{"id":10,"date":"2021-11-07T13:57:26","date_gmt":"2021-11-07T12:57:26","guid":{"rendered":"https:\/\/wniosek.businessfirst.pl\/?page_id=10"},"modified":"2023-04-25T20:27:44","modified_gmt":"2023-04-25T18:27:44","slug":"wniosek","status":"publish","type":"page","link":"https:\/\/wniosek.businessfirst.pl\/","title":{"rendered":"Wniosek"},"content":{"rendered":"<html xmlns=\"http:\/\/www.w3.org\/1999\/html\">\r\n<head>\r\n    <link rel=\"stylesheet\" href=\"https:\/\/code.jquery.com\/ui\/1.14.1\/themes\/base\/jquery-ui.css\">\r\n    <link href=\"https:\/\/cdn.jsdelivr.net\/npm\/bootstrap@5.1.0\/dist\/css\/bootstrap.min.css\" rel=\"stylesheet\"\r\n          integrity=\"sha384-KyZXEAg3QhqLMpG8r+8fhAXLRk2vvoC2f3B09zVXn8CA5QIVfZOJ3BCsw2P0p\/We\" crossorigin=\"anonymous\">\r\n<\/head>\r\n<body>\r\n<form>\r\n    <div class=\"dynamic-line mb-5\"><\/div>\r\n    <div class=\"logo m-5 mt-0\">\r\n        <img loading=\"lazy\" decoding=\"async\" width=\"175\" height=\"24\"\r\n             src=\"https:\/\/wniosek.businessfirst.pl\/\/wp-content\/uploads\/2021\/11\/ATR_businessfirst_rgb_hr.png\"\/>\r\n    <\/div>\r\n\r\n    <div>\r\n        <div class=\"main-banner mb-4\">\r\n            <div class=\"main-banner-header\">\r\n                <p>Tw\u00f3j rozw\u00f3j, nasze do\u015bwiadczenie<\/p>\r\n            <\/div>\r\n        <\/div>\r\n    <\/div>\r\n\r\n    <div class=\"container\">\r\n        <div id=\"successModal\" class=\"modal\" tabindex=\"-1\">\r\n            <div class=\"modal-dialog\">\r\n                <div class=\"modal-content\">\r\n                    <div class=\"modal-header\">\r\n                        <h5 class=\"modal-title\">Wniosek wys\u0142any<\/h5>\r\n                        <button type=\"button\" class=\"btn-close\" data-dismiss=\"modal\" aria-label=\"Close\"><\/button>\r\n                    <\/div>\r\n                    <div class=\"modal-body\">\r\n                        <p>Dzi\u0119kujemy. Wniosek zosta\u0142 przes\u0142any do akceptacji.<\/p>\r\n                    <\/div>\r\n                    <div class=\"modal-footer\">\r\n                        <button type=\"button\" class=\"btn btn-secondary\" data-dismiss=\"modal\">Zamknij<\/button>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n\r\n        <div class=\"row\">\r\n            <div class=\"col-sm-6\">\r\n                <div id=\"chooseActorForm\">\r\n                    <div class=\"row section\">\r\n                        <div class=\"col\">\r\n                            <label class=\"section-label\">Kto wype\u0142nia wniosek?<\/label>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <input id=\"chooseActorInputBroker\" name=\"chooseActorInput\" type=\"radio\" value=\"1\" checked \/>\r\n                                    <label for=\"chooseActorInputBroker\">Po\u015brednik ubezpieczeniowy<\/label>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <input id=\"chooseActorInputRepresentative\" name=\"chooseActorInput\" type=\"radio\" value=\"2\" \/>\r\n                                    <label for=\"chooseActorInputRepresentative\">Osoba upowa\u017cniona do reprezentacji przedsi\u0119biorcy<\/label>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <button id=\"chooseActorToStep1\" type=\"button\" class=\"btn btn-primary\">Nast\u0119pny krok<\/button>\r\n                <\/div>\r\n                <div id=\"step1form\">\r\n                    <div class=\"row section\">\r\n                        <div class=\"col\">\r\n                            <label class=\"section-label\">Informacja<\/label>\r\n                            <h5>Poni\u017cszy wniosek ma charakter jedynie informacyjny, jego wype\u0142nienie i wys\u0142anie do\r\n                                akceptacji\r\n                                nie\r\n                                oznacza zawarcia umowy.<\/h5>\r\n                            <h5>Zawarcie polisy b\u0119dzie mo\u017cliwe po ostatecznej akceptacji warunk\u00f3w ubezpieczenia, kt\u00f3re\r\n                                b\u0119d\u0119\r\n                                dostarczone w osobnym dokumencie.<\/h5>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <div class=\"row section brokerOnly\">\r\n                        <div class=\"col\">\r\n                            <label class=\"section-label\">Dane po\u015brednika<\/label>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"brokerNameInput\" class=\"form-control\"\r\n                                               name=\"brokerName\"\/>\r\n                                        <label id=\"brokerNameInputValid\" for=\"brokerNameInput\">Imi\u0119 i nazwisko osoby reprezentuj\u0105cej po\u015brednika<\/label>\r\n                                        <label id=\"brokerNameInputInvalid\" for=\"brokerNameInput\"\r\n                                               class=\"validation\">Imi\u0119 i nazwisko osoby reprezentuj\u0105cej po\u015brednika nie moga by\u0107 puste<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"brokerEmailInput\" class=\"form-control\"\r\n                                               name=\"brokerEmail\"\/>\r\n                                        <label id=\"brokerEmailInputValid\" for=\"brokerEmailInput\">Adres e-mail osoby reprezentuj\u0105cej po\u015brednika<\/label>\r\n                                        <label id=\"brokerEmailInputInvalid\" for=\"brokerEmailInput\"\r\n                                               class=\"validation\">Adres e-mail po\u015brednika nie mo\u017ce by\u0107 pusty<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"brokerPhoneInput\" class=\"form-control\"\r\n                                               name=\"brokerPhone\"\/>\r\n                                        <label id=\"brokerPhoneInputValid\" for=\"brokerPhoneInput\">Numer telefonu osoby reprezentuj\u0105cej po\u015brednika<\/label>\r\n                                        <label id=\"brokerPhoneInputInvalid\" for=\"brokerPhoneInput\"\r\n                                               class=\"validation\">Nr telefonu po\u015brednika musi zawiera\u0107 9 cyfr<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"brokerDataInput\" class=\"form-control\"\r\n                                               name=\"brokerData\"\/>\r\n                                        <label id=\"brokerDataInputValid\" for=\"brokerDataInput\">Dane firmowe po\u015brednika<\/label>\r\n                                        <label id=\"brokerDataInputInvalid\" for=\"brokerDataInput\"\r\n                                               class=\"validation\">Dane firmowe po\u015brednika nie mog\u0105 by\u0107 puste<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"brokerNipInput\" class=\"form-control\" name=\"brokerNip\"\/>\r\n                                        <label id=\"brokerNipInputValid\" for=\"brokerNipInput\">Nr NIP po\u015brednika<\/label>\r\n                                        <label id=\"brokerNipInputInvalid\" for=\"brokerNipInput\" class=\"validation\">NIP po\u015brednika musi zawiera\u0107\r\n                                            10\r\n                                            cyfr<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <div class=\"row section\">\r\n                        <div class=\"col\">\r\n                            <label class=\"section-label\">Dane ubezpieczaj\u0105cego<\/label>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"companyNameInput\" class=\"form-control\"\r\n                                               name=\"companyName\"\/>\r\n                                        <label id=\"companyNameInputValid\" for=\"companyNameInput\">Nazwa firmy<\/label>\r\n                                        <label id=\"companyNameInputInvalid\" for=\"companyNameInput\" class=\"validation\">Nazwa\r\n                                            firmy\r\n                                            nie\r\n                                            mo\u017ce\r\n                                            by\u0107 pusta<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"nipInput\" class=\"form-control\" name=\"nip\"\/>\r\n                                        <label id=\"nipInputValid\" for=\"nipInput\">NIP<\/label>\r\n                                        <label id=\"nipInputInvalid\" for=\"nipInput\" class=\"validation\">NIP musi zawiera\u0107\r\n                                            10\r\n                                            cyfr<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <div class=\"row section\">\r\n                        <div class=\"col\">\r\n                            <label class=\"section-label\">Adres siedziby<\/label>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"cityInput\" class=\"form-control\" name=\"companyName\"\/>\r\n                                        <label id=\"cityInputValid\" for=\"cityInput\">Miejscowo\u015b\u0107<\/label>\r\n                                        <label id=\"cityInputInvalid\" for=\"cityInput\" class=\"validation\">Miejscowo\u015b\u0107 nie\r\n                                            mo\u017ce by\u0107\r\n                                            pusta<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"zipCodeInput\" class=\"form-control\" name=\"zipCode\"\/>\r\n                                        <label id=\"zipCodeInputValid\" for=\"zipCodeInput\">Kod pocztowy<\/label>\r\n                                        <label id=\"zipCodeInputInvalid\" for=\"zipCodeInput\" class=\"validation\">Kod\r\n                                            pocztowy nie mo\u017ce\r\n                                            by\u0107\r\n                                            pusty<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"streetInput\" class=\"form-control\" name=\"zipCode\"\/>\r\n                                        <label id=\"streetInputValid\" for=\"streetInput\">Ulica i nr<\/label>\r\n                                        <label id=\"streetInputInvalid\" for=\"streetInput\" class=\"validation\">Ulica nie\r\n                                            mo\u017ce by\u0107\r\n                                            pusta<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <button id=\"step1ToChooseActor\" type=\"button\" class=\"btn btn-primary\">Poprzedni krok<\/button>\r\n                    <button id=\"step1to2\" type=\"button\" class=\"btn btn-primary\">Nast\u0119pny krok<\/button>\r\n                <\/div>\r\n                <div id=\"step2form\">\r\n                    <div class=\"row section\">\r\n                        <div class=\"col\">\r\n                            <label class=\"section-label\">\r\n                                <div>Poni\u017csza kalkulacja ma jedynie charakter informacyjny.<\/div>\r\n                                <div>Kalkulacja jest mo\u017cliwa tylko dla podmiot\u00f3w, kt\u00f3rych przych\u00f3d netto w ostatnim\r\n                                    roku obrotowym nie by\u0142 wy\u017cszy ni\u017c 20 000 000 PLN.\r\n                                <\/div>\r\n                            <\/label>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <div class=\"row section\">\r\n                        <div class=\"col\">\r\n                            <label class=\"section-label\">Przychody netto w ostatnim zamkni\u0119tym roku obrotowym (w\r\n                                pe\u0142nych\r\n                                z\u0142otych)<\/label>\r\n                            <div class=\"row\">\r\n                                <div class=\"col-2\">\r\n                                    <label id=\"countryIncomeInputValid\" for=\"countryIncomeInput\"\r\n                                           class=\"input-horizontal-label\">Kraj<\/label>\r\n                                    <label id=\"countryIncomeInputInvalid\" for=\"countryIncomeInput\"\r\n                                           class=\"validation input-horizontal-label\">Warto\u015b\u0107\r\n                                        przychodu nie\r\n                                        mo\u017ce by\u0107 pusta<\/label>\r\n                                <\/div>\r\n                                <div class=\"col-10\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <div class=\"input-group\">\r\n                                            <span class=\"input-group-text\">z\u0142<\/span>\r\n                                            <input type=\"text\" id=\"countryIncomeInput\" class=\"form-control\"\r\n                                                   name=\"countryIncome\"\/>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col-2\">\r\n                                    <label id=\"exportIncomeInputValid\" for=\"exportIncomeInput\"\r\n                                           class=\"input-horizontal-label\">Eksport<\/label>\r\n                                    <label id=\"exportIncomeInputInvalid\" for=\"exportIncomeInput\"\r\n                                           class=\"validation input-horizontal-label\">Warto\u015b\u0107\r\n                                        przychodu nie\r\n                                        mo\u017ce by\u0107 pusta<\/label>\r\n                                <\/div>\r\n                                <div class=\"col-10\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <div class=\"input-group\">\r\n                                            <span class=\"input-group-text\">z\u0142<\/span>\r\n                                            <input type=\"text\" id=\"exportIncomeInput\" class=\"form-control\"\r\n                                                   name=\"exportIncome\"\/>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"row\">\r\n                                        <div class=\"col\">\r\n                                            Przychody \u0142\u0105cznie\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                    <div class=\"row\">\r\n                                        <div class=\"col\">\r\n                                            <h3>\r\n                                                <span id=\"totalIncomeLabel\"><span\r\n                                                        id=\"totalIncomeValue\"><\/span> z\u0142<\/span>\r\n                                            <\/h3>\r\n                                            <label id=\"totalIncomeInputInvalid\"\r\n                                                   class=\"validation input-horizontal-label\" style=\"color: red\">\u0141\u0105czne przychody nie mog\u0105 przekracza\u0107 20 000 000 z\u0142<\/label>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <div class=\"row section\">\r\n                        <div class=\"col\">\r\n                            <label class=\"section-label\">Kody PKD<\/label>\r\n                            <label class=\"mb-3\">\r\n                                <div>Prosimy w poni\u017cszej wyszukiwarce wybra\u0107 dzia\u0142alno\u015b\u0107 g\u0142\u00f3wn\u0105 podmiotu, kt\u00f3ra ma\r\n                                    podlega\u0107 ubezpieczeniu.\r\n                                <\/div>\r\n                                <div>Do ubezpieczenia mo\u017cna wskaza\u0107 maksymalnie 3 kody dzia\u0142alno\u015bci.<\/div>\r\n                            <\/label>\r\n                            <label id=\"pkdInputValidation\" class=\"validation\" style=\"color: red\">Nale\u017cy wybra\u0107\r\n                                przynajmniej jeden prawid\u0142owy kod PKD z listy<\/label>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input id=\"pkd1Input\" class=\"form-control\" type=\"text\" name=\"pkd1\"\/>\r\n                                        <label for=\"pkd1Input\">Kod PKD 1<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input id=\"pkd2Input\" class=\"form-control\" type=\"text\" name=\"pkd2\"\/>\r\n                                        <label for=\"pkd2Input\">Kod PKD 2<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input id=\"pkd3Input\" class=\"form-control\" type=\"text\" name=\"pkd3\"\/>\r\n                                        <label for=\"pkd3Input\">Kod PKD 3<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <div class=\"row section\">\r\n                        <div class=\"col\">\r\n                            <label class=\"section-label\">Data rozpocz\u0119cia ochrony ubezpieczeniowej<\/label>\r\n                            <label id=\"assuranceStartDateInputInvalid\"\r\n                                   class=\"validation\">Nale\u017cy wybra\u0107 dat\u0119 rozpocz\u0119cia ochrony ubezpieczeniowej<\/label>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"assuranceStartDateInput\" class=\"form-control datepicker\"\r\n                                               name=\"assuranceStartDate\"\/>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <div class=\"row section\">\r\n                        <div class=\"col\">\r\n                            <label class=\"section-label\">Maksymalna kwota odszkodowania<\/label>\r\n                            <label id=\"maxAssuranceInputInvalid\"\r\n                                   class=\"validation\">Nale\u017cy wybra\u0107 maksymaln\u0105 kwot\u0119 odszkodowania<\/label>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <select id=\"maxAssuranceInput\" class=\"form-select\">\r\n                                        <option value=\"\">--Wybierz--<\/option>\r\n                                        <option id=\"maxAssurance250k\" class=\"maxAssuranceOption\" value=\"250000\">250,000\r\n                                            z\u0142\r\n                                        <\/option>\r\n                                        <option id=\"maxAssurance375k\" class=\"maxAssuranceOption\" value=\"375000\">375,000\r\n                                            z\u0142\r\n                                        <\/option>\r\n                                        <option id=\"maxAssurance500k\" class=\"maxAssuranceOption\" value=\"500000\">500,000\r\n                                            z\u0142\r\n                                        <\/option>\r\n                                        <option id=\"maxAssurance625k\" class=\"maxAssuranceOption\" value=\"625000\">625,000\r\n                                            z\u0142\r\n                                        <\/option>\r\n                                        <option id=\"maxAssurance750k\" class=\"maxAssuranceOption\" value=\"750000\">750,000\r\n                                            z\u0142\r\n                                        <\/option>\r\n                                        <option id=\"maxAssurance875k\" class=\"maxAssuranceOption\" value=\"875000\">875,000\r\n                                            z\u0142\r\n                                        <\/option>\r\n                                        <option id=\"maxAssurance1000k\" class=\"maxAssuranceOption\" value=\"1000000\">\r\n                                            1,000,000 z\u0142\r\n                                        <\/option>\r\n                                        <option id=\"maxAssurance1500k\" class=\"maxAssuranceOption\" value=\"1500000\">\r\n                                            1,500,000 z\u0142\r\n                                        <\/option>\r\n                                    <\/select>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <div class=\"row section\">\r\n                        <div class=\"col\">\r\n                            <label class=\"section-label\">Spos\u00f3b p\u0142atno\u015bci sk\u0142adki<\/label>\r\n                            <label id=\"paymentTypeInputInvalid\"\r\n                                   class=\"validation\">Nale\u017cy wybra\u0107 spos\u00f3b p\u0142atno\u015bci sk\u0142adki<\/label>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <select id=\"paymentTypeInput\" class=\"form-select\">\r\n                                        <option id=\"oneTime\" value=\"1\">Rocznie<\/option>\r\n                                        <option id=\"semiAnnually\" value=\"3\">P\u00f3\u0142rocznie<\/option>\r\n                                        <option id=\"quarterly\" value=\"2\">Kwartalnie<\/option>\r\n                                    <\/select>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <div class=\"premiumContainer\">\r\n                        <div class=\"row premiumLabelYearly section\">\r\n                            <div class=\"col\">\r\n                                <label class=\"section-label\">Sk\u0142adka roczna wg kalkulacji<\/label>\r\n                                <div class=\"row premiumLabelYearly\">\r\n                                    <div class=\"col\">\r\n                                        <h3 style=\"color: green\">\r\n                                            <span id=\"premiumValueYearly\"><\/span> z\u0142\r\n                                        <\/h3>\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"row premiumLabelQuarterly\">\r\n                                    <div class=\"col\">\r\n                                        Sk\u0142adka p\u0142atna kwartalnie\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"row premiumLabelQuarterly\">\r\n                                    <div class=\"col\">\r\n                                        <h3 style=\"color: green\">\r\n                                            <span id=\"premiumValueQuarterly\"><\/span> z\u0142\r\n                                        <\/h3>\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"row premiumLabelMonthly\">\r\n                                    <div class=\"col\">\r\n                                        Sk\u0142adka p\u0142atna p\u00f3\u0142rocznie\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"row premiumLabelMonthly\">\r\n                                    <div class=\"col\">\r\n                                        <h3 style=\"color: green\">\r\n                                            <span id=\"premiumValueMonthly\"><\/span> z\u0142\r\n                                        <\/h3>\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <input id=\"premium\" type=\"hidden\"\/>\r\n                                <input id=\"periodicalPremium\" type=\"hidden\"\/>\r\n\r\n                                <div class=\"row\">\r\n                                    <div class=\"col\">\r\n                                        <div id=\"lump20k\">\r\n                                            <div class=\"form-check\">\r\n                                                <input id=\"lump20kInput\" class=\"form-check-input\" name=\"lump20k\"\r\n                                                       type=\"checkbox\"\/>\r\n                                                <label class=\"form-check-label fw-bold\" for=\"lump20kInput\">\r\n                                                    Wybieram ubezpieczenie rycza\u0142towe 20,000 z\u0142 i jednocze\u015bnie akceptuj\u0119\r\n                                                    ubezpieczenie ca\u0142ego obrotu\r\n                                                <\/label>\r\n                                            <\/div>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                                <div class=\"row\">\r\n                                    <div class=\"col\">\r\n                                        <div id=\"lump40k\">\r\n                                            <div class=\"form-check\">\r\n                                                <input id=\"lump40kInput\" class=\"form-check-input\" name=\"lump40k\"\r\n                                                       type=\"checkbox\"\/>\r\n                                                <label class=\"form-check-label fw-bold\" for=\"lump40kInput\">\r\n                                                    Wybieram ubezpieczenie rycza\u0142towe 40,000 z\u0142 i jednocze\u015bnie akceptuj\u0119\r\n                                                    ubezpieczenie ca\u0142ego obrotu\r\n                                                <\/label>\r\n                                            <\/div>\r\n                                        <\/div>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <button id=\"step2to1\" type=\"button\" class=\"btn btn-primary\">Poprzedni krok<\/button>\r\n                    <button id=\"step2to3\" type=\"button\" class=\"btn btn-primary\">Nast\u0119pny krok<\/button>\r\n                <\/div>\r\n                <div id=\"step3form\">\r\n                    <div class=\"row section\">\r\n                        <div class=\"col\">\r\n                            <label class=\"section-label\">Sta\u0142e parametry polisy<\/label>\r\n                            <div class=\"row fw-bold mt-1 mt-1\">\r\n                                <div class=\"col\">Okres obowi\u0105zywania polisy - 12 miesi\u0119cy<\/div>\r\n                            <\/div>\r\n                            <div class=\"row fw-bold mt-1\">\r\n                                <div class=\"col\">Okres oczekiwania na zdarzenie szkodowe - 6 miesi\u0119cy<\/div>\r\n                            <\/div>\r\n                            <div class=\"row fw-bold mt-1\">\r\n                                <div class=\"col\">Okres wystawienia faktury - 30 dni<\/div>\r\n                            <\/div>\r\n                            <div class=\"row fw-bold mt-1\">\r\n                                <div class=\"col\">Maksymalny termin p\u0142atno\u015bci - 180 dni<\/div>\r\n                            <\/div>\r\n                            <div class=\"row fw-bold mt-1\">\r\n                                <div class=\"col\">Maksymalna prolongata p\u0142atno\u015bci - 60 dni<\/div>\r\n                            <\/div>\r\n                            <div class=\"row fw-bold mt-1\">\r\n                                <div class=\"col\">Maksymalna suma decyzji limitowych - 16,000,000<\/div>\r\n                            <\/div>\r\n                            <div class=\"row fw-bold mt-1\">\r\n                                <div class=\"col\">Pu\u0142ap limitu on-line - 60,000 z\u0142<\/div>\r\n                            <\/div>\r\n                            <div class=\"row fw-bold mt-1\">\r\n                                <div class=\"col\">Franszyza integralna - 2,000 z\u0142<\/div>\r\n                            <\/div>\r\n                            <div class=\"row fw-bold mt-1\">\r\n                                <div class=\"col\">Pr\u00f3g zg\u0142oszenia up\u0142yni\u0119cia maksymalnej prolongaty p\u0142atno\u015bci - 2,000\r\n                                    z\u0142\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row fw-bold mt-1\">\r\n                                <div class=\"col\">Pr\u00f3g windykacji - 2,000 z\u0142<\/div>\r\n                            <\/div>\r\n                            <div class=\"row fw-bold mt-1\">\r\n                                <div class=\"col\">Op\u0142ata za badanie wiarygodno\u015bci kredytowej - 80 z\u0142<\/div>\r\n                            <\/div>\r\n                            <div class=\"row fw-bold mt-1\">\r\n                                <div class=\"col\">Procentowy zakres ochrony - 90%<\/div>\r\n                            <\/div>\r\n                            <div class=\"row fw-bold mt-1\">\r\n                                <div class=\"col\">Wykaz kraj\u00f3w - EU + OECD<\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <div class=\"row section\">\r\n                        <div class=\"col\">\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"representingPersonInput\" class=\"form-control\"\r\n                                               name=\"representingPerson\"\/>\r\n                                        <label id=\"representingPersonInputValid\" for=\"representingPersonInput\">\r\n                                            <span class=\"representativeOnly\">Osoba reprezentuj\u0105ca przedsi\u0119biorc\u0119<\/span>\r\n                                            <span class=\"brokerOnly\">Osoby reprezentuj\u0105ce przedsi\u0119biorc\u0119 zgodnie z rejestracj\u0105 przedsi\u0119biorcy<\/span>\r\n                                        <\/label>\r\n                                        <label id=\"representingPersonInputInvalid\" for=\"representingPersonInput\" class=\"validation\">\r\n                                            <span class=\"representativeOnly\">Nale\u017cy poda\u0107 osob\u0119 reprezentuj\u0105c\u0105 przedsi\u0119biorc\u0119<\/span>\r\n                                            <span class=\"brokerOnly\">Nale\u017cy poda\u0107 osoby reprezentuj\u0105ce przedsi\u0119biorc\u0119 zgodnie z rejestracj\u0105 przedsi\u0119biorcy<\/span>\r\n                                        <\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"emailInput\" class=\"form-control\"\r\n                                               name=\"email\"\/>\r\n                                        <label id=\"emailInputValid\" for=\"emailInput\">Adres e-mail do kontaktu<\/label>\r\n                                        <label id=\"emailInputInvalid\" for=\"emailInput\"\r\n                                               class=\"validation\">Adres e-mail nie mo\u017ce by\u0107 pusty<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"phoneInput\" class=\"form-control\"\r\n                                               name=\"phone\"\/>\r\n                                        <label id=\"phoneInputValid\" for=\"phoneInput\">Nr telefonu do kontaktu<\/label>\r\n                                        <label id=\"phoneInputInvalid\" for=\"phoneInput\"\r\n                                               class=\"validation\">Nr telefonu musi zawiera\u0107 9 cyfr<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"bankInput\" class=\"form-control\"\r\n                                               name=\"bank\"\/>\r\n                                        <label id=\"bankInputValid\" for=\"bankInput\">Nazwa banku obs\u0142uguj\u0105cego\r\n                                            podmiot<\/label>\r\n                                        <label id=\"bankInputInvalid\" for=\"bankInput\"\r\n                                               class=\"validation\">Nazwa banku nie mo\u017ce by\u0107 pusta<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"swiftInput\" class=\"form-control\"\r\n                                               name=\"swift\"\/>\r\n                                        <label id=\"swiftInputValid\" for=\"swiftInput\">Kod SWIFT<\/label>\r\n                                        <label id=\"swiftInputInvalid\" for=\"swiftInput\"\r\n                                               class=\"validation\">Kod SWIFT nie mo\u017ce by\u0107 pusty<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <div class=\"form-floating mb-3\">\r\n                                        <input type=\"text\" id=\"accountNumberInput\" class=\"form-control\"\r\n                                               name=\"accountNumber\"\/>\r\n                                        <label id=\"accountNumberInputValid\" for=\"accountNumberInput\">Nr konta\r\n                                            bankowego<\/label>\r\n                                        <label id=\"accountNumberInputInvalid\" for=\"accountNumberInput\"\r\n                                               class=\"validation\">Nr konta bankowego musi zawiera\u0107 26 cyfr<\/label>\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <div class=\"row section\">\r\n                        <div class=\"col\">\r\n                            <label class=\"section-label\">Prosz\u0119 wskaza\u0107 czy polisa b\u0119dzie zabezpieczeniem kredytu lub\r\n                                faktoringu lub b\u0119dzie dokonywana cesja praw<\/label>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <label id=\"transferInputInvalid\" class=\"validation\">Nale\u017cy wybra\u0107 opcj\u0119\r\n                                        cesji<\/label>\r\n                                    <select id=\"transferInput\" class=\"form-select\">\r\n                                        <option value=\"\">--Wybierz--<\/option>\r\n                                        <option id=\"transferYes\" value=\"1\">Tak<\/option>\r\n                                        <option id=\"transferNo\" value=\"0\">Nie<\/option>\r\n                                    <\/select>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <div class=\"row section representativeOnly\">\r\n                        <div class=\"col\">\r\n                            <label class=\"section-label\">O\u015bwiadczenie<\/label>\r\n                            <div class=\"row\">\r\n                                <div class=\"col\">\r\n                                    <p>WNIOSKODAWCA O\u015aWIADCZA, \u017bE<\/p>\r\n                                    <div>1. Zapozna\u0142 si\u0119 z aktualnymi Warunkami Ubezpieczenia Polisa Modu\u0142owa First.\r\n                                    <\/div>\r\n                                    <div>2. Wyra\u017ca wol\u0119 zawarcia umowy ubezpieczenia nale\u017cno\u015bci na warunkach okre\u015blonych\r\n                                        w niniejszym wniosku i Warunkach Ubezpieczenia Polisa modu\u0142owa First.\r\n                                    <\/div>\r\n                                    <div>3. Wyra\u017ca wol\u0119 zawarcia umowy windykacyjnej i akceptuje warunki okre\u015blone w\r\n                                        Regulaminie Umowy o Windykacj\u0119 nale\u017cno\u015bci z Atradius Collections BV Sp. z o.o.\r\n                                        Oddzia\u0142 w Polsce.\r\n                                    <\/div>\r\n                                    <div>4. Dane przedstawione w niniejszym wniosku s\u0105 prawdziwe.<\/div>\r\n                                    <div>5. Zobowi\u0105zuje si\u0119 do przes\u0142ania danych finansowych za ostatni zamkni\u0119ty rok\r\n                                        obrotowy.\r\n                                    <\/div>\r\n                                <\/div>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <button id=\"step3to2\" type=\"button\" class=\"btn btn-primary\">Poprzedni krok<\/button>\r\n                    <button id=\"step3to4\" type=\"button\" class=\"btn btn-primary\">Nast\u0119pny krok<\/button>\r\n                <\/div>\r\n                <div id=\"step4form\">\r\n                    <div class=\"row section\">\r\n                        <div class=\"form-check\">\r\n                            <input id=\"rodoInput\" class=\"form-check-input\" name=\"rodo\"\r\n                                   type=\"checkbox\"\/>\r\n                            <label class=\"form-check-label fw-bold\" for=\"rodoInput\">\r\n                                O\u015bwiadczam, \u017ce zapozna\u0142em si\u0119 z warunkami <a href=\"https:\/\/wniosek.businessfirst.pl\/wp-content\/uploads\/2022\/04\/RODO-OSWIADCZENIE.pdf\" target=\"_blank\">RODO<\/a>\r\n                                <label id=\"rodoInputInvalid\" for=\"rodoInput\" class=\"rodoValidation validation\">Nale\u017cy zaakceptowa\u0107 warunki RODO<\/label>\r\n                            <\/label>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <div class=\"row section\">\r\n                        <div class=\"col\">\r\n                            <p>Do wniosku za\u0142\u0105czam dane finansowe za ostatni zamkni\u0119ty rok obrotowy:<\/p>\r\n                            <button id=\"sendFinancialDataButton\" type=\"button\" class=\"btn btn-primary\">Wysy\u0142am dane\r\n                            <\/button>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <div class=\"row mb-3\">\r\n                        <div class=\"col\">\r\n                            <div>\r\n                                <button id=\"submitButton\" type=\"button\" class=\"btn btn-primary send-button\">WY\u015aLIJ WNIOSEK DO\r\n                                    AKCEPTACJI\r\n                                <\/button>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                    <div class=\"row\">\r\n                        <div class=\"col\">\r\n                            <div>\r\n                                <button id=\"step4to3\" type=\"button\" class=\"btn btn-primary\">Poprzedni krok<\/button>\r\n                            <\/div>\r\n                        <\/div>\r\n                    <\/div>\r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n    <\/div>\r\n<\/form>\r\n<div class=\"footer-container pt-5 pb-5 mt-4\">\r\n    <div class=\"container\">\r\n        <div class=\"row footer-logos\">\r\n            <div class=\"col\">\r\n                <div class=\"company-logo-atradius\">\r\n                    <img decoding=\"async\" class=\"catalana-logo\" src=\"https:\/\/wniosek.businessfirst.pl\/wp-content\/uploads\/2025\/07\/Atradius_Managing-Risk-Logo-scaled.png\"\r\n                            alt=\"Atradius Logo with Tagline\" height=\"40px\">\r\n                <\/div>\r\n            <\/div>\r\n            <div class=\"col\">\r\n                <div class=\"company-logo-catalana\">\r\n                    <p> Firma <\/p>\r\n                    <img decoding=\"async\" class=\"catalana-logo\" src=\"https:\/\/wniosek.businessfirst.pl\/wp-content\/uploads\/2023\/04\/catalana_occidente_group_logo11.png\"\r\n                            alt=\"Catalana Occidente\" height=\"40px\">\r\n                <\/div>\r\n            <\/div>\r\n        <\/div>\r\n    <\/div>\r\n<\/div>\r\n<\/body>\r\n<\/html>\r\n\r\n\r\n\r\n\r\n\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"template-page-builder.php","meta":{"footnotes":""},"class_list":["post-10","page","type-page","status-publish","hentry","entry"],"_links":{"self":[{"href":"https:\/\/wniosek.businessfirst.pl\/index.php?rest_route=\/wp\/v2\/pages\/10","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/wniosek.businessfirst.pl\/index.php?rest_route=\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/wniosek.businessfirst.pl\/index.php?rest_route=\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/wniosek.businessfirst.pl\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/wniosek.businessfirst.pl\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=10"}],"version-history":[{"count":3,"href":"https:\/\/wniosek.businessfirst.pl\/index.php?rest_route=\/wp\/v2\/pages\/10\/revisions"}],"predecessor-version":[{"id":24,"href":"https:\/\/wniosek.businessfirst.pl\/index.php?rest_route=\/wp\/v2\/pages\/10\/revisions\/24"}],"wp:attachment":[{"href":"https:\/\/wniosek.businessfirst.pl\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=10"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}