{"id":5679,"date":"2021-06-24T10:43:30","date_gmt":"2021-06-24T10:43:30","guid":{"rendered":"https:\/\/www.cosmosinsurance.com.cy\/get-a-quote-cyprus-choice\/"},"modified":"2025-09-25T18:08:14","modified_gmt":"2025-09-25T18:08:14","slug":"get-a-quote-cyprus-choice","status":"publish","type":"page","link":"https:\/\/www.cosmosinsurance.com.cy\/en\/get-a-quote-cyprus-choice\/","title":{"rendered":"Get a Quote CyprusCHOICE"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"5679\" class=\"elementor elementor-5679 elementor-2804\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-4ae63c00 elementor-section-stretched elementor-section-height-min-height elementor-section-boxed elementor-section-height-default elementor-section-items-middle elementor-invisible\" data-id=\"4ae63c00\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;,&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;animation&quot;:&quot;fadeIn&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-2df56f35\" data-id=\"2df56f35\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-d56e76c elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"d56e76c\" data-element_type=\"section\" data-e-type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-93b723b\" data-id=\"93b723b\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-73aeca6 elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"73aeca6\" data-element_type=\"section\" data-e-type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-c7804c4\" data-id=\"c7804c4\" data-element_type=\"column\" data-e-type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-1f4f724 elementor-widget elementor-widget-image\" data-id=\"1f4f724\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"1024\" height=\"1024\" src=\"https:\/\/www.cosmosinsurance.com.cy\/wp-content\/uploads\/2021\/05\/Cyprus-Choice-01.svg\" class=\"attachment-large size-large wp-image-4414\" alt=\"\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-f47ebc8 elementor-widget elementor-widget-heading\" data-id=\"f47ebc8\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Quotation Request<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<div class=\"elementor-element elementor-element-6242a5e elementor-align-center elementor-widget elementor-widget-lottie\" data-id=\"6242a5e\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;source_json&quot;:{&quot;url&quot;:&quot;https:\\\/\\\/www.cosmosinsurance.com.cy\\\/wp-content\\\/uploads\\\/2021\\\/04\\\/37067-blue-arrows-scrool-down.json&quot;,&quot;id&quot;:2342,&quot;size&quot;:&quot;&quot;},&quot;source&quot;:&quot;media_file&quot;,&quot;caption_source&quot;:&quot;none&quot;,&quot;link_to&quot;:&quot;none&quot;,&quot;trigger&quot;:&quot;arriving_to_viewport&quot;,&quot;viewport&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:{&quot;start&quot;:0,&quot;end&quot;:100}},&quot;play_speed&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:1,&quot;sizes&quot;:[]},&quot;start_point&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:0,&quot;sizes&quot;:[]},&quot;end_point&quot;:{&quot;unit&quot;:&quot;%&quot;,&quot;size&quot;:100,&quot;sizes&quot;:[]},&quot;renderer&quot;:&quot;svg&quot;}\" data-widget_type=\"lottie.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"e-lottie__container\"><div class=\"e-lottie__animation\"><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-1f4b05a5 elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default\" data-id=\"1f4b05a5\" data-element_type=\"section\" data-e-type=\"section\" id=\"etareia\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t\t<div class=\"elementor-background-overlay\"><\/div>\n\t\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-no\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-12dcfce6\" data-id=\"12dcfce6\" data-element_type=\"column\" data-e-type=\"column\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-95cf7b9 elementor-widget elementor-widget-text-editor\" data-id=\"95cf7b9\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p data-pm-slice=\"1 1 []\">Fill in the below information to receive your quote<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6eed02c uael-wpf-style-box uael-wpf-input-size-sm uael-wpf-button-left uael-wpf-btn-size-sm uael-wpf-highlight-style-default elementor-widget elementor-widget-uael-wpf-styler\" data-id=\"6eed02c\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;wpf_input_padding&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;wpf_input_padding_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;wpf_input_padding_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;wpf_input_radius&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;0&quot;,&quot;right&quot;:&quot;0&quot;,&quot;bottom&quot;:&quot;0&quot;,&quot;left&quot;:&quot;0&quot;,&quot;isLinked&quot;:true},&quot;wpf_input_radius_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;wpf_input_radius_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;wpf_button_align&quot;:&quot;left&quot;,&quot;wpf_button_padding&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;wpf_button_padding_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;wpf_button_padding_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;btn_border_radius&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;btn_border_radius_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;btn_border_radius_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;top&quot;:&quot;&quot;,&quot;right&quot;:&quot;&quot;,&quot;bottom&quot;:&quot;&quot;,&quot;left&quot;:&quot;&quot;,&quot;isLinked&quot;:true},&quot;form_fields_margin&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;form_fields_margin_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;form_fields_margin_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;form_label_margin_bottom&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;form_label_margin_bottom_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;form_label_margin_bottom_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;form_desc_margin_top&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;form_desc_margin_top_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;form_desc_margin_top_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;check_radio_items_spacing&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;check_radio_items_spacing_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;check_radio_items_spacing_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;submit_spacing&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;submit_spacing_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]},&quot;submit_spacing_mobile&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\" data-widget_type=\"uael-wpf-styler.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class = \"uael-wpf-container\">\n\t\t\t\t\t\t<div class = \"uael-wpf uael-wpf-style elementor-clickable\">\n\t\t\t\t\t\t<div class=\"wpforms-container \" id=\"wpforms-5681\"><form id=\"wpforms-form-5681\" class=\"wpforms-validate wpforms-form\" data-formid=\"5681\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/5679\" data-token=\"2d3c13cde1f00963e06e5722395aa607\" data-token-time=\"1779447513\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#67c8c7\" data-scroll=\"1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> - <\/span><span class=\"wpforms-page-indicator-steps\">Step <span class=\"wpforms-page-indicator-steps-current\">1<\/span> of 2<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:50%;background-color:#67c8c7\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-5681-field_16-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"16\"><\/div><div id=\"wpforms-5681-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><label class=\"wpforms-field-label\" for=\"wpforms-5681-field_0\">Main Insured\u2019s Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5681-field_0\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][0]\" required><\/div><div id=\"wpforms-5681-field_9-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-5681-field_9\">Date of birth of the Main Insured <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-5681-field_9\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][9][date]\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-5681-field_12-container\" class=\"wpforms-field wpforms-field-select wpforms-conditional-trigger wpforms-field-select-style-classic\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-5681-field_12\">Number of Dependents (Including Spouse &amp; Children) <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-5681-field_12\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][12]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Choose<\/option><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><\/select><\/div><div id=\"wpforms-5681-field_27-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"27\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5681-field_27\">Age #1<\/label><input type=\"text\" id=\"wpforms-5681-field_27\" class=\"wpforms-field-large\" name=\"wpforms[fields][27]\" ><\/div><div id=\"wpforms-5681-field_28-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"28\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5681-field_28\">Age #2<\/label><input type=\"text\" id=\"wpforms-5681-field_28\" class=\"wpforms-field-large\" name=\"wpforms[fields][28]\" ><\/div><div id=\"wpforms-5681-field_29-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"29\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5681-field_29\">Age #3<\/label><input type=\"text\" id=\"wpforms-5681-field_29\" class=\"wpforms-field-large\" name=\"wpforms[fields][29]\" ><\/div><div id=\"wpforms-5681-field_30-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-id=\"30\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-5681-field_30\">Age #4<\/label><input type=\"text\" id=\"wpforms-5681-field_30\" class=\"wpforms-field-large\" name=\"wpforms[fields][30]\" ><\/div><div id=\"wpforms-5681-field_22-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"22\"><label class=\"wpforms-field-label\" for=\"wpforms-5681-field_22\">Does the Main Insured or any of the dependents have a health problem? If yes, provide information in the General Comments field below. <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-5681-field_22\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][22]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Choose<\/option><option value=\"Yes\" >Yes<\/option><option value=\"No\" >No<\/option><\/select><\/div><div id=\"wpforms-5681-field_14-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-5681-field_14\">Payment Frequency <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-5681-field_14\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][14]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Choose<\/option><option value=\"Monthly\" >Monthly<\/option><option value=\"Quarterly\" >Quarterly<\/option><option value=\"Biannual\" >Biannual<\/option><option value=\"Annually\" >Annually<\/option><\/select><\/div><div id=\"wpforms-5681-field_23-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"23\"><label class=\"wpforms-field-label\" for=\"wpforms-5681-field_23\">Please select your desirable annual deductible <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-5681-field_23\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][23]\" required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Choose<\/option><option value=\"\u20ac50 \" >\u20ac50<\/option><option value=\"\u20ac85\" >\u20ac85<\/option><option value=\"\u20ac150\" >\u20ac150<\/option><option value=\"\u20ac300  \" >\u20ac300<\/option><option value=\"\u20ac500  \" >\u20ac500<\/option><option value=\"\u20ac1000  \" >\u20ac1000<\/option><option value=\"\u20ac2000  \" >\u20ac2000<\/option><\/select><\/div><div id=\"wpforms-5681-field_18-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-id=\"18\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"5681\" disabled>Next<\/button><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2 last \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-5681-field_4-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"4\"><label class=\"wpforms-field-label\" for=\"wpforms-5681-field_4\">Name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5681-field_4\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][4]\" required><\/div><div id=\"wpforms-5681-field_24-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"24\"><label class=\"wpforms-field-label\" for=\"wpforms-5681-field_24\">Surname <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-5681-field_24\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][24]\" required><\/div><div id=\"wpforms-5681-field_25-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-id=\"25\"><label class=\"wpforms-field-label\" for=\"wpforms-5681-field_25\">Date of birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-5681-field_25\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-large\" data-date-format=\"m\/d\/Y\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][25][date]\" required><a title=\"Clear Date\" data-clear class=\"wpforms-datepicker-clear\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-5681-field_10-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-5681-field_10\">District <span class=\"wpforms-required-label\">*<\/span><\/label><select id=\"wpforms-5681-field_10\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][10]\" required=\"required\"><option value=\"Nicosia\" >Nicosia<\/option><option value=\"Larnaca\" >Larnaca<\/option><option value=\"Limassol\" >Limassol<\/option><option value=\"Paphos\" >Paphos<\/option><option value=\"Famagusta\" >Famagusta<\/option><\/select><\/div><div id=\"wpforms-5681-field_5-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-5681-field_5\">Identification Number (ID) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"number\" id=\"wpforms-5681-field_5\" class=\"wpforms-field-large wpforms-field-required\" 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required=\"required\"><option value=\"\" class=\"placeholder\" disabled  selected='selected'>Choose<\/option><option value=\"Before noon\" >Before noon<\/option><option value=\"After noon\" >After noon<\/option><\/select><\/div><div id=\"wpforms-5681-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-5681-field_2\">General comments <span class=\"wpforms-required-label\">*<\/span><\/label><textarea id=\"wpforms-5681-field_2\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][2]\" required><\/textarea><\/div><div id=\"wpforms-5681-field_8-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"8\"><ul id=\"wpforms-5681-field_8\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-5681-field_8_1\" name=\"wpforms[fields][8][]\" value=\"I agree to the processing of personal data in accordance with &lt;a 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