstName]\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"First name\"><span class=\"content\">First name<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"executor[0][firstName]\"><\/span>\n    <\/div>\n      <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"executor[0][familyName]\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Last name\"><span class=\"content\">Last name<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"executor[0][familyName]\"><\/span>\n    <\/div>\n      <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"executor[0][contactPhoneNumber]\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Phone number\"><span class=\"content\">Phone number<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"executor[0][contactPhoneNumber]\"><\/span>\n    <\/div>\n      <div class=\"confirmation-field\" data-fieldtype=\"text\" data-field-id=\"executor[0][contactEmail]\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Email address\"><span class=\"content\">Email address<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"executor[0][contactEmail]\"><\/span>\n    <\/div>\n      <div class=\"confirmation-field\" data-fieldtype=\"address-picker\" data-field-id=\"executor[0][address]\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Address\"><span class=\"content\">Address<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"executor[0][address]\"><\/span>\n    <\/div>\n                    <\/div>\n                            \n                                                           <div class=\"grid-col\" id=\"confirm-page-packages\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\"  data-name=\"Packages\"><span class=\"content\">Packages<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"object-stock\" data-field-id=\"cremationPackage\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Packages\"><span class=\"content\">Packages<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"cremationPackage\"><\/span>\n    <\/div>\n                    \n                            \n                        <\/div>\n                            \n                                                           <div class=\"grid-col\" id=\"confirm-page-casket\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\"  data-name=\"Casket Selection\"><span class=\"content\">Casket Selection<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"object-stock\" data-field-id=\"selectedCoffin\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Selected Casket\"><span class=\"content\">Selected Casket<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"selectedCoffin\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"textarea\" data-field-id=\"clientOtherDetails\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Other details you want the Funeral Director to know\"><span class=\"content\">Other details you want the Funeral Director to know<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientOtherDetails\"><\/span>\n    <\/div>\n                <\/div>\n                            \n                                                           <div class=\"grid-col\" id=\"confirm-page-urn\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\"  data-name=\"Urn \/ Jewelry Selection\"><span class=\"content\">Urn \/ Jewelry Selection<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"object-stock\" data-field-id=\"selectedUrnJewellery\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Selected Urn \/ Jewelry\"><span class=\"content\">Selected Urn \/ Jewelry<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"selectedUrnJewellery\"><\/span>\n    <\/div>\n                <\/div>\n                            \n                                                           <div class=\"grid-col\" id=\"confirm-page-post-cremation\">\n              \n                              <div class=\"form-element\" style=\"padding-left: 0;margin-bottom: 0;\">\n                      <h6 style=\"margin-top: 5px;\"  data-name=\"Disposition Details\"><span class=\"content\">Disposition Details<\/span><\/h6>\n                  <\/div>\n                            \n              <h3><\/h3>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"clientCertifiedDeathCertificate\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Do you require a copy of the death certificate? A cost of $15 applies for each copy.\"><span class=\"content\">Do you require a copy of the death certificate? A cost of $15 applies for each copy.<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"clientCertifiedDeathCertificate\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"certifiedDeathCertificateQuantity\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"Number of copies of the death certificate required?\"><span class=\"content\">Number of copies of the death certificate required?<\/span><\/label>:<\/strong> <span style=\"margin-top: 0.2rem;\" class=\"confirmation-field-value\" data-idvalue=\"certifiedDeathCertificateQuantity\"><\/span>\n    <\/div>\n                    \n              <div class=\"confirmation-field\" data-fieldtype=\"picker\" data-field-id=\"cremationCollectionType\">\n      <strong style=\"margin-right: 5px;\"><label class=\"control-label\"  data-name=\"After the cremation has 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