{"id":5834,"date":"2022-09-21T13:12:02","date_gmt":"2022-09-21T17:12:02","guid":{"rendered":"https:\/\/gulf.adept.sr\/forms\/?page_id=5834"},"modified":"2022-09-27T13:04:55","modified_gmt":"2022-09-27T17:04:55","slug":"exercise-early-maturity-test","status":"publish","type":"page","link":"https:\/\/gulf.adept.sr\/forms\/exercise-early-maturity-test\/","title":{"rendered":"Exercise Early Maturity TEST"},"content":{"rendered":"<p style=\"text-align: center;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-5148\" src=\"https:\/\/gulf.adept.sr\/forms\/wp-content\/uploads\/2021\/01\/Assuria_TT-logo-with-slogan-01-1-300x117.png\" alt=\"\" width=\"300\" height=\"117\" srcset=\"https:\/\/gulf.adept.sr\/forms\/wp-content\/uploads\/2021\/01\/Assuria_TT-logo-with-slogan-01-1-300x117.png 300w, https:\/\/gulf.adept.sr\/forms\/wp-content\/uploads\/2021\/01\/Assuria_TT-logo-with-slogan-01-1-1024x400.png 1024w, https:\/\/gulf.adept.sr\/forms\/wp-content\/uploads\/2021\/01\/Assuria_TT-logo-with-slogan-01-1.png 1212w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/p>\n<h2 style=\"text-align: center;\">Annuity Optional Maturity Date Change<\/h2>\n<p style=\"text-align: center;\"><script type=\"text\/javascript\">var gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,initializeOnLoaded:function(o){gform.domLoaded&&gform.scriptsLoaded?o():!gform.domLoaded&&gform.scriptsLoaded?window.addEventListener(\"DOMContentLoaded\",o):document.addEventListener(\"gform_main_scripts_loaded\",o)},hooks:{action:{},filter:{}},addAction:function(o,n,r,t){gform.addHook(\"action\",o,n,r,t)},addFilter:function(o,n,r,t){gform.addHook(\"filter\",o,n,r,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,n){gform.removeHook(\"action\",o,n)},removeFilter:function(o,n,r){gform.removeHook(\"filter\",o,n,r)},addHook:function(o,n,r,t,i){null==gform.hooks[o][n]&&(gform.hooks[o][n]=[]);var e=gform.hooks[o][n];null==i&&(i=n+\"_\"+e.length),gform.hooks[o][n].push({tag:i,callable:r,priority:t=null==t?10:t})},doHook:function(n,o,r){var t;if(r=Array.prototype.slice.call(r,1),null!=gform.hooks[n][o]&&((o=gform.hooks[n][o]).sort(function(o,n){return o.priority-n.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==n?t.apply(null,r):r[0]=t.apply(null,r)})),\"filter\"==n)return r[0]},removeHook:function(o,n,t,i){var r;null!=gform.hooks[o][n]&&(r=(r=gform.hooks[o][n]).filter(function(o,n,r){return!!(null!=i&&i!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][n]=r)}});<\/script>\n                <div class='gf_browser_gecko gform_wrapper transaction-form_wrapper gform_legacy_markup_wrapper' id='gform_wrapper_102' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_102' class='transaction-form gform_legacy_markup' action='\/forms\/wp-json\/wp\/v2\/pages\/5834' novalidate autocomplete=\"off\">\n                        <div class='gform_body gform-body'><ul id='gform_fields_102' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_102_95\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_95\"><label class='gfield_label' for='input_102_95' >Please Select Policy Type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_95' id='input_102_95' class='medium gfield_select' tabindex='49'   aria-required=\"true\" aria-invalid=\"false\" ><option value='ERA' >ERA<\/option><option value='URA' >URA<\/option><option value='RAP' >RAP<\/option><\/select><\/div><\/li><li id=\"field_102_96\"  class=\"gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_96\"><label class='gfield_label' for='input_102_96' >Policy No.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_96' id='input_102_96' type='text' value='' class='medium'  aria-describedby=\"gfield_description_102_96\" tabindex='50' placeholder='Policy No.' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_102_96'>ERA Policy Number only<\/div><\/li><li id=\"field_102_97\"  class=\"gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_97\"><label class='gfield_label' for='input_102_97' >Policy No.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_97' id='input_102_97' type='text' value='' class='medium'  aria-describedby=\"gfield_description_102_97\" tabindex='51' placeholder='Policy No.' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_102_97'>URA Policy Number only<\/div><\/li><li id=\"field_102_7\"  class=\"gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_7\"><label class='gfield_label' for='input_102_7' >Policy No.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_7' id='input_102_7' type='text' value='' class='medium'  aria-describedby=\"gfield_description_102_7\" tabindex='52' placeholder='Policy No.' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_102_7'>RAP<\/div><\/li><li id=\"field_102_72\"  class=\"gfield clr gfield_html gfield_html_formatted field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_72\"><\/li><li id=\"field_102_1\"  class=\"gfield salutation field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_1\"><label class='gfield_label' for='input_102_1' >Salutation<\/label><div class='ginput_container ginput_container_select'><select name='input_1' id='input_102_1' class='large gfield_select' tabindex='53'    aria-invalid=\"false\" ><option value='Mr.' >Mr.<\/option><option value='Miss.' >Miss.<\/option><option value='Mrs.' >Mrs.<\/option><option value='Dr.' >Dr.<\/option><\/select><\/div><\/li><li id=\"field_102_2\"  class=\"gfield name gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_2\"><label class='gfield_label' for='input_102_2' >First Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_2' id='input_102_2' type='text' value='' class='large'   tabindex='54' placeholder='First Name' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_102_6\"  class=\"gfield name field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_6\"><label class='gfield_label' for='input_102_6' >Middle Name<\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_6' id='input_102_6' type='text' value='' class='large'   tabindex='55' placeholder='Middle Name'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_102_4\"  class=\"gfield name gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_4\"><label class='gfield_label' for='input_102_4' >Last Name<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_4' id='input_102_4' type='text' value='' class='large'   tabindex='56' placeholder='Last Name' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_102_8\"  class=\"gfield gf_middle_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_8\"><label class='gfield_label' for='input_102_8' >Contact No.<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input autocomplete=\"off\"  name='input_8' id='input_102_8' type='tel' value='' class='large' tabindex='57' placeholder='Contact No.' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_102_9\"  class=\"gfield gf_right_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_9\"><label class='gfield_label' for='input_102_9' >Email<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input autocomplete=\"off\"  name='input_9' id='input_102_9' type='email' value='' class='large' tabindex='58'  placeholder='Email' aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_102_84\"  class=\"gfield clr gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_84\"><\/li><li id=\"field_102_91\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_102_91\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label'  >Maturity Proceeds<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_102_91'>\n\t\t\t<li class='gchoice gchoice_102_91_0'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_91' type='radio' value='Request for maturity proceeds'  id='choice_102_91_0' tabindex='59'   \/>\n\t\t\t\t<label for='choice_102_91_0' id='label_102_91_0'>Request for maturity proceeds<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_102_91_1'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_91' type='radio' value='Request for maturity date change'  id='choice_102_91_1' tabindex='60'   \/>\n\t\t\t\t<label for='choice_102_91_1' id='label_102_91_1'>Request for date d change<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_102_91'>Please select whether you are requesting Change of Maturity Date or Maturity Proceeds<\/div><\/li><li id=\"field_102_103\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_103\"><label class='gfield_label'  >Are you in possession of the policy contract?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_102_103'>\n\t\t\t<li class='gchoice gchoice_102_103_0'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_103' type='radio' value='Yes'  id='choice_102_103_0' tabindex='61'   \/>\n\t\t\t\t<label for='choice_102_103_0' id='label_102_103_0'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_102_103_1'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_103' type='radio' value='No'  id='choice_102_103_1' tabindex='62'   \/>\n\t\t\t\t<label for='choice_102_103_1' id='label_102_103_1'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_102_94\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_94\"><label class='gfield_label'  >Maturity Option<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_102_94'>\n\t\t\t<li class='gchoice gchoice_102_94_0'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_94' type='radio' value='Request for maturity proceeds'  id='choice_102_94_0' tabindex='63'   \/>\n\t\t\t\t<label for='choice_102_94_0' id='label_102_94_0'>Request for Maturity Proceeds<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_102_94_1'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_94' type='radio' value='Request for maturity date change'  id='choice_102_94_1' tabindex='64'   \/>\n\t\t\t\t<label for='choice_102_94_1' id='label_102_94_1'>Request Change of Retirement Age<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_102_94'>Please select whether you are requesting Change of Maturity Date or Maturity Proceeds<\/div><\/li><li id=\"field_102_129\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_129\"><label class='gfield_label'  >Change of Retirement Age Type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_102_129'>\n\t\t\t<li class='gchoice gchoice_102_129_0'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_129' type='radio' value='Correction'  id='choice_102_129_0' tabindex='65'   \/>\n\t\t\t\t<label for='choice_102_129_0' id='label_102_129_0'>Correction<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_102_129_1'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_129' type='radio' value='Change of Retirement Age'  id='choice_102_129_1' tabindex='66'   \/>\n\t\t\t\t<label for='choice_102_129_1' id='label_102_129_1'>Change of Retirement Age<\/label>\n\t\t\t<\/li><\/ul><\/div><div class='gfield_description' id='gfield_description_102_129'>Please select whether you are correcting information on prior request or Changing of Maturity Date<\/div><\/li><li id=\"field_102_86\"  class=\"gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_86\"><label class='gfield_label' for='input_102_86' >Please select current Maturity Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input autocomplete=\"off\"  name='input_86' id='input_102_86' type='text' value='' class='datepicker dmy datepicker_with_icon gdatepicker_with_icon' tabindex='67'  placeholder='dd\/mm\/yyyy' aria-describedby=\"input_102_86_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_102_86_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input autocomplete=\"off\"  type='hidden' id='gforms_calendar_icon_input_102_86' class='gform_hidden' value='https:\/\/gulf.adept.sr\/forms\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_102_130\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_130\"><script src=\"https:\/\/code.jquery.com\/jquery-3.5.1.min.js\"><\/script>\n\n<h4 id=\"date_warning\" style=\"display: none; color:red;\">Your selected date is in the future. Please note that airslate slate will be put on pending until maturity date.<\/h4>\n\n<script>\n $(document).ready(function() {\n    const dateInput = $(\"#input_102_86\");\n    const warning = $(\"#date_warning\");\n\n    dateInput.change(function() {\n      const selectedDate = new Date(dateInput.val());\n      const today = new Date();\n\n      if (selectedDate < today) {\n        warning.prop('style', 'display: none'); \/\/ Hide the warning message\n      } else {\n        warning.prop('style', 'display: block'); \/\/ Show the warning message\n      }\n    });\n  });\n<\/script><\/li><li id=\"field_102_116\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_116\"><h2 class=\"gsection_title\">Early Maturity Information<\/h2><\/li><li id=\"field_102_87\"  class=\"gfield gf_middle_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_87\"><label class='gfield_label' for='input_102_87' >Please enter your date of birth<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input autocomplete=\"off\"  name='input_87' id='input_102_87' type='text' value='' class='datepicker dmy datepicker_with_icon gdatepicker_with_icon' tabindex='68'  placeholder='dd\/mm\/yyyy' aria-describedby=\"input_102_87_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_102_87_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input autocomplete=\"off\"  type='hidden' id='gforms_calendar_icon_input_102_87' class='gform_hidden' value='https:\/\/gulf.adept.sr\/forms\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_102_140\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_140\"><script src=\"https:\/\/code.jquery.com\/jquery-3.6.0.min.js\"><\/script>\n<script>\nfunction calculateExactDateOfBirthPlus70Years(dateOfBirth) {\n    \/\/ Validate input date format\n    const datePattern = \/^\\d{2}\\\/\\d{2}\\\/\\d{4}$\/;\n    if (!datePattern.test(dateOfBirth)) {\n        console.error(\"Invalid date format. Please enter date in DD\/MM\/YYYY format.\");\n        return null;\n    }\n\n    \/\/ Split the date string into day, month, and year\n    const [day, month, year] = dateOfBirth.split('\/').map(Number);\n\n    \/\/ Validate input date components\n    if (isNaN(year) || isNaN(month) || isNaN(day)) {\n        console.error(\"Invalid date components.\");\n        return null;\n    }\n\n    \/\/ Create a new Date object with the given date of birth\n    const dob = new Date(year, month - 1, day); \/\/ Note: Month is 0-indexed in JavaScript\n\n    \/\/ Add 70 years to the date of birth\n    dob.setFullYear(dob.getFullYear() + 70);\n\n    \/\/ Return the exact date of birth plus 70 years\n    return dob.toLocaleDateString('en-GB'); \/\/ Convert to local date format (DD\/MM\/YYYY)\n}\n\n$(document).ready(function() {\n    $(\"#input_102_87\").on(\"change\", function() {\n        \/\/ Retrieve the value of the input field with ID input_102_87\n        const dateOfBirth = $(this).val();\n        \n        \/\/ Calculate the exact date of birth plus 70 years\n        const exactDateOfBirthPlus70Years = calculateExactDateOfBirthPlus70Years(dateOfBirth);\n        \n        \/\/ Log the result to the console if it's not null\n        if (exactDateOfBirthPlus70Years !== null) {\n            console.log(exactDateOfBirthPlus70Years);\n            \/\/ Prefill the date field with the calculated date\n            $(\"#input_102_104\").val(exactDateOfBirthPlus70Years);\n        }\n    });\n});\n<\/script>\n<\/li><li id=\"field_102_104\"  class=\"gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_104\"><label class='gfield_label' for='input_102_104' >Please select desired Maturity Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input autocomplete=\"off\"  name='input_104' id='input_102_104' type='text' value='' class='datepicker dmy datepicker_with_icon gdatepicker_with_icon' tabindex='69'  placeholder='dd\/mm\/yyyy' aria-describedby=\"input_102_104_date_format gfield_description_102_104\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_102_104_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input autocomplete=\"off\"  type='hidden' id='gforms_calendar_icon_input_102_104' class='gform_hidden' value='https:\/\/gulf.adept.sr\/forms\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><div class='gfield_description' id='gfield_description_102_104'>Date Selected Should Only Be First (1st) of the Month<\/div><\/li><li id=\"field_102_101\"  class=\"gfield gf_middle_third field_sublabel_below field_description_above gfield_visibility_hidden\"  data-js-reload=\"field_102_101\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label' for='input_102_101' >Please select desired Maturity Date(old)<\/label><div class='ginput_container ginput_container_date'>\n                            <input autocomplete=\"off\"  name='input_101' id='input_102_101' type='text' value='' class='datepicker dmy datepicker_with_icon gdatepicker_with_icon' tabindex='70'  placeholder='dd\/mm\/yyyy' aria-describedby=\"input_102_101_date_format\" aria-invalid=\"false\" \/>\n                            <span id='input_102_101_date_format' class='screen-reader-text'>DD slash MM slash YYYY<\/span>\n                        <\/div>\n                        <input autocomplete=\"off\"  type='hidden' id='gforms_calendar_icon_input_102_101' class='gform_hidden' value='https:\/\/gulf.adept.sr\/forms\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_102_98\"  class=\"gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_98\"><label class='gfield_label' for='input_102_98' >BIR Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_98' id='input_102_98' type='text' value='' class='medium'   tabindex='71' placeholder='BIR Number' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_102_99\"  class=\"gfield gf_middle_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_99\"><label class='gfield_label' for='input_102_99' >Identification Type<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_99' id='input_102_99' class='medium gfield_select' tabindex='72'   aria-required=\"true\" aria-invalid=\"false\" ><option value='Driver&#039;s Permit' >Driver&#039;s Permit<\/option><option value='National ID' >National ID<\/option><option value='Passport' >Passport<\/option><\/select><\/div><\/li><li id=\"field_102_100\"  class=\"gfield gf_right_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_100\"><label class='gfield_label' for='input_102_100' >Identification Number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_100' id='input_102_100' type='text' value='' class='medium'   tabindex='73'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_102_85\"  class=\"gfield clr gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_85\"><\/li><li id=\"field_102_117\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_117\"><h2 class=\"gsection_title\">Maturity Proceeds Information<\/h2><\/li><li id=\"field_102_126\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_126\"><p><i>I hereby request the following <b>optional method<\/b> to receive the maturity benefit on the above-stated <b>Policy<\/b> :<\/i><\/p><\/li><li id=\"field_102_121\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_121\"><label class='gfield_label'  >Optional Method of Recieving Annuity Maturity Benefit<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_102_121'>\n\t\t\t<li class='gchoice gchoice_102_121_0'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_121' type='radio' value='Pensionable'  id='choice_102_121_0' tabindex='74'   \/>\n\t\t\t\t<label for='choice_102_121_0' id='label_102_121_0'>Pensionable<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_102_121_1'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_121' type='radio' value='Lumpsum'  id='choice_102_121_1' tabindex='75'   \/>\n\t\t\t\t<label for='choice_102_121_1' id='label_102_121_1'>Lumpsum<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_102_127\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_127\"><p><i>Only if the expected monthly pension is less than five hundred dollars ($500.00), the full accumulation (lump sum) is payable, in accordance with <b>Section 28(7)(b)<\/b> of the <b>Income Tax Act<\/b>.<\/i><\/p><\/li><li id=\"field_102_124\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_124\"><label class='gfield_label'  >Pensionable Options<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_102_124'>\n\t\t\t<li class='gchoice gchoice_102_124_0'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_124' type='radio' value='Full Benefit on Pension'  id='choice_102_124_0' tabindex='76'   \/>\n\t\t\t\t<label for='choice_102_124_0' id='label_102_124_0'>Full Benefit on Pension<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_102_124_1'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_124' type='radio' value='Reduced Benefit ( Tax Free Lump Sum 25 % )'  id='choice_102_124_1' tabindex='77'   \/>\n\t\t\t\t<label for='choice_102_124_1' id='label_102_124_1'>Reduced Benefit ( Tax Free Lump Sum 25 % )<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_102_139\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_139\"><div style=\"background-color: #f8d7da; color: #721c24; padding: 10px; margin-bottom: 15px;\">\n    <p><strong>Warning:<\/strong> Please Note Payment by Cheque is Unavailable as All Funds goes towards Pension.<\/p>\n<\/div><\/li><li id=\"field_102_128\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_128\"><label class='gfield_label' for='input_102_128' >Select Pension Option<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_128' id='input_102_128' class='medium gfield_select' tabindex='78'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Select Pension Option<\/option><option value='Life' >Life - An Annuity payable during the lifetime of the Annuitant, but without any Guaranteed period of Payment.<\/option><option value='5 Years' >5 Years - An Annuity payable during the lifetime of the Annuitant, but Guaranteed in any event for five (5) full years<\/option><option value='10 Years' >10 Years - An Annuity payable during the lifetime of the Annuitant, but Guaranteed in any event for ten (10) full years<\/option><option value='15 Years' >15 Years - An Annuity payable during the lifetime of the Annuitant, but Guaranteed in any event for fifteen (15) full years<\/option><\/select><\/div><\/li><li id=\"field_102_109\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_109\"><h3>Please enter the following Details<\/h3><\/li><li id=\"field_102_11\"  class=\"gfield gf_left_half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_11\"><label class='gfield_label' for='input_102_11' >Address 1<\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_11' id='input_102_11' type='text' value='' class='small'   tabindex='79' placeholder='Address 1'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_102_12\"  class=\"gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_12\"><label class='gfield_label' for='input_102_12' >Address 2<\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_12' id='input_102_12' type='text' value='' class='small'   tabindex='80' placeholder='Address 2'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_102_13\"  class=\"gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_13\"><label class='gfield_label' for='input_102_13' >Town\/City<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_13' id='input_102_13' type='text' value='' class='small'   tabindex='81' placeholder='Town\/City' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_102_14\"  class=\"gfield gf_right_half field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_14\"><label class='gfield_label' for='input_102_14' >Country<\/label><div class='ginput_container ginput_container_select'><select name='input_14' id='input_102_14' class='small gfield_select' tabindex='82'    aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Country<\/option><option value='Trinidad and Tobago' >Trinidad and Tobago<\/option><option value='Afghanistan' >Afghanistan<\/option><option value='\u00c5land Islands' >\u00c5land Islands<\/option><option value='Albania' >Albania<\/option><option value='Algeria' >Algeria<\/option><option value='American Samoa' >American Samoa<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguilla<\/option><option value='Antarctica' >Antarctica<\/option><option value='Antigua and Barbuda' >Antigua and Barbuda<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaijan' >Azerbaijan<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bahrain' >Bahrain<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Belarus' >Belarus<\/option><option value='Belgium' >Belgium<\/option><option value='Belize' >Belize<\/option><option value='Benin' >Benin<\/option><option value='Bermuda' >Bermuda<\/option><option value='Bhutan' >Bhutan<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, Sint Eustatius and Saba' >Bonaire, Sint Eustatius and Saba<\/option><option value='Bosnia and Herzegovina' >Bosnia and Herzegovina<\/option><option value='Botswana' >Botswana<\/option><option value='Bouvet Island' >Bouvet Island<\/option><option value='Brazil' >Brazil<\/option><option value='British Indian Ocean Territory' >British Indian Ocean Territory<\/option><option value='Brunei Darrussalam' >Brunei Darrussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='Cambodia' >Cambodia<\/option><option value='Cameroon' >Cameroon<\/option><option value='Canada' >Canada<\/option><option value='Cape Verde' >Cape Verde<\/option><option value='Cayman Islands' >Cayman Islands<\/option><option value='Central African Republic' >Central African Republic<\/option><option value='Chad' >Chad<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Christmas Island' >Christmas Island<\/option><option value='Cocos Islands' >Cocos Islands<\/option><option value='Colombia' >Colombia<\/option><option value='Comoros' >Comoros<\/option><option value='Congo, Democratic Republic of the' >Congo, Democratic Republic of the<\/option><option value='Congo, Republic of the' >Congo, Republic of the<\/option><option value='Cook Islands' >Cook Islands<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='C\u00f4te d&#039;Ivoire' >C\u00f4te d&#039;Ivoire<\/option><option value='Croatia' >Croatia<\/option><option value='Cuba' >Cuba<\/option><option value='Cura\u00e7ao' >Cura\u00e7ao<\/option><option value='Cyprus' >Cyprus<\/option><option value='Czech Republic' >Czech Republic<\/option><option value='Denmark' >Denmark<\/option><option value='Djibouti' >Djibouti<\/option><option value='Dominica' >Dominica<\/option><option value='Dominican Republic' >Dominican Republic<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egypt' >Egypt<\/option><option value='El Salvador' >El Salvador<\/option><option value='Equatorial Guinea' >Equatorial Guinea<\/option><option value='Eritrea' >Eritrea<\/option><option value='Estonia' >Estonia<\/option><option value='Eswatini (Swaziland)' >Eswatini (Swaziland)<\/option><option value='Ethiopia' >Ethiopia<\/option><option value='Falkland Islands' >Falkland Islands<\/option><option value='Faroe Islands' >Faroe Islands<\/option><option value='Fiji' >Fiji<\/option><option value='Finland' >Finland<\/option><option value='France' >France<\/option><option value='French Guiana' >French Guiana<\/option><option value='French Polynesia' >French Polynesia<\/option><option value='French Southern Territories' >French Southern Territories<\/option><option value='Gabon' >Gabon<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Germany' >Germany<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Greece' >Greece<\/option><option value='Greenland' >Greenland<\/option><option value='Grenada' >Grenada<\/option><option value='Guadeloupe' >Guadeloupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea-Bissau' >Guinea-Bissau<\/option><option value='Guyana' >Guyana<\/option><option value='Haiti' >Haiti<\/option><option value='Heard and McDonald Islands' >Heard and McDonald Islands<\/option><option value='Holy See' >Holy See<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungary' >Hungary<\/option><option value='Iceland' >Iceland<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iran' >Iran<\/option><option value='Iraq' >Iraq<\/option><option value='Ireland' >Ireland<\/option><option value='Isle of Man' >Isle of Man<\/option><option value='Israel' >Israel<\/option><option value='Italy' >Italy<\/option><option value='Jamaica' >Jamaica<\/option><option value='Japan' >Japan<\/option><option value='Jersey' >Jersey<\/option><option value='Jordan' >Jordan<\/option><option value='Kazakhstan' >Kazakhstan<\/option><option value='Kenya' >Kenya<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kuwait' >Kuwait<\/option><option value='Kyrgyzstan' >Kyrgyzstan<\/option><option value='Lao People&#039;s Democratic Republic' >Lao People&#039;s Democratic Republic<\/option><option value='Latvia' >Latvia<\/option><option value='Lebanon' >Lebanon<\/option><option value='Lesotho' >Lesotho<\/option><option value='Liberia' >Liberia<\/option><option value='Libya' >Libya<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lithuania' >Lithuania<\/option><option value='Luxembourg' >Luxembourg<\/option><option value='Macau' >Macau<\/option><option value='Macedonia' >Macedonia<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malawi' >Malawi<\/option><option value='Malaysia' >Malaysia<\/option><option value='Maldives' >Maldives<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marshall Islands' >Marshall Islands<\/option><option value='Martinique' >Martinique<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mauritius' >Mauritius<\/option><option value='Mayotte' >Mayotte<\/option><option value='Mexico' >Mexico<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldova' >Moldova<\/option><option value='Monaco' >Monaco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Morocco' >Morocco<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Netherlands' >Netherlands<\/option><option value='New Caledonia' >New Caledonia<\/option><option value='New Zealand' >New Zealand<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Niger' >Niger<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Norfolk Island' >Norfolk Island<\/option><option value='North Korea' >North Korea<\/option><option value='Northern Mariana Islands' >Northern Mariana Islands<\/option><option value='Norway' >Norway<\/option><option value='Oman' >Oman<\/option><option value='Pakistan' >Pakistan<\/option><option value='Palau' >Palau<\/option><option value='Palestine, State of' >Palestine, State of<\/option><option value='Panama' >Panama<\/option><option value='Papua New Guinea' >Papua New Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Peru' >Peru<\/option><option value='Philippines' >Philippines<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Poland' >Poland<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='R\u00e9union' >R\u00e9union<\/option><option value='Romania' >Romania<\/option><option value='Russia' >Russia<\/option><option value='Rwanda' >Rwanda<\/option><option value='Saint Barth\u00e9lemy' >Saint Barth\u00e9lemy<\/option><option value='Saint Helena' >Saint Helena<\/option><option value='Saint Kitts and Nevis' >Saint Kitts and Nevis<\/option><option value='Saint Lucia' >Saint Lucia<\/option><option value='Saint Martin' >Saint Martin<\/option><option value='Saint Pierre and Miquelon' >Saint Pierre and Miquelon<\/option><option value='Saint Vincent and the Grenadines' >Saint Vincent and the Grenadines<\/option><option value='Samoa' >Samoa<\/option><option value='San Marino' >San Marino<\/option><option value='Sao Tome and Principe' >Sao Tome and Principe<\/option><option value='Saudi Arabia' >Saudi Arabia<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leone' >Sierra Leone<\/option><option value='Singapore' >Singapore<\/option><option value='Sint Maarten' >Sint Maarten<\/option><option value='Slovakia' >Slovakia<\/option><option value='Slovenia' >Slovenia<\/option><option value='Solomon Islands' >Solomon Islands<\/option><option value='Somalia' >Somalia<\/option><option value='South Africa' >South Africa<\/option><option value='South Georgia' >South Georgia<\/option><option value='South Korea' >South Korea<\/option><option value='South Sudan' >South Sudan<\/option><option value='Spain' >Spain<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sudan' >Sudan<\/option><option value='Suriname' >Suriname<\/option><option value='Svalbard and Jan Mayen Islands' >Svalbard and Jan Mayen Islands<\/option><option value='Sweden' >Sweden<\/option><option value='Switzerland' >Switzerland<\/option><option value='Syria' >Syria<\/option><option value='Taiwan' >Taiwan<\/option><option value='Tajikistan' >Tajikistan<\/option><option value='Tanzania' >Tanzania<\/option><option value='Thailand' >Thailand<\/option><option value='Timor-Leste' >Timor-Leste<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Tunisia' >Tunisia<\/option><option value='Turkey' >Turkey<\/option><option value='Turkmenistan' >Turkmenistan<\/option><option value='Turks and Caicos Islands' >Turks and Caicos Islands<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='Uganda' >Uganda<\/option><option value='Ukraine' >Ukraine<\/option><option value='United Arab Emirates' >United Arab Emirates<\/option><option value='United Kingdom' >United Kingdom<\/option><option value='United States' >United States<\/option><option value='Uruguay' >Uruguay<\/option><option value='US Minor Outlying Islands' >US Minor Outlying Islands<\/option><option value='Uzbekistan' >Uzbekistan<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Virgin Islands, British' >Virgin Islands, British<\/option><option value='Virgin Islands, U.S.' >Virgin Islands, U.S.<\/option><option value='Wallis and Futuna' >Wallis and Futuna<\/option><option value='Western Sahara' >Western Sahara<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbabwe' >Zimbabwe<\/option><\/select><\/div><\/li><li id=\"field_102_107\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_107\"><label class='gfield_label' for='input_102_107' >Please select your preferred method of payment<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_107' id='input_102_107' class='medium gfield_select' tabindex='83'   aria-required=\"true\" aria-invalid=\"false\" ><option value='Cheque' >Cheque<\/option><option value='Direct Deposit' >Direct Deposit<\/option><\/select><\/div><\/li><li id=\"field_102_110\"  class=\"gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_110\"><label class='gfield_label' for='input_102_110' >Name of Institution<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_110' id='input_102_110' class='medium gfield_select' tabindex='84'   aria-required=\"true\" aria-invalid=\"false\" ><option value='First Citizens Bank Ltd.' >First Citizens Bank Ltd.<\/option><option value='RBC Bank Ltd.' >RBC Bank Ltd.<\/option><option value='Republic Bank Ltd.' >Republic Bank Ltd.<\/option><option value='Scotiabank T&amp;T Ltd.' >Scotiabank T&amp;T Ltd.<\/option><option value='JMMB Bank' >JMMB Bank<\/option><option value='Intercommercial Bank' >Intercommercial Bank<\/option><option value='Credit Union\/Other' >Credit Union\/Other<\/option><\/select><\/div><\/li><li id=\"field_102_113\"  class=\"gfield gf_middle_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_113\"><label class='gfield_label' for='input_102_113' >Branch of Account<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_113' id='input_102_113' type='text' value='' class='medium'   tabindex='85'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_102_111\"  class=\"gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_111\"><label class='gfield_label' for='input_102_111' >Other\/Credit Union<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_111' id='input_102_111' type='text' value='' class='medium'   tabindex='86'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_102_112\"  class=\"gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_112\"><label class='gfield_label' for='input_102_112' >Account number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input autocomplete=\"off\"  name='input_112' id='input_102_112' type='number' step='any'   value='' class='medium' tabindex='87'    aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_102_138\"  class=\"gfield gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_138\"><div style=\"background-color: #f8d7da; color: #721c24; padding: 10px; margin-bottom: 15px;\">\n    <p><strong>Warning:<\/strong> Please note that payments for Pension will go towards that Direct ACH Account above.<\/p>\n<\/div><\/li><li id=\"field_102_131\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_131\"><h2 class=\"gsection_title\">Pension Payment ACH Information<\/h2><\/li><li id=\"field_102_132\"  class=\"gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_132\"><label class='gfield_label' for='input_102_132' >Pension - Name of Institution<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_132' id='input_102_132' class='medium gfield_select' tabindex='88'   aria-required=\"true\" aria-invalid=\"false\" ><option value='First Citizens Bank Ltd.' >First Citizens Bank Ltd.<\/option><option value='RBC Bank Ltd.' >RBC Bank Ltd.<\/option><option value='Republic Bank Ltd.' >Republic Bank Ltd.<\/option><option value='Scotiabank T&amp;T Ltd.' >Scotiabank T&amp;T Ltd.<\/option><option value='JMMB Bank' >JMMB Bank<\/option><option value='Intercommercial Bank' >Intercommercial Bank<\/option><option value='Credit Union\/Other' >Credit Union\/Other<\/option><\/select><\/div><\/li><li id=\"field_102_133\"  class=\"gfield gf_middle_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_133\"><label class='gfield_label' for='input_102_133' >Pension - Branch of Account<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_133' id='input_102_133' type='text' value='' class='medium'   tabindex='89'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_102_135\"  class=\"gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_135\"><label class='gfield_label' for='input_102_135' >Pension - Other\/Credit Union<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_135' id='input_102_135' type='text' value='' class='medium'   tabindex='90'  aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_102_136\"  class=\"gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_136\"><label class='gfield_label' for='input_102_136' >Pension - Account number<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input autocomplete=\"off\"  name='input_136' id='input_102_136' type='number' step='any'   value='' class='medium' tabindex='91'    aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/li><li id=\"field_102_118\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_118\"><h2 class=\"gsection_title\">Signing<\/h2><\/li><li id=\"field_102_89\"  class=\"gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_89\"><label class='gfield_label' for='input_102_89' >Branch of Request\/CSR<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_89' id='input_102_89' class='medium gfield_select' tabindex='92'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Branch of Request<\/option><option value='San Fernando' >San Fernando<\/option><option value='Tobago' >Tobago<\/option><option value='Port of Spain' >Port of Spain<\/option><option value='Arima' >Arima<\/option><option value='Chaguanas' >Chaguanas<\/option><\/select><\/div><\/li><li id=\"field_102_93\"  class=\"gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_93\"><label class='gfield_label' for='input_102_93' >Preferred Branch to Collect Payment<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_93' id='input_102_93' class='medium gfield_select' tabindex='93'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Preferred Branch<\/option><option value='San Fernando' >San Fernando<\/option><option value='Chaguanas' >Chaguanas<\/option><option value='Arima' >Arima<\/option><option value='Tobago' >Tobago<\/option><option value='Port of Spain' >Port of Spain<\/option><\/select><\/div><\/li><li id=\"field_102_102\"  class=\"gfield gf_right_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_102\"><label class='gfield_label' for='input_102_102' >Preferred Branch to Collect Endorsement<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_102' id='input_102_102' class='medium gfield_select' tabindex='94'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Preferred Branch<\/option><option value='San Fernando' >San Fernando<\/option><option value='Chaguanas' >Chaguanas<\/option><option value='Arima' >Arima<\/option><option value='Tobago' >Tobago<\/option><option value='Port of Spain' >Port of Spain<\/option><\/select><\/div><\/li><li id=\"field_102_106\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_106\"><label class='gfield_label' for='input_102_106' >Additional Comment<\/label><div class='ginput_container ginput_container_textarea'><textarea autocomplete=\"off\"  name='input_106' id='input_102_106' class='textarea medium' tabindex='95'  maxlength='500'   aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_102_88\"  class=\"gfield clr gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_88\"><\/li><li id=\"field_102_22\"  class=\"gfield gf_left_half gfield_contains_required field_sublabel_below field_description_below gfield_visibility_hidden\"  data-js-reload=\"field_102_22\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label'  >Signature of Policyholder<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_102_22'>\n\t\t\t<li class='gchoice gchoice_102_22_0'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_22' type='radio' value='Type-in Signature'  id='choice_102_22_0' tabindex='96'   \/>\n\t\t\t\t<label for='choice_102_22_0' id='label_102_22_0'>Type-in Signature<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_102_22_1'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_22' type='radio' value='Digital Signature'  id='choice_102_22_1' tabindex='97'   \/>\n\t\t\t\t<label for='choice_102_22_1' id='label_102_22_1'>Digital Signature<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_102_28\"  class=\"gfield clr gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_28\"><\/li><li id=\"field_102_23\"  class=\"gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_23\"><label class='gfield_label' for='input_102_23' >Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_23' id='input_102_23' type='text' value='' class='medium'   tabindex='98' placeholder='Signature' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_102_29\"  class=\"gfield clr gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_29\"><\/li><li id=\"field_102_17\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_17\"><label class='gfield_label' for='input_102_17' >Signature<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div ><div id='input_102_17_Container' class='gfield_signature_container ginput_container' style='height:180px; width:1000px; ' ><input autocomplete=\"off\"  type='hidden' class='gform_hidden' name='input_102_17_valid' id='input_102_17_valid' \/><canvas id='input_102_17' width='1000' height='180'><\/canvas><\/div><\/div><\/li><li id=\"field_102_33\"  class=\"gfield clr gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_33\"><\/li><li id=\"field_102_19\"  class=\"gfield gf_left_third gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_102_19\"><label class='gfield_label' for='input_102_19' >Date<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input autocomplete=\"off\"  name='input_19' id='input_102_19' type='text' value='' class='datepicker mdy datepicker_no_icon gdatepicker-no-icon' tabindex='99'  placeholder='Date' aria-describedby=\"input_102_19_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_102_19_date_format' class='screen-reader-text'>MM slash DD slash YYYY<\/span>\n                        <\/div>\n                        <input autocomplete=\"off\"  type='hidden' id='gforms_calendar_icon_input_102_19' class='gform_hidden' value='https:\/\/gulf.adept.sr\/forms\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_102' class='gform_button button' value='Submit' tabindex='100' onclick='if(window[\"gf_submitting_102\"]){return false;}  if( !jQuery(\"#gform_102\")[0].checkValidity || jQuery(\"#gform_102\")[0].checkValidity()){window[\"gf_submitting_102\"]=true;}  ' onkeypress='if( event.keyCode == 13 ){ if(window[\"gf_submitting_102\"]){return false;} if( 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                 <\/form>\n                        <\/div><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Annuity Optional Maturity Date Change<\/p>\n","protected":false},"author":13,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-5834","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/gulf.adept.sr\/forms\/wp-json\/wp\/v2\/pages\/5834","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/gulf.adept.sr\/forms\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/gulf.adept.sr\/forms\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/gulf.adept.sr\/forms\/wp-json\/wp\/v2\/users\/13"}],"replies":[{"embeddable":true,"href":"https:\/\/gulf.adept.sr\/forms\/wp-json\/wp\/v2\/comments?post=5834"}],"version-history":[{"count":3,"href":"https:\/\/gulf.adept.sr\/forms\/wp-json\/wp\/v2\/pages\/5834\/revisions"}],"predecessor-version":[{"id":5846,"href":"https:\/\/gulf.adept.sr\/forms\/wp-json\/wp\/v2\/pages\/5834\/revisions\/5846"}],"wp:attachment":[{"href":"https:\/\/gulf.adept.sr\/forms\/wp-json\/wp\/v2\/media?parent=5834"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}