{"id":8849,"date":"2026-02-13T14:41:04","date_gmt":"2026-02-13T19:41:04","guid":{"rendered":"https:\/\/steelworkerspensionplan.ca\/?page_id=8849"},"modified":"2026-02-13T14:42:40","modified_gmt":"2026-02-13T19:42:40","slug":"formulaire-dinscription","status":"publish","type":"page","link":"https:\/\/steelworkerspensionplan.ca\/fr\/formulaire-dinscription\/","title":{"rendered":"Formulaire d\u2019inscription"},"content":{"rendered":"<p>[et_pb_section fb_built=&#8221;1&#8243; disabled_on=&#8221;on|on|on&#8221; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#FFB515&#8243; z_index=&#8221;70&#8243; custom_margin=&#8221;2px||||false|false&#8221; custom_padding=&#8221;0px||0px||false|false&#8221; disabled=&#8221;on&#8221; saved_tabs=&#8221;all&#8221; locked=&#8221;off&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.27.5&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;0.5%||0.5%||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; text_font=&#8221;Roboto Condensed|700||on|||||&#8221; text_text_color=&#8221;#1F3162&#8243; text_letter_spacing=&#8221;1px&#8221; text_orientation=&#8221;center&#8221; link_option_url=&#8221;https:\/\/members.steelworkerspensionplan.ca\/Account\/Login&#8221; link_option_url_new_window=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<p><span style=\"color: #1f3162;\"><a href=\"https:\/\/members.steelworkerspensionplan.ca\/\" target=\"_blank\" rel=\"noopener\" style=\"color: #1f3162;\">Member Login \/ Registration<\/a><\/span><\/p>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; admin_label=&#8221;Member Sign Up Login Bar FRENCH&#8221; _builder_version=&#8221;4.27.5&#8243; _module_preset=&#8221;default&#8221; background_color=&#8221;#1F3162&#8243; z_index=&#8221;1000&#8243; custom_padding=&#8221;0px||0px||false|false&#8221; sticky_position=&#8221;top&#8221; saved_tabs=&#8221;all&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_row _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; custom_padding=&#8221;20px||10px||false|false&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.27.4&#8243; _module_preset=&#8221;default&#8221; text_text_color=&#8221;#FFFFFF&#8221; link_font=&#8221;||||on||||&#8221; link_text_color=&#8221;#FFB515&#8243; header_2_font=&#8221;|700||on|||||&#8221; header_2_text_align=&#8221;center&#8221; header_2_text_color=&#8221;#FFFFFF&#8221; header_2_font_size=&#8221;20px&#8221; header_2_letter_spacing=&#8221;0.05em&#8221; header_2_font_size_tablet=&#8221;&#8221; header_2_font_size_phone=&#8221;16px&#8221; header_2_font_size_last_edited=&#8221;on|phone&#8221; header_2_line_height_tablet=&#8221;&#8221; header_2_line_height_phone=&#8221;1.2em&#8221; header_2_line_height_last_edited=&#8221;on|phone&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>Tirez le meilleur parti de votre pension. <a href=\"https:\/\/steelworkerspensionplan.ca\/fr\/renseignements-importants-administrateur-du-regime-de-retraite\/\">Connectez-vous ou cr\u00e9ez un compte maintenant.<\/a><\/h2>\n<p>[\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=&#8221;1&#8243; custom_padding_last_edited=&#8221;on|phone&#8221; admin_label=&#8221;Header Section&#8221; _builder_version=&#8221;4.16&#8243; background_color=&#8221;#1F3162&#8243; use_background_color_gradient=&#8221;on&#8221; background_color_gradient_direction=&#8221;154deg&#8221; background_color_gradient_stops=&#8221;rgba(31,49,98,0.9) 58%|rgba(35,116,187,0.65) 96%&#8221; background_color_gradient_overlays_image=&#8221;on&#8221; background_color_gradient_start=&#8221;rgba(31,49,98,0.9)&#8221; background_color_gradient_start_position=&#8221;58%&#8221; background_color_gradient_end=&#8221;rgba(35,116,187,0.65)&#8221; background_color_gradient_end_position=&#8221;96%&#8221; background_image=&#8221;https:\/\/steelworkerspensionplan.ca\/wp-content\/uploads\/2021\/08\/Design-2-banner-B-FPO.jpg&#8221; custom_padding=&#8221;80px||50px||false|false&#8221; custom_padding_tablet=&#8221;&#8221; custom_padding_phone=&#8221;15%||15%||false|false&#8221; top_divider_color=&#8221;#000000&#8243; background_last_edited=&#8221;on|phone&#8221; background_image_phone=&#8221;https:\/\/steelworkerspensionplan.ca\/wp-content\/uploads\/2021\/08\/Design-2-banner-B-FPO.jpg&#8221; background_enable_image_phone=&#8221;on&#8221; global_colors_info=&#8221;{}&#8221; title_text_phone=&#8221;Solar-Panel-One&#8221;][et_pb_row use_custom_gutter=&#8221;on&#8221; gutter_width=&#8221;1&#8243; make_equal=&#8221;on&#8221; admin_label=&#8221;Header Row&#8221; _builder_version=&#8221;4.16&#8243; background_enable_color=&#8221;off&#8221; z_index=&#8221;53&#8243; custom_margin=&#8221;||||false|false&#8221; custom_padding=&#8221;0px|0px|0px|0px|false|false&#8221; border_radii=&#8221;on|10px|10px|10px|10px&#8221; box_shadow_style=&#8221;preset4&#8243; box_shadow_horizontal=&#8221;743px&#8221; box_shadow_vertical=&#8221;-95px&#8221; box_shadow_color=&#8221;#2374BB&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_column type=&#8221;4_4&#8243; _builder_version=&#8221;4.16&#8243; custom_padding=&#8221;|||&#8221; custom_css_main_element=&#8221;margin:auto&#8221; global_colors_info=&#8221;{}&#8221; custom_padding__hover=&#8221;|||&#8221;][et_pb_text admin_label=&#8221;Title &#038; Paragraph&#8221; _builder_version=&#8221;4.27.5&#8243; text_font=&#8221;||||||||&#8221; text_text_color=&#8221;#FFFFFF&#8221; text_font_size=&#8221;20px&#8221; header_font=&#8221;||||||||&#8221; header_text_color=&#8221;#ffffff&#8221; header_2_font=&#8221;Roboto Condensed|700|||||||&#8221; header_2_text_color=&#8221;#FFB515&#8243; header_2_font_size=&#8221;50px&#8221; header_2_line_height=&#8221;1.2em&#8221; background_layout=&#8221;dark&#8221; width=&#8221;70%&#8221; width_tablet=&#8221;&#8221; width_phone=&#8221;100%&#8221; width_last_edited=&#8221;on|phone&#8221; max_width=&#8221;100%&#8221; max_width_tablet=&#8221;&#8221; max_width_phone=&#8221;100%&#8221; max_width_last_edited=&#8221;on|phone&#8221; module_alignment=&#8221;left&#8221; custom_margin=&#8221;||||false|false&#8221; custom_margin_tablet=&#8221;&#8221; custom_margin_phone=&#8221;|116px||0px|false|false&#8221; custom_margin_last_edited=&#8221;on|phone&#8221; custom_padding=&#8221;||||false|false&#8221; 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id='gfield_description_10_109'>Ce champ n\u2019est utilis\u00e9 qu\u2019\u00e0 des fins de validation et devrait rester inchang\u00e9.<\/div><\/div><div id=\"field_10_90\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5f5456ee\" data-field-span=\"12\"><\/div><div id=\"field_10_28\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"cee02c19\" data-field-span=\"12\"><\/div><div id=\"field_10_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"0ffa99c7\" data-field-span=\"6\"><label id='gfield_label_10_13' class='gfield_label gform-field-label' for='input_10_13'><span class='gform-field-label__text'>Employeur<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_10_13' type='text' value='' class='large'   tabindex='49'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_8\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"0ffa99c7\" data-field-span=\"6\"><label id='gfield_label_10_8' class='gfield_label gform-field-label' for='input_10_8'><span class='gform-field-label__text'>NAS<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_10_8' type='text' value='' class='large'   tabindex='50' placeholder='999-999-999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"999-999-999\"\/><\/div><\/div><fieldset id=\"field_10_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"be65339d\" data-field-span=\"12\"><legend id='gfield_label_10_1' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_1'>\n                            \n                            <span id='input_10_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_10_1_3' value='' tabindex='52'  aria-required='true'     aria-labelledby=\"input_10_1_3_label gfield_label_10_1\"\/>\n                                                    <label for='input_10_1_3' id='input_10_1_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_10_1_6' value='' tabindex='54'  aria-required='true'     \/>\n                                                    <label for='input_10_1_6' id='input_10_1_6_label' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_10\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"733e8e93\" data-field-span=\"3\"><label id='gfield_label_10_10' class='gfield_label gform-field-label' for='input_10_10'><span class='gform-field-label__text'>Sexe<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_10_10' class='large gfield_select' tabindex='56'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Sexe<\/option><option value='Masculin' >Masculin<\/option><option value='F\u00e9minin' >F\u00e9minin<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_10_9\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"733e8e93\" data-field-span=\"3\"><label id='gfield_label_10_9' class='gfield_label gform-field-label' for='input_10_9'><span class='gform-field-label__text'>Date De Naissance<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_9'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_9'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\ttabindex='57' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_9' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_9' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_9' aria-label='Date De Naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_5\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"733e8e93\" data-field-span=\"3\"><label id='gfield_label_10_5' class='gfield_label gform-field-label' for='input_10_5'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_10_5' type='tel' value='' class='large' tabindex='58' placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_10_12\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"733e8e93\" data-field-span=\"3\"><label id='gfield_label_10_12' class='gfield_label gform-field-label' for='input_10_12'><span class='gform-field-label__text'>Langue pr\u00e9f\u00e9r\u00e9e<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_12' id='input_10_12' class='large gfield_select' tabindex='59'    aria-invalid=\"false\" ><option value='Fran\u00e7ais' selected='selected'>Fran\u00e7ais<\/option><option value='Anglais' >Anglais<\/option><\/select><\/div><\/div><fieldset id=\"field_10_4\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5e6abf03\" data-field-span=\"12\"><legend id='gfield_label_10_4' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Adresse<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_10_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_10_4_1_container' >\n                                        <input type='text' name='input_4.1' id='input_10_4_1' value='' tabindex='60'   aria-required='true'    aria-labelledby=\"input_10_4_1_label gfield_label_10_4\"\/>\n                                        <label for='input_10_4_1' id='input_10_4_1_label' class='gform-field-label gform-field-label--type-sub '>Rue<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_10_4_3_container' >\n                                    <input type='text' name='input_4.3' id='input_10_4_3' value='' tabindex='61'   aria-required='true'    \/>\n                                    <label for='input_10_4_3' id='input_10_4_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_10_4_4_container' >\n                                        <select name='input_4.4' id='input_10_4_4' tabindex='62'    aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alberta' >Alberta<\/option><option value='Colombie-Britannique' >Colombie-Britannique<\/option><option value='Manitoba' >Manitoba<\/option><option value='Nouveau-Brunswick' >Nouveau-Brunswick<\/option><option value='Terre-Neuve-et-Labrador' >Terre-Neuve-et-Labrador<\/option><option value='Territoires du Nord-Ouest' >Territoires du Nord-Ouest<\/option><option value='Nouvelle-\u00c9cosse' >Nouvelle-\u00c9cosse<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='\u00cele du Prince-\u00c9douard' >\u00cele du Prince-\u00c9douard<\/option><option value='Qu\u00e9bec' >Qu\u00e9bec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_10_4_4' id='input_10_4_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_10_4_5_container' >\n                                    <input type='text' name='input_4.5' id='input_10_4_5' value='' tabindex='64'   aria-required='true'    \/>\n                                    <label for='input_10_4_5' id='input_10_4_5_label' class='gform-field-label gform-field-label--type-sub '>Code Postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_4.6' id='input_10_4_6' value='CA' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_10_6\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"70a18b76\" data-field-span=\"12\"><label id='gfield_label_10_6' class='gfield_label gform-field-label' for='input_10_6'><span class='gform-field-label__text'>Courriel<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_6' id='input_10_6' type='email' value='' class='large' tabindex='65'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_10_16' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' tabindex='66'>Suivant<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_2' class='gform_page' data-js='page-field-id-16' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_2' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><div id=\"field_10_91\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"9d78b636\" data-field-span=\"12\"><script type=\"text\/javascript\">\njQuery(document).on('gform_post_render', function(event, formId, current_page){\n    if (window.gform) {\n        \/\/ This filter checks the final boolean result of the logic rule on the front-end\n        gform.addFilter('gform_is_value_match', function(isMatch, formId, rule) {\n            \n            \/\/ Map of English province names to their French translations\n            var translatedProvinces = {\n                'British Columbia': 'Colombie-Britannique',\n                'New Brunswick': 'Nouveau-Brunswick',\n                'Newfoundland and Labrador': 'Terre-Neuve-et-Labrador',\n                'Northwest Territories': 'Territoires du Nord-Ouest',\n                'Nova Scotia': 'Nouvelle-\u00c9cosse',\n                'Prince Edward Island': '\u00cele du Prince-\u00c9douard',\n                'Quebec': 'Qu\u00e9bec'\n            };\n\n            \/\/ Check if the conditional logic rule is looking for one of these English provinces\n            if (translatedProvinces[rule.value] !== undefined) {\n                \n                var fieldId = rule.fieldId.toString().replace('.', '_');\n                var currentValue = jQuery('#input_' + formId + '_' + fieldId).val();\n\n                \/\/ If the user selected the French version of the province the rule is looking for\n                if (currentValue === translatedProvinces[rule.value]) {\n                    \n                    \/\/ Force the correct logic based on the operator used\n                    if (rule.operator === 'is') {\n                        return true;  \/\/ It IS the province, so pass the rule\n                    } else if (rule.operator === 'isnot') {\n                        return false; \/\/ It IS the province, so fail the \"is not\" rule\n                    }\n                }\n            }\n            \n            \/\/ For all other rules and operators, proceed normally\n            return isMatch;\n        });\n    }\n});\n<\/script><\/div><div id=\"field_10_37\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"a139f6c1\" data-field-span=\"12\"><p><strong>D\u00e9finition de \u00ab conjoint \u00bb \u2013 Alberta<\/strong><\/p>\n\n<p>Aux fins du R\u00e9gime de retraite des M\u00e9tallos, un \u00ab conjoint \u00bb s\u2019entend d\u2019une personne qui :<\/p>\n\n<ol type=\"a\">\n  <li>Est mari\u00e9e avec vous; ou<\/li>\n  <li>N\u2019est pas mari\u00e9e avec vous, mais vit avec vous dans une relation conjugale depuis au moins trois (3) ann\u00e9es cons\u00e9cutives; ou<\/li>\n  <li>N\u2019est pas mari\u00e9e avec vous, mais vit avec vous dans une relation conjugale d\u2019une certaine permanence, s\u2019il existe un enfant issu de cette relation, par naissance ou par adoption.<\/li>\n<\/ol>\n\n<p>Selon cette d\u00e9finition, je certifie que :<\/p>\n<\/div><div id=\"field_10_36\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"992a5f47\" data-field-span=\"12\"><p><strong>D\u00e9finition de \u00ab conjoint \u00bb \u2013 Colombie-Britannique<\/strong><\/p>\n\n<p>Aux fins du R\u00e9gime de retraite des M\u00e9tallos, un \u00ab conjoint \u00bb s\u2019entend d\u2019une personne qui :<\/p>\n\n<ol type=\"a\">\n  <li>Est mari\u00e9e avec vous ou est partie \u00e0 un mariage nul avec vous; ou<\/li>\n  <li>N\u2019est pas mari\u00e9e avec vous, mais vit avec vous dans une relation conjugale depuis au moins deux (2) ans.<\/li>\n<\/ol>\n\n<p>Selon cette d\u00e9finition, je certifie que :<\/p>\n<\/div><div id=\"field_10_38\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"6a9f464c\" data-field-span=\"12\"><p><strong>D\u00e9finition de \u00ab conjoint \u00bb \u2013 Manitoba<\/strong><\/p>\n\n<p>Aux fins du R\u00e9gime de retraite des M\u00e9tallos, un \u00ab conjoint \u00bb s\u2019entend d\u2019une personne qui :<\/p>\n\n<ol type=\"a\">\n  <li>Est mari\u00e9e avec vous; ou<\/li>\n  <li>N\u2019est pas mari\u00e9e avec vous, mais a enregistr\u00e9 avec vous une union de fait en vertu de la <em>Loi sur les statistiques de l\u2019\u00e9tat civil<\/em>; ou<\/li>\n  <li>\n    N\u2019est pas mari\u00e9e avec vous, mais vit avec vous dans une relation conjugale pendant une p\u00e9riode :\n    <ol type=\"i\">\n      <li>d\u2019au moins trois (3) ans, si l\u2019un de vous est mari\u00e9; ou<\/li>\n      <li>d\u2019au moins un (1) an, si aucun de vous n\u2019est mari\u00e9.<\/li>\n    <\/ol>\n  <\/li>\n<\/ol>\n\n<p>Selon cette d\u00e9finition, je certifie que :<\/p><\/div><div id=\"field_10_39\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"0e419600\" data-field-span=\"12\"><p><strong>D\u00e9finition de \u00ab conjoint \u00bb \u2013 Nouvelle-\u00c9cosse<\/strong><\/p>\n\n<p>Aux fins du R\u00e9gime de retraite des M\u00e9tallos, un \u00ab conjoint \u00bb s\u2019entend d\u2019une personne qui :<\/p>\n\n<ol type=\"a\">\n  <li>Est mari\u00e9e avec vous; ou<\/li>\n  <li>Est mari\u00e9e avec vous par un mariage annulable qui n\u2019a pas \u00e9t\u00e9 annul\u00e9 par une d\u00e9claration de nullit\u00e9; ou<\/li>\n  <li>A contract\u00e9 avec vous, de bonne foi, une forme de mariage qui est nul et vit avec vous, ou, si vous avez cess\u00e9 de vivre ensemble, a v\u00e9cu avec vous au cours des douze (12) derniers mois; ou<\/li>\n  <li>N\u2019est pas mari\u00e9e avec vous, mais est un partenaire domestique au sens de l\u2019article 52 de la <em>Loi sur les statistiques de l\u2019\u00e9tat civil<\/em>; ou<\/li>\n  <li>\n    N\u2019est pas mari\u00e9e avec vous, mais vit avec vous dans une relation conjugale depuis :\n    <ol type=\"i\">\n      <li>au moins trois (3) ans, si l\u2019un de vous est mari\u00e9; ou<\/li>\n      <li>au moins un (1) an, si aucun de vous n\u2019est mari\u00e9.<\/li>\n    <\/ol>\n  <\/li>\n<\/ol>\n\n<p>Selon cette d\u00e9finition, je certifie que :<\/p><\/div><div id=\"field_10_40\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"8698f96e\" data-field-span=\"12\"><p><strong>D\u00e9finition de \u00ab conjoint \u00bb \u2013 Ontario<\/strong><\/p>\n\n<p>Aux fins du R\u00e9gime de retraite des M\u00e9tallos, un \u00ab conjoint \u00bb s\u2019entend d\u2019une personne qui :<\/p>\n\n<ol type=\"a\">\n  <li>Est mari\u00e9e avec vous; ou<\/li>\n  <li>N\u2019est pas mari\u00e9e avec vous, mais vit avec vous dans une relation conjugale de fa\u00e7on continue depuis au moins trois (3) ans; ou<\/li>\n  <li>N\u2019est pas mari\u00e9e avec vous, mais vit avec vous dans une relation conjugale d\u2019une certaine permanence, si ensemble vous \u00eates les parents d\u2019un enfant, au sens de l\u2019article 4 de la <em>Loi portant r\u00e9forme du droit de l\u2019enfance (Ontario)<\/em>.<\/li>\n<\/ol>\n\n<p>Selon cette d\u00e9finition, je certifie que :<\/p>\n<\/div><div id=\"field_10_26\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c309e1df\" data-field-span=\"12\"><p><strong>D\u00e9finition de \u00ab conjoint \u00bb \u2013 F\u00e9d\u00e9ral<\/strong><\/p>\n\n<p>Aux fins du R\u00e9gime de retraite des M\u00e9tallos, un \u00ab conjoint \u00bb s\u2019entend d\u2019une personne qui :<\/p>\n\n<ol type=\"a\">\n  <li>Est mari\u00e9e avec vous ou est partie \u00e0 un mariage nul avec vous; ou<\/li>\n  <li>N\u2019est pas mari\u00e9e avec vous, mais vit avec vous dans une relation conjugale depuis au moins un (1) an.<\/li>\n<\/ol>\n\n<p>Selon cette d\u00e9finition, je certifie que :<\/p>\n<\/div><div id=\"field_10_29\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"f6f6d3a4\" data-field-span=\"12\"><p><strong>** ATTENTION **<\/strong><\/p>\n\n<p>La loi sur les r\u00e9gimes de retraite pr\u00e9voit automatiquement que votre conjoint est le b\u00e9n\u00e9ficiaire de toute prestation de d\u00e9c\u00e8s qui pourrait devenir payable en vertu du R\u00e9gime \u00e0 votre d\u00e9c\u00e8s. Si vous n\u2019avez pas de conjoint, ou si votre conjoint souhaite renoncer \u00e0 ses droits et que vous d\u00e9sirez d\u00e9signer une autre personne \u00e0 titre de b\u00e9n\u00e9ficiaire, veuillez communiquer avec WA Health afin d\u2019obtenir les renseignements n\u00e9cessaires pour proc\u00e9der \u00e0 la d\u00e9signation d\u2019un b\u00e9n\u00e9ficiaire.<\/p>\n<\/div><fieldset id=\"field_10_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"793de769\" data-field-span=\"12\"><legend id='gfield_label_10_27' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>D\u00e9claration relative au conjoint<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_27'>\n\t\t\t<div class='gchoice gchoice_10_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='J\u2019ai un conjoint'  id='choice_10_27_0' onchange='gformToggleRadioOther( this )'  aria-labelledby=\"label_10_27_0 gfield_label_10_27\" tabindex='67'  \/>\n\t\t\t\t\t<label for='choice_10_27_0' id='label_10_27_0' class='gform-field-label gform-field-label--type-inline'>J\u2019ai un conjoint<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Je n\u2019ai pas de conjoint'  id='choice_10_27_1' onchange='gformToggleRadioOther( this )'   tabindex='68'  \/>\n\t\t\t\t\t<label for='choice_10_27_1' id='label_10_27_1' class='gform-field-label gform-field-label--type-inline'>Je n\u2019ai pas de conjoint<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_18\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"169fad1a\" data-field-span=\"12\"><legend id='gfield_label_10_18' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_18'>\n                            \n                            <span id='input_10_18_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_18.3' id='input_10_18_3' value='' tabindex='70'  aria-required='true'     aria-labelledby=\"input_10_18_3_label gfield_label_10_18\"\/>\n                                                    <label for='input_10_18_3' id='input_10_18_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_18_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_18.6' id='input_10_18_6' value='' tabindex='72'  aria-required='true'     \/>\n                                                    <label for='input_10_18_6' id='input_10_18_6_label' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_22\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"43b2ee17\" data-field-span=\"3\"><label id='gfield_label_10_22' class='gfield_label gform-field-label' for='input_10_22'><span class='gform-field-label__text'>NAS du conjoint<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_10_22' type='text' value='' class='large'   tabindex='74' placeholder='999-999-999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"999-999-999\"\/><\/div><\/div><div id=\"field_10_19\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"43b2ee17\" data-field-span=\"3\"><label id='gfield_label_10_19' class='gfield_label gform-field-label' for='input_10_19'><span class='gform-field-label__text'>Date De Naissance<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_19'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_19'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\ttabindex='75' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_19' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_19' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_19' aria-label='Date De Naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_30\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"43b2ee17\" data-field-span=\"3\"><label id='gfield_label_10_30' class='gfield_label gform-field-label' for='input_10_30'><span class='gform-field-label__text'>Date du mariage<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_30'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_30'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\ttabindex='76' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_30' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_30' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_30' aria-label='Date du mariage: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_20\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"43b2ee17\" data-field-span=\"3\"><label id='gfield_label_10_20' class='gfield_label gform-field-label' for='input_10_20'><span class='gform-field-label__text'>Sexe<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_20' id='input_10_20' class='large gfield_select' tabindex='77'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Sexe<\/option><option value='Masculin' >Masculin<\/option><option value='F\u00e9minin' >F\u00e9minin<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_10_50\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"db482fa6\" data-field-span=\"6\"><label id='gfield_label_10_50' class='gfield_label gform-field-label' for='input_10_50'><span class='gform-field-label__text'>Courriel<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_50' id='input_10_50' type='email' value='' class='large' tabindex='78'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_104\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"db482fa6\" data-field-span=\"6\"><label id='gfield_label_10_104' class='gfield_label gform-field-label' for='input_10_104'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_104' id='input_10_104' type='tel' value='' class='large' tabindex='79' placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_10_88' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' tabindex='80'>Pr\u00e9c\u00e9dent<\/button> <button type='button' id='gform_next_button_10_88' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' tabindex='81'>Suivant<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_3' class='gform_page' data-js='page-field-id-88' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_3' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><div id=\"field_10_89\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"123a0757\" data-field-span=\"12\"><p>\nIl est recommand\u00e9 de d\u00e9signer un b\u00e9n\u00e9ficiaire.\nSi aucun b\u00e9n\u00e9ficiaire n\u2019est d\u00e9sign\u00e9, toute prestation de d\u00e9c\u00e8s sera g\u00e9n\u00e9ralement vers\u00e9e \u00e0 votre succession, sous r\u00e9serve des lois applicables et des dispositions du R\u00e9gime.\n<\/p><\/div><div id=\"field_10_48\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"cdf0e406\" data-field-span=\"12\"><p>\nSi vous avez un conjoint, celui-ci est automatiquement votre b\u00e9n\u00e9ficiaire principal.\n\nIl est recommand\u00e9 que les participants d\u00e9signent un ou plusieurs b\u00e9n\u00e9ficiaires rempla\u00e7ants.\nSi aucun b\u00e9n\u00e9ficiaire n\u2019est d\u00e9sign\u00e9, toute prestation de d\u00e9c\u00e8s sera g\u00e9n\u00e9ralement vers\u00e9e \u00e0 votre succession, sous r\u00e9serve des lois applicables et des dispositions du R\u00e9gime.\n<\/p>\n<\/div><div id=\"field_10_47\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c0d190ad\" data-field-span=\"12\"><label id='gfield_label_10_47' class='gfield_label gform-field-label' for='input_10_47'><span class='gform-field-label__text'>Nombre de b\u00e9n\u00e9ficiaires<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_47' id='input_10_47' class='large gfield_select' tabindex='82'    aria-invalid=\"false\" ><option value='0' >0<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><\/select><\/div><\/div><div id=\"field_10_51\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"b841e348\" data-field-span=\"12\"><h3 class=\"gsection_title\">B\u00e9n\u00e9ficiaire 1<\/h3><\/div><fieldset id=\"field_10_52\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"028eab62\" data-field-span=\"6\"><legend id='gfield_label_10_52' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_52'>\n                            \n                            <span id='input_10_52_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_52.3' id='input_10_52_3' value='' tabindex='84'  aria-required='false'     aria-labelledby=\"input_10_52_3_label gfield_label_10_52\"\/>\n                                                    <label for='input_10_52_3' id='input_10_52_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_52_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_52.6' id='input_10_52_6' value='' tabindex='86'  aria-required='false'     \/>\n                                                    <label for='input_10_52_6' id='input_10_52_6_label' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_56\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"028eab62\" data-field-span=\"6\"><label id='gfield_label_10_56' class='gfield_label gform-field-label' for='input_10_56'><span class='gform-field-label__text'>Date De Naissance<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_56'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_56'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\ttabindex='88' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_56' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_56' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_56' aria-label='Date De Naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_53\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"3e0b004b\" data-field-span=\"4\"><label id='gfield_label_10_53' class='gfield_label gform-field-label' for='input_10_53'><span class='gform-field-label__text'>Lien de parent\u00e9<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_10_53' type='text' value='' class='large'   tabindex='89'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_55\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"3e0b004b\" data-field-span=\"4\"><label id='gfield_label_10_55' class='gfield_label gform-field-label' for='input_10_55'><span class='gform-field-label__text'>Sexe<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_55' id='input_10_55' class='large gfield_select' tabindex='90'    aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Sexe<\/option><option value='Masculin' >Masculin<\/option><option value='F\u00e9minin' >F\u00e9minin<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_10_66\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"3e0b004b\" data-field-span=\"4\"><label id='gfield_label_10_66' class='gfield_label gform-field-label' for='input_10_66'><span class='gform-field-label__text'>Pourcentage (%)<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_66' id='input_10_66' type='number' step='any'   value='' class='large' tabindex='91'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_10_92\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"7d6fe1b1\" data-field-span=\"6\"><label id='gfield_label_10_92' class='gfield_label gform-field-label' for='input_10_92'><span class='gform-field-label__text'>Courriel<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_92' id='input_10_92' type='email' value='' class='large' tabindex='92'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_93\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"7d6fe1b1\" data-field-span=\"6\"><label id='gfield_label_10_93' class='gfield_label gform-field-label' for='input_10_93'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_93' id='input_10_93' type='tel' value='' class='large' tabindex='93' placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_10_57\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"0d0706ca\" data-field-span=\"12\"><h3 class=\"gsection_title\">B\u00e9n\u00e9ficiaire 2<\/h3><\/div><fieldset id=\"field_10_67\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"2f62f7de\" data-field-span=\"6\"><legend id='gfield_label_10_67' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_67'>\n                            \n                            <span id='input_10_67_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_67.3' id='input_10_67_3' value='' tabindex='95'  aria-required='false'     aria-labelledby=\"input_10_67_3_label gfield_label_10_67\"\/>\n                                                    <label for='input_10_67_3' id='input_10_67_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_67_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_67.6' id='input_10_67_6' value='' tabindex='97'  aria-required='false'     \/>\n                                                    <label for='input_10_67_6' id='input_10_67_6_label' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_68\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"2f62f7de\" data-field-span=\"6\"><label id='gfield_label_10_68' class='gfield_label gform-field-label' for='input_10_68'><span class='gform-field-label__text'>Date De Naissance<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_68'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_68'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\ttabindex='99' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_68' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_68' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_68' aria-label='Date De Naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_69\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c9d81256\" data-field-span=\"4\"><label id='gfield_label_10_69' class='gfield_label gform-field-label' for='input_10_69'><span class='gform-field-label__text'>Lien de parent\u00e9<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_10_69' type='text' value='' class='large'   tabindex='100'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_70\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c9d81256\" data-field-span=\"4\"><label id='gfield_label_10_70' class='gfield_label gform-field-label' for='input_10_70'><span class='gform-field-label__text'>Sexe<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_70' id='input_10_70' class='large gfield_select' tabindex='101'    aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Sexe<\/option><option value='Masculin' >Masculin<\/option><option value='F\u00e9minin' >F\u00e9minin<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_10_71\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c9d81256\" data-field-span=\"4\"><label id='gfield_label_10_71' class='gfield_label gform-field-label' for='input_10_71'><span class='gform-field-label__text'>Pourcentage (%)<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_71' id='input_10_71' type='number' step='any'   value='' class='large' tabindex='102'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_10_94\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"4448a0ec\" data-field-span=\"6\"><label id='gfield_label_10_94' class='gfield_label gform-field-label' for='input_10_94'><span class='gform-field-label__text'>Courriel<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_94' id='input_10_94' type='email' value='' class='large' tabindex='103'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_100\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"4448a0ec\" data-field-span=\"6\"><label id='gfield_label_10_100' class='gfield_label gform-field-label' for='input_10_100'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_100' id='input_10_100' type='tel' value='' class='large' tabindex='104' placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_10_64\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"30f2c34c\" data-field-span=\"12\"><h3 class=\"gsection_title\">B\u00e9n\u00e9ficiaire 3<\/h3><\/div><fieldset id=\"field_10_72\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"25385d59\" data-field-span=\"6\"><legend id='gfield_label_10_72' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_72'>\n                            \n                            <span id='input_10_72_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_72.3' id='input_10_72_3' value='' tabindex='106'  aria-required='false'     aria-labelledby=\"input_10_72_3_label gfield_label_10_72\"\/>\n                                                    <label for='input_10_72_3' id='input_10_72_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_72_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_72.6' id='input_10_72_6' value='' tabindex='108'  aria-required='false'     \/>\n                                                    <label for='input_10_72_6' id='input_10_72_6_label' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_73\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"25385d59\" data-field-span=\"6\"><label id='gfield_label_10_73' class='gfield_label gform-field-label' for='input_10_73'><span class='gform-field-label__text'>Date De Naissance<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_73'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_73'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\ttabindex='110' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_73' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_73' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_73' aria-label='Date De Naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_74\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c115b29d\" data-field-span=\"4\"><label id='gfield_label_10_74' class='gfield_label gform-field-label' for='input_10_74'><span class='gform-field-label__text'>Lien de parent\u00e9<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_74' id='input_10_74' type='text' value='' class='large'   tabindex='111'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_75\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c115b29d\" data-field-span=\"4\"><label id='gfield_label_10_75' class='gfield_label gform-field-label' for='input_10_75'><span class='gform-field-label__text'>Sexe<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_75' id='input_10_75' class='large gfield_select' tabindex='112'    aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Sexe<\/option><option value='Masculin' >Masculin<\/option><option value='F\u00e9minin' >F\u00e9minin<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_10_76\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c115b29d\" data-field-span=\"4\"><label id='gfield_label_10_76' class='gfield_label gform-field-label' for='input_10_76'><span class='gform-field-label__text'>Pourcentage (%)<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_76' id='input_10_76' type='number' step='any'   value='' class='large' tabindex='113'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_10_95\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"bffa905f\" data-field-span=\"6\"><label id='gfield_label_10_95' class='gfield_label gform-field-label' for='input_10_95'><span class='gform-field-label__text'>Courriel<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_95' id='input_10_95' type='email' value='' class='large' tabindex='114'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_99\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"bffa905f\" data-field-span=\"6\"><label id='gfield_label_10_99' class='gfield_label gform-field-label' for='input_10_99'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_99' id='input_10_99' type='tel' value='' class='large' tabindex='115' placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_10_63\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"ef6b662a\" data-field-span=\"12\"><h3 class=\"gsection_title\">B\u00e9n\u00e9ficiaire 4<\/h3><\/div><fieldset id=\"field_10_77\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c0ffa8cb\" data-field-span=\"6\"><legend id='gfield_label_10_77' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_77'>\n                            \n                            <span id='input_10_77_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_77.3' id='input_10_77_3' value='' tabindex='117'  aria-required='false'     aria-labelledby=\"input_10_77_3_label gfield_label_10_77\"\/>\n                                                    <label for='input_10_77_3' id='input_10_77_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_77_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_77.6' id='input_10_77_6' value='' tabindex='119'  aria-required='false'     \/>\n                                                    <label for='input_10_77_6' id='input_10_77_6_label' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_78\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c0ffa8cb\" data-field-span=\"6\"><label id='gfield_label_10_78' class='gfield_label gform-field-label' for='input_10_78'><span class='gform-field-label__text'>Date De Naissance<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_78'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_78'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\ttabindex='121' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_78' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_78' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_78' aria-label='Date De Naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_81\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"f03571c9\" data-field-span=\"4\"><label id='gfield_label_10_81' class='gfield_label gform-field-label' for='input_10_81'><span class='gform-field-label__text'>Lien de parent\u00e9<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_81' id='input_10_81' type='text' value='' class='large'   tabindex='122'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_80\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"f03571c9\" data-field-span=\"4\"><label id='gfield_label_10_80' class='gfield_label gform-field-label' for='input_10_80'><span class='gform-field-label__text'>Sexe<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_80' id='input_10_80' class='large gfield_select' tabindex='123'    aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Sexe<\/option><option value='Masculin' >Masculin<\/option><option value='F\u00e9minin' >F\u00e9minin<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_10_79\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"f03571c9\" data-field-span=\"4\"><label id='gfield_label_10_79' class='gfield_label gform-field-label' for='input_10_79'><span class='gform-field-label__text'>Pourcentage (%)<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_79' id='input_10_79' type='number' step='any'   value='' class='large' tabindex='124'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_10_97\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"01a60741\" data-field-span=\"6\"><label id='gfield_label_10_97' class='gfield_label gform-field-label' for='input_10_97'><span class='gform-field-label__text'>Courriel<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_97' id='input_10_97' type='email' value='' class='large' tabindex='125'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_102\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"01a60741\" data-field-span=\"6\"><label id='gfield_label_10_102' class='gfield_label gform-field-label' for='input_10_102'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_102' id='input_10_102' type='tel' value='' class='large' tabindex='126' placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_10_62\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"e7b25d65\" data-field-span=\"12\"><h3 class=\"gsection_title\">B\u00e9n\u00e9ficiaire 5<\/h3><\/div><fieldset id=\"field_10_58\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"b5306cec\" data-field-span=\"6\"><legend id='gfield_label_10_58' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_58'>\n                            \n                            <span id='input_10_58_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_58.3' id='input_10_58_3' value='' tabindex='128'  aria-required='false'     aria-labelledby=\"input_10_58_3_label gfield_label_10_58\"\/>\n                                                    <label for='input_10_58_3' id='input_10_58_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_58_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_58.6' id='input_10_58_6' value='' tabindex='130'  aria-required='false'     \/>\n                                                    <label for='input_10_58_6' id='input_10_58_6_label' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_59\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"b5306cec\" data-field-span=\"6\"><label id='gfield_label_10_59' class='gfield_label gform-field-label' for='input_10_59'><span class='gform-field-label__text'>Date De Naissance<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_59'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_59'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\ttabindex='132' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_59' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_59' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_59' aria-label='Date De Naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_60\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"db7cae17\" data-field-span=\"4\"><label id='gfield_label_10_60' class='gfield_label gform-field-label' for='input_10_60'><span class='gform-field-label__text'>Lien de parent\u00e9<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_10_60' type='text' value='' class='large'   tabindex='133'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_65\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"db7cae17\" data-field-span=\"4\"><label id='gfield_label_10_65' class='gfield_label gform-field-label' for='input_10_65'><span class='gform-field-label__text'>Sexe<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_65' id='input_10_65' class='large gfield_select' tabindex='134'    aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Sexe<\/option><option value='Masculin' >Masculin<\/option><option value='F\u00e9minin' >F\u00e9minin<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_10_54\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"db7cae17\" data-field-span=\"4\"><label id='gfield_label_10_54' class='gfield_label gform-field-label' for='input_10_54'><span class='gform-field-label__text'>Pourcentage (%)<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_54' id='input_10_54' type='number' step='any'   value='' class='large' tabindex='135'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_10_96\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5ada71be\" data-field-span=\"6\"><label id='gfield_label_10_96' class='gfield_label gform-field-label' for='input_10_96'><span class='gform-field-label__text'>Courriel<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_96' id='input_10_96' type='email' value='' class='large' tabindex='136'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_101\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5ada71be\" data-field-span=\"6\"><label id='gfield_label_10_101' class='gfield_label gform-field-label' for='input_10_101'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_101' id='input_10_101' type='tel' value='' class='large' tabindex='137' placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_10_61\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5a0b5839\" data-field-span=\"12\"><h3 class=\"gsection_title\">B\u00e9n\u00e9ficiaire 6<\/h3><\/div><fieldset id=\"field_10_82\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"438c08d3\" data-field-span=\"6\"><legend id='gfield_label_10_82' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_82'>\n                            \n                            <span id='input_10_82_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_82.3' id='input_10_82_3' value='' tabindex='139'  aria-required='false'     aria-labelledby=\"input_10_82_3_label gfield_label_10_82\"\/>\n                                                    <label for='input_10_82_3' id='input_10_82_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_82_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_82.6' id='input_10_82_6' value='' tabindex='141'  aria-required='false'     \/>\n                                                    <label for='input_10_82_6' id='input_10_82_6_label' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_83\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"438c08d3\" data-field-span=\"6\"><label id='gfield_label_10_83' class='gfield_label gform-field-label' for='input_10_83'><span class='gform-field-label__text'>Date De Naissance<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_83'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_83'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\ttabindex='143' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_83' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_83' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_83' aria-label='Date De Naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_84\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"73bcd6fe\" data-field-span=\"4\"><label id='gfield_label_10_84' class='gfield_label gform-field-label' for='input_10_84'><span class='gform-field-label__text'>Lien de parent\u00e9<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_84' id='input_10_84' type='text' value='' class='large'   tabindex='144'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_85\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"73bcd6fe\" data-field-span=\"4\"><label id='gfield_label_10_85' class='gfield_label gform-field-label' for='input_10_85'><span class='gform-field-label__text'>Sexe<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_85' id='input_10_85' class='large gfield_select' tabindex='145'    aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Sexe<\/option><option value='Masculin' >Masculin<\/option><option value='F\u00e9minin' >F\u00e9minin<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_10_86\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"73bcd6fe\" data-field-span=\"4\"><label id='gfield_label_10_86' class='gfield_label gform-field-label' for='input_10_86'><span class='gform-field-label__text'>Pourcentage (%)<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_86' id='input_10_86' type='number' step='any'   value='' class='large' tabindex='146'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_10_98\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"b29c33ad\" data-field-span=\"6\"><label id='gfield_label_10_98' class='gfield_label gform-field-label' for='input_10_98'><span class='gform-field-label__text'>Courriel<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_98' id='input_10_98' type='email' value='' class='large' tabindex='147'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_103\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"b29c33ad\" data-field-span=\"6\"><label id='gfield_label_10_103' class='gfield_label gform-field-label' for='input_10_103'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_103' id='input_10_103' type='tel' value='' class='large' tabindex='148' placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_10_31' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' tabindex='149'>Pr\u00e9c\u00e9dent<\/button> <button type='button' id='gform_next_button_10_31' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' tabindex='150'>Suivant<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_4' class='gform_page' data-js='page-field-id-31' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_4' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><fieldset id=\"field_10_33\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"753d4cf4\" data-field-span=\"12\"><legend id='gfield_label_10_33' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>CONSENTEMENT ET SIGNATURE<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_10_33'><div class='gfield_consent_description_text gform-theme__no-reset--children' tabindex='0'><strong>CONSENTEMENT \u00c0 LA COLLECTE, \u00c0 L\u2019UTILISATION ET \u00c0 LA COMMUNICATION DE RENSEIGNEMENTS PERSONNELS<\/strong><br \/>\n<br \/>\nLes renseignements personnels contenus dans le pr\u00e9sent formulaire sont confidentiels et ne seront utilis\u00e9s qu\u2019aux fins de l\u2019administration du R\u00e9gime de retraite des M\u00e9tallos.<br \/>\n<br \/>\nEn signant ci-dessous, je consens \u00e0 la collecte, \u00e0 l\u2019utilisation et \u00e0 la communication de mes renseignements personnels aux fins de l\u2019administration du R\u00e9gime, et j\u2019autorise la collecte et l\u2019utilisation de mes renseignements personnels ainsi que de ceux de mon conjoint par l\u2019administrateur du R\u00e9gime, ses mandataires, d\u00e9l\u00e9gataires et fournisseurs de services, ainsi que par les employeurs participants, conform\u00e9ment \u00e0 la D\u00e9claration de confidentialit\u00e9 du R\u00e9gime.<br \/>\n<br \/>\n<strong>AUTORISATION \u00c9LECTRONIQUE<\/strong><br \/>\n<br \/>\nEn s\u00e9lectionnant la case de consentement et en apposant ma signature \u00e9lectronique, je confirme avoir lu ce qui pr\u00e9c\u00e8de et consentir \u00e0 la collecte, \u00e0 l\u2019utilisation et \u00e0 la communication de mes renseignements personnels comme d\u00e9crit ci-dessus.<\/div><\/div><div class='ginput_container ginput_container_consent'><input name='input_33.1' id='input_10_33_1' type='checkbox' value='1' tabindex='151' aria-describedby=\"gfield_consent_description_10_33\" aria-labelledby=\"input_10_33_1_label gfield_label_10_33\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label id='input_10_33_1_label' class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_10_33_1' ><span class='gform-field-label__text'>J\u2019ai lu ce qui pr\u00e9c\u00e8de et je consens \u00e0 la collecte, \u00e0 l\u2019utilisation et \u00e0 la communication de mes renseignements personnels comme d\u00e9crit ci-dessus<\/span><\/label><input type='hidden' name='input_33.2' value='J\u2019ai lu ce qui pr\u00e9c\u00e8de et je consens \u00e0 la collecte, \u00e0 l\u2019utilisation et \u00e0 la communication de mes renseignements personnels comme d\u00e9crit ci-dessus' class='gform_hidden' \/><input type='hidden' name='input_33.3' value='14' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_10_105\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"259a4ad1\" data-field-span=\"12\"><legend id='gfield_label_10_105' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Signature (obligatoire)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class=\"ginput_container ginput_container_signature\"><input type='hidden' value='' name='input_105' id='input_10_105_signature_filename' class='gfield_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_10_105_Container' class='gfield_signature_container' style='height:90px; width:700px; ' ><input type='hidden' id='input_10_105_data' name='input_10_105_data' class='gfield_signature_data' \/><canvas id=\"input_10_105\" width=\"700\" height=\"90\" style=\"border-style: Dashed; border-width: 2px; border-color: #757575; background-color:#FFFFFF; cursor: url(https:\/\/steelworkerspensionplan.ca\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;\" tabindex=\"0\" aria-label=\"Signature pad\" ><\/canvas><input type='text' id='input_10_105_textinput' name='input_10_105_textinput' class='gfield_signature_text_input' style='text-indent:10px;display:none;width:700px;height:90px;border-style:Dashed;border-width:2px;border-color:#757575;background-color:#FFFFFF;font-family:&quot;Snell Roundhand&quot;, &quot;Segoe Script&quot;, cursive;font-size:2em;padding:0 12px;box-sizing:border-box;color:#000000;' placeholder='Type your signature' autocomplete='off' aria-label='Type your signature' \/><style type='text\/css'>\n                #input_10_105_textinput::placeholder {\n                    font-size: 1.5rem;\n                    font-family: Arial;\n                    opacity: 0.8;\n                }\n            <\/style><\/div><div id='input_10_105_toolbar' class='gfield_signature_toolbar' dir='ltr' style='margin:5px 0;position:relative;height:35px;width:700px;max-width:100%;display:flex;align-items:center;'><div id='input_10_105_status' class='gfield_signature_status gform-visually-hidden' role='status' aria-live='polite' aria-atomic='true' style='position:absolute;width:1px;height:1px;padding:0;margin:-1px;overflow:hidden;clip:rect(0,0,0,0);white-space:nowrap;border:0;'><\/div><input type='hidden' id='input_10_105_font_select' class='gfield_signature_font_select' value='script' \/><div 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3C3<\/p>\n<p><span style=\"font-weight: 400;\"><\/span><\/p>\n<p><span style=\"font-weight: 400;\">Politique de confidentialit\u00e9<\/span> <i class=\"fas fa-chevron-right\"><\/i><\/p>\n<p><span style=\"font-weight: 400;\">Contactez-nous<\/span> <i class=\"fas fa-chevron-right\"><\/i>[\/et_pb_text][\/et_pb_column][et_pb_column type=&#8221;3_5&#8243; _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; global_colors_info=&#8221;{}&#8221;][et_pb_text _builder_version=&#8221;4.16&#8243; _module_preset=&#8221;default&#8221; text_text_color=&#8221;#1F3162&#8243; header_2_font=&#8221;|700|||||||&#8221; global_colors_info=&#8221;{}&#8221;]<\/p>\n<h2>ABONNEZ-VOUS \u00c0 L\u2019INFOLETTRE DU PRM<\/h2>\n<p>L\u2019infolettre du PRM contient des nouvelles \u00e0 propos du plan et<br \/>\nde l\u2019information susceptible d\u2019int\u00e9resser les participants actifs et potentiels.[\/et_pb_text][et_pb_code _builder_version=&#8221;4.16&#8243; 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maxlength=\"100\"><\/textarea><\/label>\n\t\t\t\t\t\t<input type=\"hidden\" id=\"ak_js_2\" name=\"ak_js\" value=\"36\" \/>\n\t\t\t\t\t\t<script>\ndocument.getElementById( \"ak_js_2\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n\n\t\t\t\t\t<\/div>\n                        <div class='gform-body gform_body'><div id='gform_fields_8' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><fieldset id=\"field_8_2\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_hidden_label gfield--no-description field_description_below hidden_label field_validation_below gfield_visibility_visible\" data-group-id=\"57ad72b1\" data-field-span=\"12\"><legend id='gfield_label_8_2' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><span class=\"gfield_required\"><span class=\"gfield_required 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courriel<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_1' id='input_8_1' type='email' value='' class='large' tabindex='54'  placeholder='Adresse courriel' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_8_3\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"e3fa5336\" data-field-span=\"6\"><legend id='gfield_label_8_3' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Je suis membre du Syndicat des M\u00e9tallos.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_3'>\n\t\t\t<div class='gchoice gchoice_8_3_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Oui'  id='choice_8_3_0' onchange='gformToggleRadioOther( this )'  aria-labelledby=\"label_8_3_0 gfield_label_8_3\" tabindex='55'  \/>\n\t\t\t\t\t<label for='choice_8_3_0' id='label_8_3_0' class='gform-field-label gform-field-label--type-inline'>Oui<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_8_3_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_3' type='radio' value='Non'  id='choice_8_3_1' onchange='gformToggleRadioOther( this )'   tabindex='56'  \/>\n\t\t\t\t\t<label for='choice_8_3_1' id='label_8_3_1' class='gform-field-label gform-field-label--type-inline'>Non<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_8_4\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gf_list_inline gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"e3fa5336\" data-field-span=\"6\"><legend id='gfield_label_8_4' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Je suis un participant au PRM.<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_8_4'>\n\t\t\t<div class='gchoice gchoice_8_4_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_4' type='radio' value='Oui'  id='choice_8_4_0' onchange='gformToggleRadioOther( this )'  aria-labelledby=\"label_8_4_0 gfield_label_8_4\" tabindex='57'  \/>\n\t\t\t\t\t<label for='choice_8_4_0' id='label_8_4_0' class='gform-field-label 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ginput_container_checkbox'><div class='gfield_checkbox ' id='input_8_5'><div class='gchoice gchoice_8_5_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_5.1' type='checkbox'  value='&lt;strong&gt;Je souhaite m\u2019abonner \u00e0 l\u2019infolettre du PRM. Je comprends que je peux r\u00e9silier mon abonnement en tout temps.' checked='checked' id='choice_8_5_1' tabindex='59'   aria-labelledby=\"label_8_5_1 gfield_label_8_5\"\/>\n\t\t\t\t\t\t\t\t<label for='choice_8_5_1' id='label_8_5_1' class='gform-field-label gform-field-label--type-inline'><strong>Je souhaite m\u2019abonner \u00e0 l\u2019infolettre du PRM.<\/stong> Je comprends que je peux r\u00e9silier mon abonnement en tout temps.<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <button type='submit' id='gform_submit_button_8' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' tabindex='60'>SOUMETTRE<\/button> <input type='hidden' name='gform_ajax' value='form_id=8&amp;title=&amp;description=&amp;tabindex=49&amp;theme=orbital&amp;styles=[]&amp;hash=80f840ba3b28365307f9f2cc3602703a' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_8' value='iframe' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_8' id='gform_theme_8' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_8' id='gform_style_settings_8' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_8' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='8' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='CAD' value='pA6mbHaYQcbdv8lKUm+u826d56iscOyBWJN\/Koo+EiV8veVcLHtI88SzSYpnB\/nOJuvG5pjis70ncu\/5+QIkbDg4\/Vnwo866d5VGuk8c\/dckoKc=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_8' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_8' id='gform_target_page_number_8' value='0' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_8' id='gform_source_page_number_8' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='check=First+Choice%2CSecond+Choice' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div>\n\t\t                <iframe style='display:none;width:0px;height:0px;' src='about:blank' name='gform_ajax_frame_8' id='gform_ajax_frame_8' title='Cette iframe contient la logique n\u00e9cessaire pour manipuler Gravity Forms avec Ajax.'><\/iframe>\n\t\t                <script>\ngform.initializeOnLoaded( function() {jQuery('#gform_ajax_frame_8').on('load',function(){var contents = jQuery(this).contents().find('*').html();var is_postback = contents.indexOf('GF_AJAX_POSTBACK') >= 0;if(!is_postback){return;}var form_content = jQuery(this).contents().find('#gform_wrapper_8');var is_confirmation = jQuery(this).contents().find('#gform_confirmation_wrapper_8').length > 0;var is_redirect = contents.indexOf('gformRedirect(){') >= 0;var is_form = form_content.length > 0 && ! is_redirect && ! is_confirmation;var mt = parseInt(jQuery('html').css('margin-top'), 10) + parseInt(jQuery('body').css('margin-top'), 10) + 100;if(is_form){jQuery('#gform_wrapper_8').html(form_content.html());if(form_content.hasClass('gform_validation_error')){jQuery('#gform_wrapper_8').addClass('gform_validation_error');} else {jQuery('#gform_wrapper_8').removeClass('gform_validation_error');}setTimeout( function() { \/* delay the scroll by 50 milliseconds to fix a bug in chrome *\/ jQuery(document).scrollTop(jQuery('#gform_wrapper_8').offset().top - mt); }, 50 );var current_page = jQuery('#gform_source_page_number_8').val();jQuery(document).trigger('gform_page_loaded', [8, current_page]);window['gf_submitting_8'] = false;}else if(!is_redirect){var confirmation_content = jQuery(this).contents().find('.GF_AJAX_POSTBACK').html();if(!confirmation_content){confirmation_content = contents;}jQuery('#gform_wrapper_8').replaceWith(confirmation_content);jQuery(document).scrollTop(jQuery('#gf_8').offset().top - mt);jQuery(document).trigger('gform_confirmation_loaded', [8]);if(window.gform && gform.pagination && gform.pagination.removePageQueryArg){gform.pagination.removePageQueryArg(8);}window['gf_submitting_8'] = false;wp.a11y.speak(jQuery('#gform_confirmation_message_8').text());}else{jQuery('#gform_8').append(contents);if(window['gformRedirect']) {gformRedirect();}}jQuery(document).trigger(\"gform_pre_post_render\", [{ formId: \"8\", currentPage: \"current_page\", abort: function() { this.preventDefault(); } }]);        if (event && event.defaultPrevented) {                return;        }        const gformWrapperDiv = document.getElementById( \"gform_wrapper_8\" );        if ( gformWrapperDiv ) {            const visibilitySpan = document.createElement( \"span\" );            visibilitySpan.id = \"gform_visibility_test_8\";            gformWrapperDiv.insertAdjacentElement( \"afterend\", visibilitySpan );        }        const visibilityTestDiv = document.getElementById( \"gform_visibility_test_8\" );        let postRenderFired = false;        function triggerPostRender() {            if ( postRenderFired ) {                return;            }            postRenderFired = true;            gform.core.triggerPostRenderEvents( 8, current_page );            if ( visibilityTestDiv ) {                visibilityTestDiv.parentNode.removeChild( visibilityTestDiv );            }        }        function debounce( func, wait, immediate ) {            var timeout;            return function() {                var context = this, args = arguments;                var later = function() {                    timeout = null;                    if ( !immediate ) func.apply( context, args );                };                var callNow = immediate && !timeout;                clearTimeout( timeout );                timeout = setTimeout( later, wait );                if ( callNow ) func.apply( context, args );            };        }        const debouncedTriggerPostRender = debounce( function() {            triggerPostRender();        }, 200 );        if ( visibilityTestDiv && visibilityTestDiv.offsetParent === null ) {            const observer = new MutationObserver( ( mutations ) => {                mutations.forEach( ( mutation ) => {                    if ( mutation.type === 'attributes' && visibilityTestDiv.offsetParent !== null ) {                        debouncedTriggerPostRender();                        observer.disconnect();                    }                });            });            observer.observe( document.body, {                attributes: true,                childList: false,                subtree: true,                attributeFilter: [ 'style', 'class' ],            });        } else {            triggerPostRender();        }    } );} );\n<\/script>\n[\/et_pb_code][\/et_pb_column][\/et_pb_row][\/et_pb_section]<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Member Login \/ RegistrationTirez le meilleur parti de votre pension. Connectez-vous ou cr\u00e9ez un compte maintenant.Formulaire d\u2019adh\u00e9sion au r\u00e9gime de retraite\n                <div class='gf_browser_gecko gform_wrapper gform-theme gform-theme--foundation gform-theme--framework gform-theme--orbital' data-form-theme='orbital' data-form-index='0' id='gform_wrapper_10' style='display:none'><style>#gform_wrapper_10[data-form-index=\"0\"].gform-theme{--gf-color-primary: #204ce5;--gf-color-primary-rgb: 32, 76, 229;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #001AB3;--gf-color-primary-lighter: #527EFF;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #204ce5;--gf-color-in-ctrl-primary-rgb: 32, 76, 229;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #001AB3;--gf-color-in-ctrl-primary-lighter: #527EFF;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg width='640' height='640' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-btn-bg-color-hover-tertiary: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_10' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data' target='gform_ajax_frame_10' id='gform_10'  action='\/fr\/wp-json\/wp\/v2\/pages\/8849#gf_10' data-formid='10' novalidate>\t\t\t\t\t<div style=\"display: none !important;\" class=\"akismet-fields-container gf_invisible\" data-prefix=\"ak_\">\n\t\t\t\t\t\t<label>&#916;<textarea name=\"ak_hp_textarea\" cols=\"45\" rows=\"8\" maxlength=\"100\"><\/textarea><\/label>\n\t\t\t\t\t\t<input type=\"hidden\" id=\"ak_js_3\" name=\"ak_js\" value=\"214\" \/>\n\t\t\t\t\t\t<script>\ndocument.getElementById( \"ak_js_3\" ).setAttribute( \"value\", ( new Date() ).getTime() );\n<\/script>\n\n\t\t\t\t\t<\/div>\n        <div id='gf_progressbar_wrapper_10' class='gf_progressbar_wrapper' data-start-at-zero='1'>\n        \t<p class=\"gf_progressbar_title\">\u00c9tape <span class='gf_step_current_page'>1<\/span> sur <span class='gf_step_page_count'>4<\/span><span class='gf_step_page_name'> - RENSEIGNEMENTS DU PARTICIPANT<\/span>\n        \t<\/p>\n            <div class='gf_progressbar gf_progressbar_blue' aria-hidden='true'>\n                <div class='gf_progressbar_percentage percentbar_blue percentbar_0' style='width:0%;'><span>0%<\/span><\/div>\n            <\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_10_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_10' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><div id=\"field_10_109\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"><label id='gfield_label_10_109' class='gfield_label gform-field-label' for='input_10_109'><span class='gform-field-label__text'>X\/Twitter<\/span><\/label><div class='ginput_container'><input name='input_109' id='input_10_109' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_10_109'>Ce champ n\u2019est utilis\u00e9 qu\u2019\u00e0 des fins de validation et devrait rester inchang\u00e9.<\/div><\/div><div id=\"field_10_90\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5f5456ee\" data-field-span=\"12\"><\/div><div id=\"field_10_28\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"cee02c19\" data-field-span=\"12\"><\/div><div id=\"field_10_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"0ffa99c7\" data-field-span=\"6\"><label id='gfield_label_10_13' class='gfield_label gform-field-label' for='input_10_13'><span class='gform-field-label__text'>Employeur<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_10_13' type='text' value='' class='large'   tabindex='49'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_8\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"0ffa99c7\" data-field-span=\"6\"><label id='gfield_label_10_8' class='gfield_label gform-field-label' for='input_10_8'><span class='gform-field-label__text'>NAS<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_8' id='input_10_8' type='text' value='' class='large'   tabindex='50' placeholder='999-999-999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"999-999-999\"\/><\/div><\/div><fieldset id=\"field_10_1\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"be65339d\" data-field-span=\"12\"><legend id='gfield_label_10_1' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_1'>\n                            \n                            <span id='input_10_1_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.3' id='input_10_1_3' value='' tabindex='52'  aria-required='true'     aria-labelledby=\"input_10_1_3_label gfield_label_10_1\"\/>\n                                                    <label for='input_10_1_3' id='input_10_1_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_1_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_1.6' id='input_10_1_6' value='' tabindex='54'  aria-required='true'     \/>\n                                                    <label for='input_10_1_6' id='input_10_1_6_label' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_10\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"733e8e93\" data-field-span=\"3\"><label id='gfield_label_10_10' class='gfield_label gform-field-label' for='input_10_10'><span class='gform-field-label__text'>Sexe<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_10' id='input_10_10' class='large gfield_select' tabindex='56'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Sexe<\/option><option value='Masculin' >Masculin<\/option><option value='F\u00e9minin' >F\u00e9minin<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_10_9\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"733e8e93\" data-field-span=\"3\"><label id='gfield_label_10_9' class='gfield_label gform-field-label' for='input_10_9'><span class='gform-field-label__text'>Date De Naissance<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_9'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_9'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\ttabindex='57' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_9' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_9' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_9' aria-label='Date De Naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_5\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"733e8e93\" data-field-span=\"3\"><label id='gfield_label_10_5' class='gfield_label gform-field-label' for='input_10_5'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_5' id='input_10_5' type='tel' value='' class='large' tabindex='58' placeholder='(999) 999-9999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_10_12\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"733e8e93\" data-field-span=\"3\"><label id='gfield_label_10_12' class='gfield_label gform-field-label' for='input_10_12'><span class='gform-field-label__text'>Langue pr\u00e9f\u00e9r\u00e9e<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_12' id='input_10_12' class='large gfield_select' tabindex='59'    aria-invalid=\"false\" ><option value='Fran\u00e7ais' selected='selected'>Fran\u00e7ais<\/option><option value='Anglais' >Anglais<\/option><\/select><\/div><\/div><fieldset id=\"field_10_4\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5e6abf03\" data-field-span=\"12\"><legend id='gfield_label_10_4' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Adresse<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_state has_zip ginput_container_address gform-grid-row' id='input_10_4' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_10_4_1_container' >\n                                        <input type='text' name='input_4.1' id='input_10_4_1' value='' tabindex='60'   aria-required='true'    aria-labelledby=\"input_10_4_1_label gfield_label_10_4\"\/>\n                                        <label for='input_10_4_1' id='input_10_4_1_label' class='gform-field-label gform-field-label--type-sub '>Rue<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_10_4_3_container' >\n                                    <input type='text' name='input_4.3' id='input_10_4_3' value='' tabindex='61'   aria-required='true'    \/>\n                                    <label for='input_10_4_3' id='input_10_4_3_label' class='gform-field-label gform-field-label--type-sub '>Ville<\/label>\n                                 <\/span><span class='ginput_right address_state ginput_address_state gform-grid-col' id='input_10_4_4_container' >\n                                        <select name='input_4.4' id='input_10_4_4' tabindex='62'    aria-required='true'    ><option value='' selected='selected'><\/option><option value='Alberta' >Alberta<\/option><option value='Colombie-Britannique' >Colombie-Britannique<\/option><option value='Manitoba' >Manitoba<\/option><option value='Nouveau-Brunswick' >Nouveau-Brunswick<\/option><option value='Terre-Neuve-et-Labrador' >Terre-Neuve-et-Labrador<\/option><option value='Territoires du Nord-Ouest' >Territoires du Nord-Ouest<\/option><option value='Nouvelle-\u00c9cosse' >Nouvelle-\u00c9cosse<\/option><option value='Nunavut' >Nunavut<\/option><option value='Ontario' >Ontario<\/option><option value='\u00cele du Prince-\u00c9douard' >\u00cele du Prince-\u00c9douard<\/option><option value='Qu\u00e9bec' >Qu\u00e9bec<\/option><option value='Saskatchewan' >Saskatchewan<\/option><option value='Yukon' >Yukon<\/option><\/select>\n                                        <label for='input_10_4_4' id='input_10_4_4_label' class='gform-field-label gform-field-label--type-sub '>Province<\/label>\n                                      <\/span><span class='ginput_left address_zip ginput_address_zip gform-grid-col' id='input_10_4_5_container' >\n                                    <input type='text' name='input_4.5' id='input_10_4_5' value='' tabindex='64'   aria-required='true'    \/>\n                                    <label for='input_10_4_5' id='input_10_4_5_label' class='gform-field-label gform-field-label--type-sub '>Code Postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_4.6' id='input_10_4_6' value='CA' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_10_6\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"70a18b76\" data-field-span=\"12\"><label id='gfield_label_10_6' class='gfield_label gform-field-label' for='input_10_6'><span class='gform-field-label__text'>Courriel<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_6' id='input_10_6' type='email' value='' class='large' tabindex='65'   aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_10_16' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' tabindex='66'>Suivant<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_2' class='gform_page' data-js='page-field-id-16' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_2' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><div id=\"field_10_91\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_hidden\" data-group-id=\"9d78b636\" data-field-span=\"12\"><script type=\"text\/javascript\">\njQuery(document).on('gform_post_render', function(event, formId, current_page){\n    if (window.gform) {\n        \/\/ This filter checks the final boolean result of the logic rule on the front-end\n        gform.addFilter('gform_is_value_match', function(isMatch, formId, rule) {\n            \n            \/\/ Map of English province names to their French translations\n            var translatedProvinces = {\n                'British Columbia': 'Colombie-Britannique',\n                'New Brunswick': 'Nouveau-Brunswick',\n                'Newfoundland and Labrador': 'Terre-Neuve-et-Labrador',\n                'Northwest Territories': 'Territoires du Nord-Ouest',\n                'Nova Scotia': 'Nouvelle-\u00c9cosse',\n                'Prince Edward Island': '\u00cele du Prince-\u00c9douard',\n                'Quebec': 'Qu\u00e9bec'\n            };\n\n            \/\/ Check if the conditional logic rule is looking for one of these English provinces\n            if (translatedProvinces[rule.value] !== undefined) {\n                \n                var fieldId = rule.fieldId.toString().replace('.', '_');\n                var currentValue = jQuery('#input_' + formId + '_' + fieldId).val();\n\n                \/\/ If the user selected the French version of the province the rule is looking for\n                if (currentValue === translatedProvinces[rule.value]) {\n                    \n                    \/\/ Force the correct logic based on the operator used\n                    if (rule.operator === 'is') {\n                        return true;  \/\/ It IS the province, so pass the rule\n                    } else if (rule.operator === 'isnot') {\n                        return false; \/\/ It IS the province, so fail the \"is not\" rule\n                    }\n                }\n            }\n            \n            \/\/ For all other rules and operators, proceed normally\n            return isMatch;\n        });\n    }\n});\n<\/script><\/div><div id=\"field_10_37\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"a139f6c1\" data-field-span=\"12\"><p><strong>D\u00e9finition de \u00ab conjoint \u00bb \u2013 Alberta<\/strong><\/p>\n\n<p>Aux fins du R\u00e9gime de retraite des M\u00e9tallos, un \u00ab conjoint \u00bb s\u2019entend d\u2019une personne qui :<\/p>\n\n<ol type=\"a\">\n  <li>Est mari\u00e9e avec vous; ou<\/li>\n  <li>N\u2019est pas mari\u00e9e avec vous, mais vit avec vous dans une relation conjugale depuis au moins trois (3) ann\u00e9es cons\u00e9cutives; ou<\/li>\n  <li>N\u2019est pas mari\u00e9e avec vous, mais vit avec vous dans une relation conjugale d\u2019une certaine permanence, s\u2019il existe un enfant issu de cette relation, par naissance ou par adoption.<\/li>\n<\/ol>\n\n<p>Selon cette d\u00e9finition, je certifie que :<\/p>\n<\/div><div id=\"field_10_36\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"992a5f47\" data-field-span=\"12\"><p><strong>D\u00e9finition de \u00ab conjoint \u00bb \u2013 Colombie-Britannique<\/strong><\/p>\n\n<p>Aux fins du R\u00e9gime de retraite des M\u00e9tallos, un \u00ab conjoint \u00bb s\u2019entend d\u2019une personne qui :<\/p>\n\n<ol type=\"a\">\n  <li>Est mari\u00e9e avec vous ou est partie \u00e0 un mariage nul avec vous; ou<\/li>\n  <li>N\u2019est pas mari\u00e9e avec vous, mais vit avec vous dans une relation conjugale depuis au moins deux (2) ans.<\/li>\n<\/ol>\n\n<p>Selon cette d\u00e9finition, je certifie que :<\/p>\n<\/div><div id=\"field_10_38\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"6a9f464c\" data-field-span=\"12\"><p><strong>D\u00e9finition de \u00ab conjoint \u00bb \u2013 Manitoba<\/strong><\/p>\n\n<p>Aux fins du R\u00e9gime de retraite des M\u00e9tallos, un \u00ab conjoint \u00bb s\u2019entend d\u2019une personne qui :<\/p>\n\n<ol type=\"a\">\n  <li>Est mari\u00e9e avec vous; ou<\/li>\n  <li>N\u2019est pas mari\u00e9e avec vous, mais a enregistr\u00e9 avec vous une union de fait en vertu de la <em>Loi sur les statistiques de l\u2019\u00e9tat civil<\/em>; ou<\/li>\n  <li>\n    N\u2019est pas mari\u00e9e avec vous, mais vit avec vous dans une relation conjugale pendant une p\u00e9riode :\n    <ol type=\"i\">\n      <li>d\u2019au moins trois (3) ans, si l\u2019un de vous est mari\u00e9; ou<\/li>\n      <li>d\u2019au moins un (1) an, si aucun de vous n\u2019est mari\u00e9.<\/li>\n    <\/ol>\n  <\/li>\n<\/ol>\n\n<p>Selon cette d\u00e9finition, je certifie que :<\/p><\/div><div id=\"field_10_39\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"0e419600\" data-field-span=\"12\"><p><strong>D\u00e9finition de \u00ab conjoint \u00bb \u2013 Nouvelle-\u00c9cosse<\/strong><\/p>\n\n<p>Aux fins du R\u00e9gime de retraite des M\u00e9tallos, un \u00ab conjoint \u00bb s\u2019entend d\u2019une personne qui :<\/p>\n\n<ol type=\"a\">\n  <li>Est mari\u00e9e avec vous; ou<\/li>\n  <li>Est mari\u00e9e avec vous par un mariage annulable qui n\u2019a pas \u00e9t\u00e9 annul\u00e9 par une d\u00e9claration de nullit\u00e9; ou<\/li>\n  <li>A contract\u00e9 avec vous, de bonne foi, une forme de mariage qui est nul et vit avec vous, ou, si vous avez cess\u00e9 de vivre ensemble, a v\u00e9cu avec vous au cours des douze (12) derniers mois; ou<\/li>\n  <li>N\u2019est pas mari\u00e9e avec vous, mais est un partenaire domestique au sens de l\u2019article 52 de la <em>Loi sur les statistiques de l\u2019\u00e9tat civil<\/em>; ou<\/li>\n  <li>\n    N\u2019est pas mari\u00e9e avec vous, mais vit avec vous dans une relation conjugale depuis :\n    <ol type=\"i\">\n      <li>au moins trois (3) ans, si l\u2019un de vous est mari\u00e9; ou<\/li>\n      <li>au moins un (1) an, si aucun de vous n\u2019est mari\u00e9.<\/li>\n    <\/ol>\n  <\/li>\n<\/ol>\n\n<p>Selon cette d\u00e9finition, je certifie que :<\/p><\/div><div id=\"field_10_40\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"8698f96e\" data-field-span=\"12\"><p><strong>D\u00e9finition de \u00ab conjoint \u00bb \u2013 Ontario<\/strong><\/p>\n\n<p>Aux fins du R\u00e9gime de retraite des M\u00e9tallos, un \u00ab conjoint \u00bb s\u2019entend d\u2019une personne qui :<\/p>\n\n<ol type=\"a\">\n  <li>Est mari\u00e9e avec vous; ou<\/li>\n  <li>N\u2019est pas mari\u00e9e avec vous, mais vit avec vous dans une relation conjugale de fa\u00e7on continue depuis au moins trois (3) ans; ou<\/li>\n  <li>N\u2019est pas mari\u00e9e avec vous, mais vit avec vous dans une relation conjugale d\u2019une certaine permanence, si ensemble vous \u00eates les parents d\u2019un enfant, au sens de l\u2019article 4 de la <em>Loi portant r\u00e9forme du droit de l\u2019enfance (Ontario)<\/em>.<\/li>\n<\/ol>\n\n<p>Selon cette d\u00e9finition, je certifie que :<\/p>\n<\/div><div id=\"field_10_26\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c309e1df\" data-field-span=\"12\"><p><strong>D\u00e9finition de \u00ab conjoint \u00bb \u2013 F\u00e9d\u00e9ral<\/strong><\/p>\n\n<p>Aux fins du R\u00e9gime de retraite des M\u00e9tallos, un \u00ab conjoint \u00bb s\u2019entend d\u2019une personne qui :<\/p>\n\n<ol type=\"a\">\n  <li>Est mari\u00e9e avec vous ou est partie \u00e0 un mariage nul avec vous; ou<\/li>\n  <li>N\u2019est pas mari\u00e9e avec vous, mais vit avec vous dans une relation conjugale depuis au moins un (1) an.<\/li>\n<\/ol>\n\n<p>Selon cette d\u00e9finition, je certifie que :<\/p>\n<\/div><div id=\"field_10_29\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"f6f6d3a4\" data-field-span=\"12\"><p><strong>** ATTENTION **<\/strong><\/p>\n\n<p>La loi sur les r\u00e9gimes de retraite pr\u00e9voit automatiquement que votre conjoint est le b\u00e9n\u00e9ficiaire de toute prestation de d\u00e9c\u00e8s qui pourrait devenir payable en vertu du R\u00e9gime \u00e0 votre d\u00e9c\u00e8s. Si vous n\u2019avez pas de conjoint, ou si votre conjoint souhaite renoncer \u00e0 ses droits et que vous d\u00e9sirez d\u00e9signer une autre personne \u00e0 titre de b\u00e9n\u00e9ficiaire, veuillez communiquer avec WA Health afin d\u2019obtenir les renseignements n\u00e9cessaires pour proc\u00e9der \u00e0 la d\u00e9signation d\u2019un b\u00e9n\u00e9ficiaire.<\/p>\n<\/div><fieldset id=\"field_10_27\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"793de769\" data-field-span=\"12\"><legend id='gfield_label_10_27' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>D\u00e9claration relative au conjoint<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_10_27'>\n\t\t\t<div class='gchoice gchoice_10_27_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='J\u2019ai un conjoint'  id='choice_10_27_0' onchange='gformToggleRadioOther( this )'  aria-labelledby=\"label_10_27_0 gfield_label_10_27\" tabindex='67'  \/>\n\t\t\t\t\t<label for='choice_10_27_0' id='label_10_27_0' class='gform-field-label gform-field-label--type-inline'>J\u2019ai un conjoint<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_10_27_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_27' type='radio' value='Je n\u2019ai pas de conjoint'  id='choice_10_27_1' onchange='gformToggleRadioOther( this )'   tabindex='68'  \/>\n\t\t\t\t\t<label for='choice_10_27_1' id='label_10_27_1' class='gform-field-label gform-field-label--type-inline'>Je n\u2019ai pas de conjoint<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_10_18\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"169fad1a\" data-field-span=\"12\"><legend id='gfield_label_10_18' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_18'>\n                            \n                            <span id='input_10_18_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_18.3' id='input_10_18_3' value='' tabindex='70'  aria-required='true'     aria-labelledby=\"input_10_18_3_label gfield_label_10_18\"\/>\n                                                    <label for='input_10_18_3' id='input_10_18_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_18_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_18.6' id='input_10_18_6' value='' tabindex='72'  aria-required='true'     \/>\n                                                    <label for='input_10_18_6' id='input_10_18_6_label' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_22\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"43b2ee17\" data-field-span=\"3\"><label id='gfield_label_10_22' class='gfield_label gform-field-label' for='input_10_22'><span class='gform-field-label__text'>NAS du conjoint<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_22' id='input_10_22' type='text' value='' class='large'   tabindex='74' placeholder='999-999-999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"999-999-999\"\/><\/div><\/div><div id=\"field_10_19\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"43b2ee17\" data-field-span=\"3\"><label id='gfield_label_10_19' class='gfield_label gform-field-label' for='input_10_19'><span class='gform-field-label__text'>Date De Naissance<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_19'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_19'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\taria-required=\"true\"\n\t\t\t\t\ttabindex='75' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_19' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_19' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_19' aria-label='Date De Naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_30\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-quarter field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"43b2ee17\" data-field-span=\"3\"><label id='gfield_label_10_30' class='gfield_label gform-field-label' for='input_10_30'><span class='gform-field-label__text'>Date du mariage<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_30'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_30'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\ttabindex='76' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_30' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_30' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_30' aria-label='Date du mariage: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_20\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"43b2ee17\" data-field-span=\"3\"><label id='gfield_label_10_20' class='gfield_label gform-field-label' for='input_10_20'><span class='gform-field-label__text'>Sexe<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_20' id='input_10_20' class='large gfield_select' tabindex='77'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Sexe<\/option><option value='Masculin' >Masculin<\/option><option value='F\u00e9minin' >F\u00e9minin<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_10_50\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"db482fa6\" data-field-span=\"6\"><label id='gfield_label_10_50' class='gfield_label gform-field-label' for='input_10_50'><span class='gform-field-label__text'>Courriel<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_50' id='input_10_50' type='email' value='' class='large' tabindex='78'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_104\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"db482fa6\" data-field-span=\"6\"><label id='gfield_label_10_104' class='gfield_label gform-field-label' for='input_10_104'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_104' id='input_10_104' type='tel' value='' class='large' tabindex='79' placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_10_88' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' tabindex='80'>Pr\u00e9c\u00e9dent<\/button> <button type='button' id='gform_next_button_10_88' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' tabindex='81'>Suivant<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_3' class='gform_page' data-js='page-field-id-88' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_3' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><div id=\"field_10_89\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"123a0757\" data-field-span=\"12\"><p>\nIl est recommand\u00e9 de d\u00e9signer un b\u00e9n\u00e9ficiaire.\nSi aucun b\u00e9n\u00e9ficiaire n\u2019est d\u00e9sign\u00e9, toute prestation de d\u00e9c\u00e8s sera g\u00e9n\u00e9ralement vers\u00e9e \u00e0 votre succession, sous r\u00e9serve des lois applicables et des dispositions du R\u00e9gime.\n<\/p><\/div><div id=\"field_10_48\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"cdf0e406\" data-field-span=\"12\"><p>\nSi vous avez un conjoint, celui-ci est automatiquement votre b\u00e9n\u00e9ficiaire principal.\n\nIl est recommand\u00e9 que les participants d\u00e9signent un ou plusieurs b\u00e9n\u00e9ficiaires rempla\u00e7ants.\nSi aucun b\u00e9n\u00e9ficiaire n\u2019est d\u00e9sign\u00e9, toute prestation de d\u00e9c\u00e8s sera g\u00e9n\u00e9ralement vers\u00e9e \u00e0 votre succession, sous r\u00e9serve des lois applicables et des dispositions du R\u00e9gime.\n<\/p>\n<\/div><div id=\"field_10_47\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c0d190ad\" data-field-span=\"12\"><label id='gfield_label_10_47' class='gfield_label gform-field-label' for='input_10_47'><span class='gform-field-label__text'>Nombre de b\u00e9n\u00e9ficiaires<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_47' id='input_10_47' class='large gfield_select' tabindex='82'    aria-invalid=\"false\" ><option value='0' >0<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><\/select><\/div><\/div><div id=\"field_10_51\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"b841e348\" data-field-span=\"12\"><h3 class=\"gsection_title\">B\u00e9n\u00e9ficiaire 1<\/h3><\/div><fieldset id=\"field_10_52\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"028eab62\" data-field-span=\"6\"><legend id='gfield_label_10_52' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_52'>\n                            \n                            <span id='input_10_52_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_52.3' id='input_10_52_3' value='' tabindex='84'  aria-required='false'     aria-labelledby=\"input_10_52_3_label gfield_label_10_52\"\/>\n                                                    <label for='input_10_52_3' id='input_10_52_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_52_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_52.6' id='input_10_52_6' value='' tabindex='86'  aria-required='false'     \/>\n                                                    <label for='input_10_52_6' id='input_10_52_6_label' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_56\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"028eab62\" data-field-span=\"6\"><label id='gfield_label_10_56' class='gfield_label gform-field-label' for='input_10_56'><span class='gform-field-label__text'>Date De Naissance<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_56'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_56'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\ttabindex='88' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_56' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_56' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_56' aria-label='Date De Naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_53\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"3e0b004b\" data-field-span=\"4\"><label id='gfield_label_10_53' class='gfield_label gform-field-label' for='input_10_53'><span class='gform-field-label__text'>Lien de parent\u00e9<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_53' id='input_10_53' type='text' value='' class='large'   tabindex='89'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_55\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"3e0b004b\" data-field-span=\"4\"><label id='gfield_label_10_55' class='gfield_label gform-field-label' for='input_10_55'><span class='gform-field-label__text'>Sexe<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_55' id='input_10_55' class='large gfield_select' tabindex='90'    aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Sexe<\/option><option value='Masculin' >Masculin<\/option><option value='F\u00e9minin' >F\u00e9minin<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_10_66\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"3e0b004b\" data-field-span=\"4\"><label id='gfield_label_10_66' class='gfield_label gform-field-label' for='input_10_66'><span class='gform-field-label__text'>Pourcentage (%)<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_66' id='input_10_66' type='number' step='any'   value='' class='large' tabindex='91'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_10_92\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"7d6fe1b1\" data-field-span=\"6\"><label id='gfield_label_10_92' class='gfield_label gform-field-label' for='input_10_92'><span class='gform-field-label__text'>Courriel<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_92' id='input_10_92' type='email' value='' class='large' tabindex='92'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_93\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"7d6fe1b1\" data-field-span=\"6\"><label id='gfield_label_10_93' class='gfield_label gform-field-label' for='input_10_93'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_93' id='input_10_93' type='tel' value='' class='large' tabindex='93' placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_10_57\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"0d0706ca\" data-field-span=\"12\"><h3 class=\"gsection_title\">B\u00e9n\u00e9ficiaire 2<\/h3><\/div><fieldset id=\"field_10_67\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"2f62f7de\" data-field-span=\"6\"><legend id='gfield_label_10_67' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_67'>\n                            \n                            <span id='input_10_67_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_67.3' id='input_10_67_3' value='' tabindex='95'  aria-required='false'     aria-labelledby=\"input_10_67_3_label gfield_label_10_67\"\/>\n                                                    <label for='input_10_67_3' id='input_10_67_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_67_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_67.6' id='input_10_67_6' value='' tabindex='97'  aria-required='false'     \/>\n                                                    <label for='input_10_67_6' id='input_10_67_6_label' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_68\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"2f62f7de\" data-field-span=\"6\"><label id='gfield_label_10_68' class='gfield_label gform-field-label' for='input_10_68'><span class='gform-field-label__text'>Date De Naissance<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_68'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_68'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\ttabindex='99' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_68' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_68' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_68' aria-label='Date De Naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_69\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c9d81256\" data-field-span=\"4\"><label id='gfield_label_10_69' class='gfield_label gform-field-label' for='input_10_69'><span class='gform-field-label__text'>Lien de parent\u00e9<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_10_69' type='text' value='' class='large'   tabindex='100'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_70\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c9d81256\" data-field-span=\"4\"><label id='gfield_label_10_70' class='gfield_label gform-field-label' for='input_10_70'><span class='gform-field-label__text'>Sexe<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_70' id='input_10_70' class='large gfield_select' tabindex='101'    aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Sexe<\/option><option value='Masculin' >Masculin<\/option><option value='F\u00e9minin' >F\u00e9minin<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_10_71\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c9d81256\" data-field-span=\"4\"><label id='gfield_label_10_71' class='gfield_label gform-field-label' for='input_10_71'><span class='gform-field-label__text'>Pourcentage (%)<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_71' id='input_10_71' type='number' step='any'   value='' class='large' tabindex='102'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_10_94\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"4448a0ec\" data-field-span=\"6\"><label id='gfield_label_10_94' class='gfield_label gform-field-label' for='input_10_94'><span class='gform-field-label__text'>Courriel<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_94' id='input_10_94' type='email' value='' class='large' tabindex='103'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_100\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"4448a0ec\" data-field-span=\"6\"><label id='gfield_label_10_100' class='gfield_label gform-field-label' for='input_10_100'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_100' id='input_10_100' type='tel' value='' class='large' tabindex='104' placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_10_64\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"30f2c34c\" data-field-span=\"12\"><h3 class=\"gsection_title\">B\u00e9n\u00e9ficiaire 3<\/h3><\/div><fieldset id=\"field_10_72\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"25385d59\" data-field-span=\"6\"><legend id='gfield_label_10_72' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_72'>\n                            \n                            <span id='input_10_72_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_72.3' id='input_10_72_3' value='' tabindex='106'  aria-required='false'     aria-labelledby=\"input_10_72_3_label gfield_label_10_72\"\/>\n                                                    <label for='input_10_72_3' id='input_10_72_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_72_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_72.6' id='input_10_72_6' value='' tabindex='108'  aria-required='false'     \/>\n                                                    <label for='input_10_72_6' id='input_10_72_6_label' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_73\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"25385d59\" data-field-span=\"6\"><label id='gfield_label_10_73' class='gfield_label gform-field-label' for='input_10_73'><span class='gform-field-label__text'>Date De Naissance<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_73'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_73'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\ttabindex='110' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_73' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_73' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_73' aria-label='Date De Naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_74\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c115b29d\" data-field-span=\"4\"><label id='gfield_label_10_74' class='gfield_label gform-field-label' for='input_10_74'><span class='gform-field-label__text'>Lien de parent\u00e9<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_74' id='input_10_74' type='text' value='' class='large'   tabindex='111'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_75\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c115b29d\" data-field-span=\"4\"><label id='gfield_label_10_75' class='gfield_label gform-field-label' for='input_10_75'><span class='gform-field-label__text'>Sexe<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_75' id='input_10_75' class='large gfield_select' tabindex='112'    aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Sexe<\/option><option value='Masculin' >Masculin<\/option><option value='F\u00e9minin' >F\u00e9minin<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_10_76\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c115b29d\" data-field-span=\"4\"><label id='gfield_label_10_76' class='gfield_label gform-field-label' for='input_10_76'><span class='gform-field-label__text'>Pourcentage (%)<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_76' id='input_10_76' type='number' step='any'   value='' class='large' tabindex='113'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_10_95\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"bffa905f\" data-field-span=\"6\"><label id='gfield_label_10_95' class='gfield_label gform-field-label' for='input_10_95'><span class='gform-field-label__text'>Courriel<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_95' id='input_10_95' type='email' value='' class='large' tabindex='114'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_99\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"bffa905f\" data-field-span=\"6\"><label id='gfield_label_10_99' class='gfield_label gform-field-label' for='input_10_99'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_99' id='input_10_99' type='tel' value='' class='large' tabindex='115' placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_10_63\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"ef6b662a\" data-field-span=\"12\"><h3 class=\"gsection_title\">B\u00e9n\u00e9ficiaire 4<\/h3><\/div><fieldset id=\"field_10_77\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c0ffa8cb\" data-field-span=\"6\"><legend id='gfield_label_10_77' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_77'>\n                            \n                            <span id='input_10_77_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_77.3' id='input_10_77_3' value='' tabindex='117'  aria-required='false'     aria-labelledby=\"input_10_77_3_label gfield_label_10_77\"\/>\n                                                    <label for='input_10_77_3' id='input_10_77_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_77_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_77.6' id='input_10_77_6' value='' tabindex='119'  aria-required='false'     \/>\n                                                    <label for='input_10_77_6' id='input_10_77_6_label' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_78\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"c0ffa8cb\" data-field-span=\"6\"><label id='gfield_label_10_78' class='gfield_label gform-field-label' for='input_10_78'><span class='gform-field-label__text'>Date De Naissance<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_78'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_78'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\ttabindex='121' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_78' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_78' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_78' aria-label='Date De Naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_81\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"f03571c9\" data-field-span=\"4\"><label id='gfield_label_10_81' class='gfield_label gform-field-label' for='input_10_81'><span class='gform-field-label__text'>Lien de parent\u00e9<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_81' id='input_10_81' type='text' value='' class='large'   tabindex='122'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_80\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"f03571c9\" data-field-span=\"4\"><label id='gfield_label_10_80' class='gfield_label gform-field-label' for='input_10_80'><span class='gform-field-label__text'>Sexe<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_80' id='input_10_80' class='large gfield_select' tabindex='123'    aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Sexe<\/option><option value='Masculin' >Masculin<\/option><option value='F\u00e9minin' >F\u00e9minin<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_10_79\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"f03571c9\" data-field-span=\"4\"><label id='gfield_label_10_79' class='gfield_label gform-field-label' for='input_10_79'><span class='gform-field-label__text'>Pourcentage (%)<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_79' id='input_10_79' type='number' step='any'   value='' class='large' tabindex='124'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_10_97\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"01a60741\" data-field-span=\"6\"><label id='gfield_label_10_97' class='gfield_label gform-field-label' for='input_10_97'><span class='gform-field-label__text'>Courriel<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_97' id='input_10_97' type='email' value='' class='large' tabindex='125'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_102\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"01a60741\" data-field-span=\"6\"><label id='gfield_label_10_102' class='gfield_label gform-field-label' for='input_10_102'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_102' id='input_10_102' type='tel' value='' class='large' tabindex='126' placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_10_62\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"e7b25d65\" data-field-span=\"12\"><h3 class=\"gsection_title\">B\u00e9n\u00e9ficiaire 5<\/h3><\/div><fieldset id=\"field_10_58\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"b5306cec\" data-field-span=\"6\"><legend id='gfield_label_10_58' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_58'>\n                            \n                            <span id='input_10_58_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_58.3' id='input_10_58_3' value='' tabindex='128'  aria-required='false'     aria-labelledby=\"input_10_58_3_label gfield_label_10_58\"\/>\n                                                    <label for='input_10_58_3' id='input_10_58_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_58_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_58.6' id='input_10_58_6' value='' tabindex='130'  aria-required='false'     \/>\n                                                    <label for='input_10_58_6' id='input_10_58_6_label' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_59\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"b5306cec\" data-field-span=\"6\"><label id='gfield_label_10_59' class='gfield_label gform-field-label' for='input_10_59'><span class='gform-field-label__text'>Date De Naissance<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_59'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_59'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\ttabindex='132' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_59' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_59' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_59' aria-label='Date De Naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_60\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"db7cae17\" data-field-span=\"4\"><label id='gfield_label_10_60' class='gfield_label gform-field-label' for='input_10_60'><span class='gform-field-label__text'>Lien de parent\u00e9<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_10_60' type='text' value='' class='large'   tabindex='133'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_65\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"db7cae17\" data-field-span=\"4\"><label id='gfield_label_10_65' class='gfield_label gform-field-label' for='input_10_65'><span class='gform-field-label__text'>Sexe<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_65' id='input_10_65' class='large gfield_select' tabindex='134'    aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Sexe<\/option><option value='Masculin' >Masculin<\/option><option value='F\u00e9minin' >F\u00e9minin<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_10_54\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"db7cae17\" data-field-span=\"4\"><label id='gfield_label_10_54' class='gfield_label gform-field-label' for='input_10_54'><span class='gform-field-label__text'>Pourcentage (%)<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_54' id='input_10_54' type='number' step='any'   value='' class='large' tabindex='135'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_10_96\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5ada71be\" data-field-span=\"6\"><label id='gfield_label_10_96' class='gfield_label gform-field-label' for='input_10_96'><span class='gform-field-label__text'>Courriel<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_96' id='input_10_96' type='email' value='' class='large' tabindex='136'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_101\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5ada71be\" data-field-span=\"6\"><label id='gfield_label_10_101' class='gfield_label gform-field-label' for='input_10_101'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_101' id='input_10_101' type='tel' value='' class='large' tabindex='137' placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><div id=\"field_10_61\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"5a0b5839\" data-field-span=\"12\"><h3 class=\"gsection_title\">B\u00e9n\u00e9ficiaire 6<\/h3><\/div><fieldset id=\"field_10_82\" class=\"gfield gfield--type-name gfield--input-type-name gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"438c08d3\" data-field-span=\"6\"><legend id='gfield_label_10_82' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Nom<\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_10_82'>\n                            \n                            <span id='input_10_82_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_82.3' id='input_10_82_3' value='' tabindex='139'  aria-required='false'     aria-labelledby=\"input_10_82_3_label gfield_label_10_82\"\/>\n                                                    <label for='input_10_82_3' id='input_10_82_3_label' class='gform-field-label gform-field-label--type-sub '>Pr\u00e9nom<\/label>\n                                                <\/span>\n                            \n                            <span id='input_10_82_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_82.6' id='input_10_82_6' value='' tabindex='141'  aria-required='false'     \/>\n                                                    <label for='input_10_82_6' id='input_10_82_6_label' class='gform-field-label gform-field-label--type-sub '>Nom de famille<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_10_83\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"438c08d3\" data-field-span=\"6\"><label id='gfield_label_10_83' class='gfield_label gform-field-label' for='input_10_83'><span class='gform-field-label__text'>Date De Naissance<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='mm\/jj\/aaaa'\n\t\t\t\t\tid='input_10_83'\n\t\t\t\t\tclass='datepicker gform-datepicker mdy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_83'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\ttabindex='143' \n\t\t\t\t\t\n\t\t\t\t\tdata-mask=\"99\/99\/9999\"\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_10_83' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_10_83' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_10_83' aria-label='Date De Naissance: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_10_84\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"73bcd6fe\" data-field-span=\"4\"><label id='gfield_label_10_84' class='gfield_label gform-field-label' for='input_10_84'><span class='gform-field-label__text'>Lien de parent\u00e9<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_84' id='input_10_84' type='text' value='' class='large'   tabindex='144'   aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_10_85\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"73bcd6fe\" data-field-span=\"4\"><label id='gfield_label_10_85' class='gfield_label gform-field-label' for='input_10_85'><span class='gform-field-label__text'>Sexe<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_85' id='input_10_85' class='large gfield_select' tabindex='145'    aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Sexe<\/option><option value='Masculin' >Masculin<\/option><option value='F\u00e9minin' >F\u00e9minin<\/option><option value='Autre' >Autre<\/option><\/select><\/div><\/div><div id=\"field_10_86\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"73bcd6fe\" data-field-span=\"4\"><label id='gfield_label_10_86' class='gfield_label gform-field-label' for='input_10_86'><span class='gform-field-label__text'>Pourcentage (%)<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_86' id='input_10_86' type='number' step='any'   value='' class='large' tabindex='146'     aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_10_98\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"b29c33ad\" data-field-span=\"6\"><label id='gfield_label_10_98' class='gfield_label gform-field-label' for='input_10_98'><span class='gform-field-label__text'>Courriel<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_98' id='input_10_98' type='email' value='' class='large' tabindex='147'    aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_10_103\" class=\"gfield gfield--type-phone gfield--input-type-phone gfield--phone-format-standard gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"b29c33ad\" data-field-span=\"6\"><label id='gfield_label_10_103' class='gfield_label gform-field-label' for='input_10_103'><span class='gform-field-label__text'>T\u00e9l\u00e9phone<\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_103' id='input_10_103' type='tel' value='' class='large' tabindex='148' placeholder='(999) 999-9999'  aria-invalid=\"false\"   data-mask=\"(999) 999-9999\" \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_10_31' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' tabindex='149'>Pr\u00e9c\u00e9dent<\/button> <button type='button' id='gform_next_button_10_31' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' tabindex='150'>Suivant<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_10_4' class='gform_page' data-js='page-field-id-31' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_10_4' class='gform_fields top_label form_sublabel_below description_below validation_below' data-column-layout='fill'><fieldset id=\"field_10_33\" class=\"gfield gfield--type-consent gfield--type-choice gfield--input-type-consent gfield--width-full gfield_contains_required field_sublabel_below gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\" data-group-id=\"753d4cf4\" data-field-span=\"12\"><legend id='gfield_label_10_33' class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>CONSENTEMENT ET SIGNATURE<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class='gfield_description gfield_consent_description' id='gfield_consent_description_10_33'><div class='gfield_consent_description_text gform-theme__no-reset--children' tabindex='0'><strong>CONSENTEMENT \u00c0 LA COLLECTE, \u00c0 L\u2019UTILISATION ET \u00c0 LA COMMUNICATION DE RENSEIGNEMENTS PERSONNELS<\/strong><br \/>\n<br \/>\nLes renseignements personnels contenus dans le pr\u00e9sent formulaire sont confidentiels et ne seront utilis\u00e9s qu\u2019aux fins de l\u2019administration du R\u00e9gime de retraite des M\u00e9tallos.<br \/>\n<br \/>\nEn signant ci-dessous, je consens \u00e0 la collecte, \u00e0 l\u2019utilisation et \u00e0 la communication de mes renseignements personnels aux fins de l\u2019administration du R\u00e9gime, et j\u2019autorise la collecte et l\u2019utilisation de mes renseignements personnels ainsi que de ceux de mon conjoint par l\u2019administrateur du R\u00e9gime, ses mandataires, d\u00e9l\u00e9gataires et fournisseurs de services, ainsi que par les employeurs participants, conform\u00e9ment \u00e0 la D\u00e9claration de confidentialit\u00e9 du R\u00e9gime.<br \/>\n<br \/>\n<strong>AUTORISATION \u00c9LECTRONIQUE<\/strong><br \/>\n<br \/>\nEn s\u00e9lectionnant la case de consentement et en apposant ma signature \u00e9lectronique, je confirme avoir lu ce qui pr\u00e9c\u00e8de et consentir \u00e0 la collecte, \u00e0 l\u2019utilisation et \u00e0 la communication de mes renseignements personnels comme d\u00e9crit ci-dessus.<\/div><\/div><div class='ginput_container ginput_container_consent'><input name='input_33.1' id='input_10_33_1' type='checkbox' value='1' tabindex='151' aria-describedby=\"gfield_consent_description_10_33\" aria-labelledby=\"input_10_33_1_label gfield_label_10_33\" aria-required=\"true\" aria-invalid=\"false\"   \/> <label id='input_10_33_1_label' class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_10_33_1' ><span class='gform-field-label__text'>J\u2019ai lu ce qui pr\u00e9c\u00e8de et je consens \u00e0 la collecte, \u00e0 l\u2019utilisation et \u00e0 la communication de mes renseignements personnels comme d\u00e9crit ci-dessus<\/span><\/label><input type='hidden' name='input_33.2' value='J\u2019ai lu ce qui pr\u00e9c\u00e8de et je consens \u00e0 la collecte, \u00e0 l\u2019utilisation et \u00e0 la communication de mes renseignements personnels comme d\u00e9crit ci-dessus' class='gform_hidden' \/><input type='hidden' name='input_33.3' value='14' class='gform_hidden' \/><\/div><\/fieldset><fieldset id=\"field_10_105\" class=\"gfield gfield--type-signature gfield--input-type-signature gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\" data-group-id=\"259a4ad1\" data-field-span=\"12\"><legend id='gfield_label_10_105' class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Signature (obligatoire)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(N\u00e9cessaire)<\/span><\/span><\/legend><div class=\"ginput_container ginput_container_signature\"><input type='hidden' value='' name='input_105' id='input_10_105_signature_filename' class='gfield_signature_filename'\/><div class='gfield_signature_ui_container gform-theme__no-reset--children' ><div id='input_10_105_Container' class='gfield_signature_container' style='height:90px; width:700px; ' ><input type='hidden' id='input_10_105_data' name='input_10_105_data' class='gfield_signature_data' \/><canvas id=\"input_10_105\" width=\"700\" height=\"90\" style=\"border-style: Dashed; border-width: 2px; border-color: #757575; background-color:#FFFFFF; cursor: url(https:\/\/steelworkerspensionplan.ca\/wp-content\/plugins\/gravityformssignature\/assets\/img\/pen.cur), pointer;\" tabindex=\"0\" aria-label=\"Signature pad\" ><\/canvas><input type='text' id='input_10_105_textinput' name='input_10_105_textinput' class='gfield_signature_text_input' style='text-indent:10px;display:none;width:700px;height:90px;border-style:Dashed;border-width:2px;border-color:#757575;background-color:#FFFFFF;font-family:&quot;Snell Roundhand&quot;, &quot;Segoe Script&quot;, cursive;font-size:2em;padding:0 12px;box-sizing:border-box;color:#000000;' placeholder='Type your signature' autocomplete='off' aria-label='Type your signature' \/><style type='text\/css'>\n                #input_10_105_textinput::placeholder {\n                    font-size: 1.5rem;\n                    font-family: Arial;\n                    opacity: 0.8;\n                }\n            <\/style><\/div><div id='input_10_105_toolbar' class='gfield_signature_toolbar' dir='ltr' style='margin:5px 0;position:relative;height:35px;width:700px;max-width:100%;display:flex;align-items:center;'><div id='input_10_105_status' class='gfield_signature_status gform-visually-hidden' role='status' aria-live='polite' aria-atomic='true' style='position:absolute;width:1px;height:1px;padding:0;margin:-1px;overflow:hidden;clip:rect(0,0,0,0);white-space:nowrap;border:0;'><\/div><input type='hidden' id='input_10_105_font_select' class='gfield_signature_font_select' value='script' \/><div id='input_10_105_font_dropdown' class='gfield_signature_font_dropdown'><span class='gform-common-icon gform-common-icon--chevron-down gfield_signature_font_dropdown_icon'><\/span><button type='button' id='input_10_105_font_select_button' class='gfield_signature_font_select_button gform-theme__disable' tabindex='0' aria-haspopup='listbox' aria-expanded='false' aria-label='Font Options' style='width:100%;box-sizing:border-box;overflow:hidden;text-overflow:ellipsis;white-space:nowrap;font-family:\"Snell Roundhand\", \"Segoe Script\", cursive;color:#000000'>Your Name<\/button><ul id='input_10_105_font_select_list' class='gfield_signature_font_select_list' role='listbox' tabindex='-1' style='display:none;position:absolute;top:100%;left:0;right:0;margin:0;padding:0;list-style:none;background:#fff;border:1px solid #ccc;z-index:10;max-height:200px;overflow-y:auto;box-sizing:border-box;'><li class='gfield_signature_font_option' role='option' data-value='script' tabindex='0' style='font-family:&quot;Snell Roundhand&quot;, &quot;Segoe Script&quot;, cursive; color:#000000' aria-label='Your Name, Script style'>Your Name<\/li><li class='gfield_signature_font_option' role='option' data-value='handwritten' tabindex='0' style='font-family:&quot;Bradley Hand&quot;, &quot;Comic Sans MS&quot;, cursive; color:#000000' aria-label='Your Name, Handwritten style'>Your Name<\/li><li class='gfield_signature_font_option' role='option' data-value='print' tabindex='0' style='font-family:&quot;Noteworthy&quot;, &quot;Segoe Print&quot;, cursive; color:#000000' aria-label='Your Name, Print style'>Your Name<\/li><\/ul><\/div><div class='gfield_signature_toolbar_icons' style='margin-left:auto;display:flex;align-items:center;'><button type='button' id='input_10_105_textbutton' class='gform-common-icon gform-common-icon--text-field gfield_signature_text_button gform-theme-no-framework' tabindex='0' style='background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Text Signature' aria-label='Text Signature'><\/button><button type='button' id='input_10_105_drawbutton' class='gform-common-icon gform-common-icon--pencil gfield_signature_draw_button gform-theme-no-framework' tabindex='0' style='display:none;background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Draw Signature' aria-label='Draw Signature'><\/button><button type='button' id='input_10_105_resetbutton' class='gform-common-icon gform-common-icon--arrow-path gfield_signature_reset_button gform-theme-no-framework' tabindex='0' style='background:none;border:0;padding:0;margin:0;appearance:none;-webkit-appearance:none;cursor:pointer;' alt='Clear Signature' aria-label='Clear Signature'><\/button><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_10_108\" class=\"gfield gfield--type-turnstile gfield--input-type-turnstile 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