{"id":460,"date":"2023-11-01T11:35:48","date_gmt":"2023-11-01T09:35:48","guid":{"rendered":"https:\/\/pvwinc.co.za\/?page_id=460"},"modified":"2024-02-20T09:56:20","modified_gmt":"2024-02-20T07:56:20","slug":"third-party-claim-form","status":"publish","type":"page","link":"https:\/\/pvwinc.co.za\/?page_id=460","title":{"rendered":"Third Party Claim Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"460\" class=\"elementor elementor-460\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c73402b e-flex e-con-boxed e-con e-parent\" data-id=\"c73402b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-0103787 elementor-widget elementor-widget-heading\" data-id=\"0103787\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Third Party Claim From <\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f0f8644 elementor-widget elementor-widget-shortcode\" data-id=\"f0f8644\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"shortcode.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t            \r\n\t\t\t   <script src=\"https:\/\/www.google.com\/recaptcha\/api.js?render=6LcGnecoAAAAAKSkZvvV_24VYWVX03CKu3mOCYx0\" async defer><\/script>\r\n\t\t\t\t\t\t\t\r\n\t\t\t\t\t\t<div class=\"elementor-shortcode\">\t\t\t<form data-id=\"form_6350e8572d2fa\" class=\"frontend-form -submit\" action=\"\" method=\"post\" novalidate=\"novalidate\" data-error-message=\"\"> \r\n\t\t\t\t\t\t<div class=\"acf-form-data acf-hidden\">\r\n\t\t\t<input type=\"hidden\" name=\"_acf_screen\" value=\"fea_form\"\/><input type=\"hidden\" name=\"_acf_nonce\" value=\"16569fc60c\"\/><input type=\"hidden\" name=\"_acf_validation\" value=\"1\"\/><input type=\"hidden\" name=\"_acf_changed\" value=\"0\"\/><input type=\"hidden\" name=\"_acf_status\" value=\"\"\/><input type=\"hidden\" name=\"_acf_message\" value=\"\"\/><input type=\"hidden\" name=\"_acf_required_message\" value=\"\"\/><input type=\"hidden\" name=\"_acf_current_url\" value=\"https:\/\/pvwinc.co.za?rest_route=wpv2pages460\"\/><input type=\"hidden\" name=\"_acf_taxonomy_type\" value=\"category\"\/><input type=\"hidden\" name=\"_acf_form\" value=\"form_6350e8572d2fa\"\/><input type=\"hidden\" name=\"_acf_referer_url\" value=\"https:\/\/pvwinc.co.za?rest_route=wpv2pages460\"\/><input type=\"hidden\" name=\"_acf_objects\" value=\"TXBkRG4wc2NMaUVzQS9SUFBvRGhDZ3lOSGdrRUpRd2cxeE82OHc4U09RQUE3SnBRbzR4bnhieWZYelR1SmlKRkk3YTNoOWs0ZFpoclk2OFdDS2pBc3orNlpjTUt4MFlKRVJUck53blBlcW89Ojr3T28NRT\/CcFbd5KKCZAnU\"\/>\t\t\t<\/div>\r\n\t\t\t\t\t\t<div class=\"acf-fields acf-form-fields -top\">\t\t\t\t  \r\n\t\t\t<div class=\"acf-field acf-field-text acf-field--validate-email acf-hidden\" style=\"display:none !important\" data-name=\"_validate_email\" data-type=\"text\" data-key=\"_validate_email\"><div  class=\"acf-label\"><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"text\" id=\"acff-_validate_email\" name=\"acff[_validate_email]\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-text acf-field-6343d4c239f76\" data-name=\"name\" data-type=\"text\" data-key=\"field_6343d4c239f76\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343d4c239f76\">Name<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"text\" id=\"acff-submission-field_6343d4c239f76\" name=\"acff[submission][field_6343d4c239f76]\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-text acf-field-6343d4cc39f77\" data-name=\"surname\" data-type=\"text\" data-key=\"field_6343d4cc39f77\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343d4cc39f77\">Surname<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"text\" id=\"acff-submission-field_6343d4cc39f77\" name=\"acff[submission][field_6343d4cc39f77]\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-number acf-field-6343d51439f79\" data-name=\"contact_number\" data-type=\"number\" data-key=\"field_6343d51439f79\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343d51439f79\">Contact Number<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"number\" id=\"acff-submission-field_6343d51439f79\" name=\"acff[submission][field_6343d51439f79]\" step=\"any\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-email acf-field-6343d4d739f78\" data-name=\"email\" data-type=\"email\" data-key=\"field_6343d4d739f78\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343d4d739f78\">Email<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"email\" id=\"acff-submission-field_6343d4d739f78\" name=\"acff[submission][field_6343d4d739f78]\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-select acf-field-6343d51a39f7a\" data-name=\"is_the_third_party_insured_or_uninsured\" data-type=\"select\" data-key=\"field_6343d51a39f7a\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343d51a39f7a\">Is the Third Party Insured or Uninsured<\/label><\/div><div class=\"acf-input\"><select id=\"acff-submission-field_6343d51a39f7a\" class=\"\" name=\"acff[submission][field_6343d51a39f7a]\" data-ui=\"0\" data-ajax=\"0\" data-multiple=\"0\" data-placeholder=\"Select\" data-allow_null=\"0\"><option value=\"Insured\">Insured<\/option><option value=\"Uninsured\">Uninsured<\/option><\/select><\/div><\/div><div class=\"acf-field acf-field-select acf-field-6343d5d939f7b\" data-name=\"Insurer\" data-type=\"select\" data-key=\"field_6343d5d939f7b\" data-conditions=\"[[{&quot;field&quot;:&quot;field_6343d51a39f7a&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Insured&quot;}]]\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343d5d939f7b\">Insurer<\/label><\/div><div class=\"acf-input\"><select id=\"acff-submission-field_6343d5d939f7b\" class=\"\" name=\"acff[submission][field_6343d5d939f7b]\" data-ui=\"0\" data-ajax=\"0\" data-multiple=\"0\" data-placeholder=\"Select\" data-allow_null=\"0\"><option value=\"Santam\">Santam<\/option><option value=\"Outsurance\">Outsurance<\/option><option value=\"MiWay\">MiWay<\/option><option value=\"King Price\">King Price<\/option><option value=\"Old Mutual\">Old Mutual<\/option><option value=\"Other Insurer (Please specify)\">Other Insurer (Please specify)<\/option><\/select><\/div><\/div><div class=\"acf-field acf-field-text acf-field-6343d68a39f7d\" data-name=\"other_insurer_please_specify\" data-type=\"text\" data-key=\"field_6343d68a39f7d\" data-conditions=\"[[{&quot;field&quot;:&quot;field_6343d5d939f7b&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Other Insurer (Please specify)&quot;}]]\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343d68a39f7d\">Other Insurer (Please specify)<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"text\" id=\"acff-submission-field_6343d68a39f7d\" name=\"acff[submission][field_6343d68a39f7d]\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-text acf-field-6343d6ca39f7e\" data-name=\"third_party_name\" data-type=\"text\" data-key=\"field_6343d6ca39f7e\" data-conditions=\"[[{&quot;field&quot;:&quot;field_6343d51a39f7a&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Insured&quot;}]]\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343d6ca39f7e\">Third Party Name<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"text\" id=\"acff-submission-field_6343d6ca39f7e\" name=\"acff[submission][field_6343d6ca39f7e]\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-text acf-field-6343d72339f7f\" data-name=\"third_party_surname\" data-type=\"text\" data-key=\"field_6343d72339f7f\" data-conditions=\"[[{&quot;field&quot;:&quot;field_6343d51a39f7a&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Insured&quot;}]]\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343d72339f7f\">Third Party Surname<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"text\" id=\"acff-submission-field_6343d72339f7f\" name=\"acff[submission][field_6343d72339f7f]\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-number acf-field-6343d73939f80\" data-name=\"third_party_contact_number\" data-type=\"number\" data-key=\"field_6343d73939f80\" data-conditions=\"[[{&quot;field&quot;:&quot;field_6343d51a39f7a&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Insured&quot;}]]\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343d73939f80\">Third Party Contact Number<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"number\" id=\"acff-submission-field_6343d73939f80\" name=\"acff[submission][field_6343d73939f80]\" step=\"any\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-email acf-field-6343d74b39f81\" data-name=\"third_party_email\" data-type=\"email\" data-key=\"field_6343d74b39f81\" data-conditions=\"[[{&quot;field&quot;:&quot;field_6343d51a39f7a&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Insured&quot;}]]\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343d74b39f81\">Third Party Email<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"email\" id=\"acff-submission-field_6343d74b39f81\" name=\"acff[submission][field_6343d74b39f81]\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-text acf-field-6343d77239f82\" data-name=\"third_party_id_number\" data-type=\"text\" data-key=\"field_6343d77239f82\" data-conditions=\"[[{&quot;field&quot;:&quot;field_6343d51a39f7a&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Insured&quot;}]]\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343d77239f82\">Third Party ID Number<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"text\" id=\"acff-submission-field_6343d77239f82\" name=\"acff[submission][field_6343d77239f82]\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-select acf-field-6343d7ce75dab\" data-name=\"nature_of_the_accident\" data-type=\"select\" data-key=\"field_6343d7ce75dab\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343d7ce75dab\">Did the third party drive into the<\/label><\/div><div class=\"acf-input\"><select id=\"acff-submission-field_6343d7ce75dab\" class=\"\" name=\"acff[submission][field_6343d7ce75dab]\" data-ui=\"0\" data-ajax=\"0\" data-multiple=\"0\" data-placeholder=\"Select\" data-allow_null=\"0\"><option value=\"Rear End (back of your car)\">Rear End (back of your car)<\/option><option value=\"Stationary Vehicle (Was your car stationary)\">Stationary Vehicle (Was your car stationary)<\/option><option value=\"Parked Vehicle\">Parked Vehicle<\/option><option value=\"Chain Collisions\">Chain Collisions<\/option><\/select><\/div><\/div><div class=\"acf-field acf-field-upload-file acf-field-6343db0575dac acf-uploads image-field\" data-name=\"accident_report_upload_if_on_hand\" data-type=\"upload_file\" data-key=\"field_6343db0575dac\" data-field_type=\"upload_file\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343db0575dac\">Accident Report Upload (If on hand)<\/label><\/div><div class=\"acf-input\">\t\t<div class=\"acf-file-uploader\" data-library=\"all\" data-mime_types=\"\" data-uploader=\"basic\" data-destination=\"\" data-resize_width=\"1920\" data-resize_height=\"1080\">\r\n\t\t\t<input type=\"hidden\" data-name=\"id\" name=\"acff[submission][field_6343db0575dac]\" value=\"\"\/>\t\t\t\t\t<div class=\"frontend-admin-hidden uploads-progress\"><div class=\"percent\">0%<\/div><div class=\"bar\"><\/div><\/div>\r\n\t\t\t\t\t<div class=\"show-if-value file-wrap\">\r\n\t\t\t\t\t\t<div class=\"file-icon\">\r\n\t\t\t\t<img decoding=\"async\" data-name=\"icon\" data-default=\"https:\/\/pvwinc.co.za\/wp-includes\/images\/media\/default.png\" src=\"\" alt=\"\"\/>\r\n\t\t\t<\/div>\r\n\t\t\t<div class=\"file-info\">\r\n\t\t\t\t<p>\r\n\t\t\t\t\t<strong data-name=\"title\"><\/strong>\r\n\t\t\t\t<\/p>\r\n\t\t\t\t<p>\r\n\t\t\t\t\t<strong>File name:<\/strong>\r\n\t\t\t\t\t<a data-name=\"filename\" href=\"\" target=\"_blank\"><\/a>\r\n\t\t\t\t<\/p>\r\n\t\t\t\t<p>\r\n\t\t\t\t\t<strong>File size:<\/strong>\r\n\t\t\t\t\t<span data-name=\"filesize\"><\/span>\r\n\t\t\t\t<\/p>\r\n\t\t\t<\/div>\r\n\t\t\t<div class=\"acf-actions -hover\">\r\n\t\t\t\t<a class=\"acf-icon -pencil dark\" data-name=\"edit-preview\" href=\"#\" title=\"Edit\"><\/a>\r\n\t\t\t\t<a class=\"acf-icon -cancel dark\" data-name=\"remove\" href=\"#\" title=\"Remove\"><\/a>\r\n\t\t\t<\/div>\r\n\t\t<\/div>\r\n\t\t<div class=\"hide-if-value\">\r\n\r\n\t\t\t\t\t\t\t\t\t\t\t\r\n\t\t\t<div class=\"acf-basic-uploader file-drop\">\r\n\t\t\t\t<input type=\"file\" name=\"upload_file_input\" id=\"acff-submission-field_6343db0575dac\" class=\"file-preview\" accept=\"image\/jpeg,image\/gif,image\/png,image\/bmp,image\/tiff,image\/webp,image\/avif,image\/x-icon,image\/heic,image\/heif,image\/heic-sequence,image\/heif-sequence,video\/x-ms-asf,video\/x-ms-wmv,video\/x-ms-wmx,video\/x-ms-wm,video\/avi,video\/divx,video\/x-flv,video\/quicktime,video\/mpeg,video\/mp4,video\/ogg,video\/webm,video\/x-matroska,video\/3gpp,video\/3gpp2,text\/plain,text\/csv,text\/tab-separated-values,text\/calendar,text\/richtext,text\/css,text\/vtt,application\/ttaf+xml,audio\/mpeg,audio\/aac,audio\/x-realaudio,audio\/wav,audio\/ogg,audio\/flac,audio\/midi,audio\/x-ms-wma,audio\/x-ms-wax,audio\/x-matroska,application\/rtf,application\/pdf,application\/java,application\/x-tar,application\/zip,application\/x-gzip,application\/rar,application\/x-7z-compressed,application\/octet-stream,application\/octet-stream,application\/msword,application\/vnd.ms-powerpoint,application\/vnd.ms-write,application\/vnd.ms-excel,application\/vnd.ms-access,application\/vnd.ms-project,application\/vnd.openxmlformats-officedocument.wordprocessingml.document,application\/vnd.ms-word.document.macroEnabled.12,application\/vnd.openxmlformats-officedocument.wordprocessingml.template,application\/vnd.ms-word.template.macroEnabled.12,application\/vnd.openxmlformats-officedocument.spreadsheetml.sheet,application\/vnd.ms-excel.sheet.macroEnabled.12,application\/vnd.ms-excel.sheet.binary.macroEnabled.12,application\/vnd.openxmlformats-officedocument.spreadsheetml.template,application\/vnd.ms-excel.template.macroEnabled.12,application\/vnd.ms-excel.addin.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.presentation,application\/vnd.ms-powerpoint.presentation.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.slideshow,application\/vnd.ms-powerpoint.slideshow.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.template,application\/vnd.ms-powerpoint.template.macroEnabled.12,application\/vnd.ms-powerpoint.addin.macroEnabled.12,application\/vnd.openxmlformats-officedocument.presentationml.slide,application\/vnd.ms-powerpoint.slide.macroEnabled.12,application\/onenote,application\/oxps,application\/vnd.ms-xpsdocument,application\/vnd.oasis.opendocument.text,application\/vnd.oasis.opendocument.presentation,application\/vnd.oasis.opendocument.spreadsheet,application\/vnd.oasis.opendocument.graphics,application\/vnd.oasis.opendocument.chart,application\/vnd.oasis.opendocument.database,application\/vnd.oasis.opendocument.formula,application\/wordperfect,application\/vnd.apple.keynote,application\/vnd.apple.numbers,application\/vnd.apple.pages,video\/videopress\" \/>\t\t\t\t<p>No file selected<\/p>\r\n\t\t\t\t<a href=\"#\" data-name=\"upload-file\" class=\"upload-files\">\r\n\t\t\t\t\tAdd File\t\t\t\t<\/a>\r\n\t\t\t<\/div>\r\n\t\t\t<div class=\"file-meta-data\"><div class=\"acf-field acf-field-text\" data-name=\"title\" data-type=\"text\"><div  class=\"acf-label\"><label for=\"acff-file_data-field_6343db0575dac-title\">Title<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"text\" id=\"acff-file_data-field_6343db0575dac-title\" class=\"fea-file-meta title\" name=\"acff[file_data][field_6343db0575dac][title]\" disabled=\"disabled\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-text\" data-name=\"alt\" data-type=\"text\"><div  class=\"acf-label\"><label for=\"acff-file_data-field_6343db0575dac-alt\">Alternative Text<\/label><\/div><div class=\"acf-input\"><p class=\"description\">Leave empty if the image is purely decorative.<\/p><div class=\"acf-input-wrap\"><input type=\"text\" id=\"acff-file_data-field_6343db0575dac-alt\" class=\"fea-file-meta alt\" name=\"acff[file_data][field_6343db0575dac][alt]\" disabled=\"disabled\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-textarea\" data-name=\"caption\" data-type=\"textarea\"><div  class=\"acf-label\"><label for=\"acff-file_data-field_6343db0575dac-caption\">Caption<\/label><\/div><div class=\"acf-input\"><textarea id=\"acff-file_data-field_6343db0575dac-caption\" class=\"fea-file-meta caption\" name=\"acff[file_data][field_6343db0575dac]\" rows=\"3\" disabled=\"disabled\"><\/textarea><\/div><\/div><div class=\"acf-field acf-field-textarea\" data-name=\"description\" data-type=\"textarea\"><div  class=\"acf-label\"><label for=\"acff-file_data-field_6343db0575dac-description\">Description<\/label><\/div><div class=\"acf-input\"><textarea id=\"acff-file_data-field_6343db0575dac-description\" class=\"fea-file-meta description\" name=\"acff[file_data][field_6343db0575dac][description]\" rows=\"3\" disabled=\"disabled\"><\/textarea><\/div><\/div><button type=\"button\" class=\"update-meta button button-primary\">Update Image<\/button><\/div>\t\t\t\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t\t\t<\/div>\r\n\t\t<\/div><\/div><div class=\"acf-field acf-field-text acf-field-6343db7c75dad\" data-name=\"accident_description\" data-type=\"text\" data-key=\"field_6343db7c75dad\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343db7c75dad\">Short Description of the accident<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"text\" id=\"acff-submission-field_6343db7c75dad\" name=\"acff[submission][field_6343db7c75dad]\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-select acf-field-6343dbb175dae\" data-name=\"was_there_any_witnesses\" data-type=\"select\" data-key=\"field_6343dbb175dae\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343dbb175dae\">Was there any witnesses<\/label><\/div><div class=\"acf-input\"><select id=\"acff-submission-field_6343dbb175dae\" class=\"\" name=\"acff[submission][field_6343dbb175dae]\" data-ui=\"0\" data-ajax=\"0\" data-multiple=\"0\" data-placeholder=\"Select\" data-allow_null=\"0\"><option value=\"Yes\">Yes<\/option><option value=\"No\">No<\/option><\/select><\/div><\/div><div class=\"acf-field acf-field-text acf-field-6343dbf44f31c\" data-name=\"witness_name\" data-type=\"text\" data-key=\"field_6343dbf44f31c\" data-conditions=\"[[{&quot;field&quot;:&quot;field_6343dbb175dae&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Yes&quot;}]]\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343dbf44f31c\">Witness Name<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"text\" id=\"acff-submission-field_6343dbf44f31c\" name=\"acff[submission][field_6343dbf44f31c]\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-text acf-field-6343dc014f31d\" data-name=\"witness_surname\" data-type=\"text\" data-key=\"field_6343dc014f31d\" data-conditions=\"[[{&quot;field&quot;:&quot;field_6343dbb175dae&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Yes&quot;}]]\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343dc014f31d\">Witness Surname<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"text\" id=\"acff-submission-field_6343dc014f31d\" name=\"acff[submission][field_6343dc014f31d]\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-number acf-field-6343dc084f31e\" data-name=\"witness_contact_number\" data-type=\"number\" data-key=\"field_6343dc084f31e\" data-conditions=\"[[{&quot;field&quot;:&quot;field_6343dbb175dae&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Yes&quot;}]]\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343dc084f31e\">Witness Contact Number<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"number\" id=\"acff-submission-field_6343dc084f31e\" name=\"acff[submission][field_6343dc084f31e]\" step=\"any\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-email acf-field-6343dc0f4f31f\" data-name=\"witness_email\" data-type=\"email\" data-key=\"field_6343dc0f4f31f\" data-conditions=\"[[{&quot;field&quot;:&quot;field_6343dbb175dae&quot;,&quot;operator&quot;:&quot;==&quot;,&quot;value&quot;:&quot;Yes&quot;}]]\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343dc0f4f31f\">Witness Email<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"email\" id=\"acff-submission-field_6343dc0f4f31f\" name=\"acff[submission][field_6343dc0f4f31f]\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-date-time-picker acf-field-6343e3903727f\" data-name=\"accident_date_time\" data-type=\"date_time_picker\" data-key=\"field_6343e3903727f\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343e3903727f\">When did the accident happen? (Date and Time)<\/label><\/div><div class=\"acf-input\">\t\t<div class=\"acf-date-time-picker acf-input-wrap\" data-date_format=\"yy-mm-dd\" data-time_format=\"HH:mm:ss\" data-first_day=\"1\">\n\t\t\t<input type=\"hidden\" id=\"acff-submission-field_6343e3903727f\" class=\"input-alt\" name=\"acff[submission][field_6343e3903727f]\" value=\"\"\/>\t\t\t<input type=\"text\" class=\"input\" value=\"\" data-default-to-today=\"0\"\/>\t\t<\/div>\n\t\t\t<\/div><\/div><div class=\"acf-field acf-field-google-map acf-field-6343dcb704637\" data-name=\"where_did_the_accident_happen\" data-type=\"google_map\" data-key=\"field_6343dcb704637\"><div  class=\"acf-label\"><label for=\"acff-submission-field_6343dcb704637\">Where did the accident happen?<\/label><\/div><div class=\"acf-input\"><div id=\"acff-submission-field_6343dcb704637\" class=\"acf-google-map\" data-lat=\"-26.146514\" data-lng=\"27.996603\" data-zoom=\"14\">\n\n\t\t\t<input type=\"hidden\" name=\"acff[submission][field_6343dcb704637]\" value=\"\"\/>\n\t<div class=\"title\">\n\n\t\t<input class=\"search\" type=\"text\" placeholder=\"Search for address...\" value=\"\" \/>\n\n\t\t<div class=\"acf-actions -hover\">\n\t\t\t<button type=\"button\" data-name=\"search\" class=\"acf-icon -search grey\" aria-label=\"Search\"><\/button>\n\t\t\t<button type=\"button\" data-name=\"clear\" class=\"acf-icon -cancel grey\" aria-label=\"Clear location\"><\/button>\n\t\t\t<button type=\"button\" data-name=\"locate\" class=\"acf-icon -location grey\" aria-label=\"Find current location\"><\/button>\n\t\t<\/div>\n\n\t\t<i class=\"acf-loading\"><\/i>\n\n\t<\/div>\n\n\t<div class=\"canvas\" style=\"height: 400px\"><\/div>\n\n<\/div>\n\t\t\t<\/div><\/div><div class=\"acf-field acf-field-number acf-field-63442edacf715\" data-name=\"damages_to_vehicle_in_rands\" data-type=\"number\" data-key=\"field_63442edacf715\"><div  class=\"acf-label\"><label for=\"acff-submission-field_63442edacf715\">Damages to vehicle in Rands<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"number\" id=\"acff-submission-field_63442edacf715\" name=\"acff[submission][field_63442edacf715]\" value=\"0\" step=\"any\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-upload-image acf-field-63442f24cf716 acf-uploads image-field\" data-name=\"photographs_of_your_damages\" data-type=\"upload_image\" data-key=\"field_63442f24cf716\" data-field_type=\"upload_image\"><div  class=\"acf-label\"><label for=\"acff-submission-field_63442f24cf716\">Photographs of your damages<\/label><\/div><div class=\"acf-input\"><p class=\"description\">1.\tOne Frontal\r\n2.\tOne of the left side of your car\r\n3.\tOne of the right side of your car\r\n4.\tOne of the rear.\r\n5.\tOne Photograph just of the damages.<\/p><div class=\"acf-image-uploader show-preview\" data-preview_size=\"medium\" data-library=\"all\" data-mime_types=\"\" data-uploader=\"basic\" data-resize=\"0\" data-min_size=\"\" data-min_width=\"\" data-min_height=\"\" data-max_size=\"\" data-max_width=\"1920\" data-max_height=\"1080\" data-preview_type=\"img\">\r\n\t\t\t<input type=\"hidden\" data-name=\"id\" name=\"acff[submission][field_63442f24cf716]\" value=\"\"\/>\r\n\t\t<div class=\"show-if-value image-wrap\" \r\n\t\t\t\t\t\tstyle=\"max-width: 300px\"\r\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t>\r\n\t\t\t\t\t<img decoding=\"async\" data-name=\"image\" src=\"https:\/\/pvwinc.co.za\/wp-includes\/images\/media\/default.png\" alt=\"\"\/>\r\n\t\t<div class=\"acf-actions -hover\">\r\n\t\t\t<a class=\"acf-icon -pencil dark\" data-name=\"edit-preview\" href=\"#\" title=\"Edit\"><\/a>\r\n\t\t\t<a class=\"acf-icon -cancel dark\" data-name=\"remove\" href=\"#\" title=\"Remove\"><\/a>\r\n\t\t<\/div>\r\n\t<\/div>\r\n\t<div class=\"hide-if-value\">\r\n\t\t\t\t\t\t<label class=\"acf-basic-uploader file-drop\">\r\n\t\t\t\t<input type=\"file\" name=\"file_input\" id=\"acff-submission-field_63442f24cf716\" class=\"image-preview\" accept=\"image\/*\" \/>\t\t\t\t<div class=\"file-custom\">\r\n\t\t\t\t\t\t\t<p>\t\t\t\t<a data-name=\"add\" class=\"acf-button button\" href=\"#\">\r\n\t\t\t\t\tAdd Image\t\t\t\t\t\t\t\t\t<\/a>\r\n\t\t\t<\/p>\r\n\t\t\t\t\t\t<\/div>\r\n\t\t\t<\/label>\r\n\t\t\t\t<div class=\"file-meta-data\"><div class=\"acf-field acf-field-text\" data-name=\"title\" data-type=\"text\"><div  class=\"acf-label\"><label for=\"acff-file_data-field_63442f24cf716-title\">Title<\/label><\/div><div class=\"acf-input\"><div class=\"acf-input-wrap\"><input type=\"text\" id=\"acff-file_data-field_63442f24cf716-title\" class=\"fea-file-meta title\" name=\"acff[file_data][field_63442f24cf716][title]\" disabled=\"disabled\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-text\" data-name=\"alt\" data-type=\"text\"><div  class=\"acf-label\"><label for=\"acff-file_data-field_63442f24cf716-alt\">Alternative Text<\/label><\/div><div class=\"acf-input\"><p class=\"description\">Leave empty if the image is purely decorative.<\/p><div class=\"acf-input-wrap\"><input type=\"text\" id=\"acff-file_data-field_63442f24cf716-alt\" class=\"fea-file-meta alt\" name=\"acff[file_data][field_63442f24cf716][alt]\" disabled=\"disabled\"\/><\/div><\/div><\/div><div class=\"acf-field acf-field-textarea\" data-name=\"caption\" data-type=\"textarea\"><div  class=\"acf-label\"><label for=\"acff-file_data-field_63442f24cf716-caption\">Caption<\/label><\/div><div class=\"acf-input\"><textarea id=\"acff-file_data-field_63442f24cf716-caption\" class=\"fea-file-meta caption\" name=\"acff[file_data][field_63442f24cf716]\" rows=\"3\" disabled=\"disabled\"><\/textarea><\/div><\/div><div class=\"acf-field acf-field-textarea\" data-name=\"description\" data-type=\"textarea\"><div  class=\"acf-label\"><label for=\"acff-file_data-field_63442f24cf716-description\">Description<\/label><\/div><div class=\"acf-input\"><textarea id=\"acff-file_data-field_63442f24cf716-description\" class=\"fea-file-meta description\" name=\"acff[file_data][field_63442f24cf716][description]\" rows=\"3\" disabled=\"disabled\"><\/textarea><\/div><\/div><button type=\"button\" class=\"update-meta button button-primary\">Update Image<\/button><\/div>\t\t\t\t\r\n\t\t<\/div>\r\n\t\t\t\t<div class=\"frontend-admin-hidden uploads-progress\"><div class=\"percent\">0%<\/div><div class=\"bar\"><\/div><\/div>\r\n\t\t<\/div>\r\n\t\t\t<\/div><\/div><div class=\"acf-field acf-field-recaptcha acf-field-65421d25785d6 is-required\" data-type=\"recaptcha\" data-key=\"field_65421d25785d6\" data-required=\"1\"><div class=\"acf-input\">\t\t\t\t<div class=\"acf-input-wrap frontend-admin-recaptcha\" data-site-key=\"6LcGnecoAAAAAKSkZvvV_24VYWVX03CKu3mOCYx0\" data-version=\"v3\">\r\n\t\t\t\t\t\r\n\t\t\t\t\t<div><\/div>\r\n\t\t\t\t\t<input type=\"hidden\" id=\"acff-submission-field_65421d25785d6\" name=\"acff[submission][field_65421d25785d6]\"\/>\t\t\t\t\t\r\n\t\t\t\t<\/div>\r\n\r\n\t\t\t\t\t\t\t\t\t<style>\r\n\t\t\t\t\t.grecaptcha-badge{\r\n\t\t\t\t\t\tdisplay: none;\r\n\t\t\t\t\t\tvisibility: hidden;\r\n\t\t\t\t\t}\r\n\t\t\t\t\t<\/style>\r\n\t\t\t\t\t<\/div><\/div>\t\t\t<\/div>\r\n\t\t\t<\/form>\r\n\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Third Party Claim From<\/p>\n","protected":false},"author":227008374,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"_crdt_document":"","_kad_post_transparent":"","_kad_post_title":"hide","_kad_post_layout":"fullwidth","_kad_post_sidebar_id":"","_kad_post_content_style":"unboxed","_kad_post_vertical_padding":"hide","_kad_post_feature":"hide","_kad_post_feature_position":"","_kad_post_header":false,"_kad_post_footer":false,"footnotes":""},"class_list":["post-460","page","type-page","status-publish","hentry"],"acf":[],"_links":{"self":[{"href":"https:\/\/pvwinc.co.za\/index.php?rest_route=\/wp\/v2\/pages\/460","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pvwinc.co.za\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/pvwinc.co.za\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/pvwinc.co.za\/index.php?rest_route=\/wp\/v2\/users\/227008374"}],"replies":[{"embeddable":true,"href":"https:\/\/pvwinc.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=460"}],"version-history":[{"count":23,"href":"https:\/\/pvwinc.co.za\/index.php?rest_route=\/wp\/v2\/pages\/460\/revisions"}],"predecessor-version":[{"id":594,"href":"https:\/\/pvwinc.co.za\/index.php?rest_route=\/wp\/v2\/pages\/460\/revisions\/594"}],"wp:attachment":[{"href":"https:\/\/pvwinc.co.za\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=460"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}