1 → What stage are you at with life insurance?*

<${validation.ErrorMessage} errors=${validation.errors} name="Stage" as=${html``} />

2 → Are you a citizen or permanent resident of Australia?*

<${validation.ErrorMessage} errors=${validation.errors} name="Citizen" as=${html``} />
<${props.ReactPhoneInput} inputProps=${{ name: "mf-mobile" }} inputExtraProps=${{ required: true, autoFocus: true, }} key=${parent.state.resetKey} searchPlaceholder="Search" inputClass="mf-input mf-input-mobile" country="us" enableSearch=${true} countryCodeEditable=${false} enableAreaCodes=${false} value=${parent.state.mobileWidget["mf-mobile"] ? parent.state.mobileWidget["mf-mobile"] : (parent.state.formData["mf-mobile"] ? parent.state.formData["mf-mobile"] : '')} } name="mf-mobile" id="mf-input-mobile-95d501a" onChange=${(value, country) => { return parent.handleOnChangePhoneInput(value, "mf-mobile", country) } } onBlur=${(event, country) => { let value = event.target.value; if(value){ value = value.replace(/[^\d]/g, ''); } parent.handleOnChangePhoneInput(value, "mf-mobile", country) } } /> parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false}, el) } /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-mobile" as=${html``} />

3 → What is your relationship status?*

<${validation.ErrorMessage} errors=${validation.errors} name="Relation" as=${html``} />

4 → How many children do you have?*

Add a number starting from 0

<${validation.ErrorMessage} errors=${validation.errors} name="Children" as=${html``} />

5 → Why do you need life insurance?*

When I die, I need my life insurance to (select any that apply)

<${validation.ErrorMessage} errors=${validation.errors} name="Life_Insurance" as=${html``} />

6 → What is your Date Of Birth?*

<${props.Flatpickr} name="mf-date" className="mf-input mf-date-input mf-left-parent " placeholder="${ parent.decodeEntities(`Select Date of Birth`) } " options=${{"minDate":"","maxDate":"","dateFormat":"d-m-Y","enableTime":"","disable":[],"mode":"single","static":true,"disableMobile":true,"time_24hr":false}} value=${parent.getValue('mf-date')} onInput=${parent.handleDateTime} aria-invalid=${validation.errors['mf-date'] ? 'true' : 'false'} ref=${el => props.DateWidget( el, '', {"message":"This field is required.","required":true}, register, parent )} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-date" as=${html``} />

7 → How shall we contact you about your quotes?*

parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":true,"expression":"null"}, el) } /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-listing-fname" as=${html``} />
parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":true,"expression":"null"}, el) } /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-listing-lname" as=${html``} />
<${props.ReactPhoneInput} inputProps=${{ name: "mf-mobile" }} inputExtraProps=${{ required: true, autoFocus: true, }} key=${parent.state.resetKey} searchPlaceholder="Search" inputClass="mf-input mf-input-mobile" country="us" enableSearch=${true} countryCodeEditable=${false} enableAreaCodes=${false} value=${parent.state.mobileWidget["mf-mobile"] ? parent.state.mobileWidget["mf-mobile"] : (parent.state.formData["mf-mobile"] ? parent.state.formData["mf-mobile"] : '')} } name="mf-mobile" id="mf-input-mobile-8878564" onChange=${(value, country) => { return parent.handleOnChangePhoneInput(value, "mf-mobile", country) } } onBlur=${(event, country) => { let value = event.target.value; if(value){ value = value.replace(/[^\d]/g, ''); } parent.handleOnChangePhoneInput(value, "mf-mobile", country) } } /> parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false}, el) } /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-mobile" as=${html``} />
parent.activateValidation({"message":"This field is required.","emailMessage":"Please enter a valid Email address","minLength":1,"maxLength":"","type":"none","required":true,"expression":"null"}, el)} /> <${validation.ErrorMessage} errors=${validation.errors} name="mf-email" as=${html``} />