{"id":5961,"date":"2024-02-02T14:39:12","date_gmt":"2024-02-02T18:39:12","guid":{"rendered":"https:\/\/gulf.adept.sr\/forms\/?page_id=5961"},"modified":"2024-03-25T16:24:41","modified_gmt":"2024-03-25T20:24:41","slug":"feedback","status":"publish","type":"page","link":"https:\/\/gulf.adept.sr\/forms\/feedback\/","title":{"rendered":"Complaint Form Page"},"content":{"rendered":"<p style=\"text-align: center;\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone\" src=\"https:\/\/gulf.adept.sr\/forms\/wp-content\/uploads\/2019\/08\/Gulf-Revised-Logo-300x140.png\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" srcset=\"https:\/\/gulf.adept.sr\/forms\/wp-content\/uploads\/2019\/08\/Gulf-Revised-Logo-300x140.png 300w, https:\/\/gulf.adept.sr\/forms\/wp-content\/uploads\/2019\/08\/Gulf-Revised-Logo-768x358.png 768w, https:\/\/gulf.adept.sr\/forms\/wp-content\/uploads\/2019\/08\/Gulf-Revised-Logo-1024x477.png 1024w\" alt=\"\" width=\"154\" height=\"72\" \/><img loading=\"lazy\" decoding=\"async\" class=\"alignnone  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=\"205\" height=\"80\" 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: 205px) 100vw, 205px\" \/><\/p>\n<h2 style=\"text-align: center;\">Feedback Form<\/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_97' style='display:none'><form method='post' enctype='multipart\/form-data'  id='gform_97' class='transaction-form gform_legacy_markup' action='\/forms\/wp-json\/wp\/v2\/pages\/5961' novalidate autocomplete=\"off\">\n                        <div class='gform_body gform-body'><ul id='gform_fields_97' class='gform_fields top_label form_sublabel_below description_below'><li id=\"field_97_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_97_109\"><script>\n\/\/ Function to generate a unique log number\nfunction generateLogNumber() {\n    var logNumber = 'LOG' + generateRandomNumberWithPadding(8);\n\n    document.getElementById('input_97_110').value = logNumber;\n}\n\n\/\/ Function to generate a random number with zero padding\nfunction generateRandomNumberWithPadding(length) {\n    var randomNumber = Math.floor(Math.random() * Math.pow(10, length));\n    return randomNumber.toString().padStart(length, '0');\n}\n\n\/\/ Automatically generate log number on page load\nwindow.onload = function() {\n    generateLogNumber();\n};\n<\/script><\/li><li id=\"field_97_110\"  class=\"gfield field_sublabel_below field_description_below hidden_label gfield_visibility_hidden\"  data-js-reload=\"field_97_110\"><div class='admin-hidden-markup'><i class='gform-icon gform-icon--hidden'><\/i><span>Hidden<\/span><\/div><label class='gfield_label' for='input_97_110' >Log Number<\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_110' id='input_97_110' type='text' value='' class='medium' maxlength='20' aria-describedby=\"gfield_description_97_110\" tabindex='97'   aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_97_110'>Automated Generated Log Number<\/div><\/li><li id=\"field_97_108\"  class=\"gfield gfield_html field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_108\"><br><\/li><li id=\"field_97_120\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_120\"><label class='gfield_label' for='input_97_120' >Branch<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_120' id='input_97_120' class='medium gfield_select' tabindex='98' aria-describedby=\"gfield_description_97_120\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='ARIMA' >Arima<\/option><option value='PORT OF SPAIN' >Port of Spain<\/option><option value='CHAGUANAS' >Chaguanas<\/option><option value='SAN FERNANDO' >San Fernando<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_97_120'>Please select Branch. Closest Location if not Known<\/div><\/li><li id=\"field_97_119\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_119\"><label class='gfield_label' for='input_97_119' >Date of Complaint\/Feedback<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_119' id='input_97_119' type='text' value='' class='datepicker dmy datepicker_with_icon gdatepicker_with_icon' tabindex='99'  placeholder='dd\/mm\/yyyy' aria-describedby=\"input_97_119_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_97_119_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_97_119' class='gform_hidden' value='https:\/\/gulf.adept.sr\/forms\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_97_1\"  class=\"gfield salutation field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_1\"><label class='gfield_label' for='input_97_1' >Salutation<\/label><div class='ginput_container ginput_container_select'><select name='input_1' id='input_97_1' class='large gfield_select' tabindex='100'    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_97_2\"  class=\"gfield name gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_2\"><label class='gfield_label' for='input_97_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_97_2' type='text' value='' class='large'   tabindex='101' placeholder='First Name' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_97_6\"  class=\"gfield name field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_6\"><label class='gfield_label' for='input_97_6' >Middle Name<\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_6' id='input_97_6' type='text' value='' class='large'   tabindex='102' placeholder='Middle Name'  aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_97_4\"  class=\"gfield name gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_4\"><label class='gfield_label' for='input_97_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_97_4' type='text' value='' class='large'   tabindex='103' placeholder='Last Name' aria-required=\"true\" aria-invalid=\"false\"   \/> <\/div><\/li><li id=\"field_97_8\"  class=\"gfield gf_middle_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_8\"><label class='gfield_label' for='input_97_8' >Contact No.<\/label><div class='ginput_container ginput_container_phone'><input autocomplete=\"off\"  name='input_8' id='input_97_8' type='tel' value='' class='large' tabindex='104' placeholder='Contact No.'  aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_97_9\"  class=\"gfield gf_right_third field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_9\"><label class='gfield_label' for='input_97_9' >Email<\/label><div class='ginput_container ginput_container_email'>\n                            <input autocomplete=\"off\"  name='input_9' id='input_97_9' type='email' value='' class='large' tabindex='105'  placeholder='Email'  aria-invalid=\"false\"  \/>\n                        <\/div><\/li><li id=\"field_97_106\"  class=\"gfield gsection field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_106\"><h2 class=\"gsection_title\">Feedback Information<\/h2><div class='gsection_description' id='gfield_description_97_106'>Just a heads-up: Feedback can cover recommendations, complaints, or reviews.<\/div><\/li><li id=\"field_97_90\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_90\"><label class='gfield_label' for='input_97_90' >Please Select Company :<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_90' id='input_97_90' class='medium gfield_select' tabindex='106'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select the option<\/option><option value='Assuria Life TT' >Assuria Life TT<\/option><option value='Gulf Insurance Ltd' >Gulf Insurance Ltd<\/option><\/select><\/div><\/li><li id=\"field_97_103\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_103\"><label class='gfield_label' for='input_97_103' >Accountable Department<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_103' id='input_97_103' class='medium gfield_select' tabindex='107' aria-describedby=\"gfield_description_97_103\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select the option<\/option><option value='Finance' >Finance<\/option><option value='Claims' >Claims<\/option><option value='Underwriting' >Underwriting<\/option><option value='Information Systems' >Information Systems<\/option><option value='Other' >Other<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_97_103'>Please select the department this complaint is directed to.<\/div><\/li><li id=\"field_97_99\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_99\"><label class='gfield_label' for='input_97_99' >Report Source<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_97_99' class='medium gfield_select' tabindex='108'   aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select the option<\/option><option value='Walk In' >Walk In<\/option><option value='Phone' >Phone<\/option><option value='Website' >Website<\/option><option value='Email' >Email<\/option><option value='Social Media' >Social Media<\/option><\/select><\/div><\/li><li id=\"field_97_100\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_100\"><label class='gfield_label' for='input_97_100' >Feedback<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_100' id='input_97_100' class='medium gfield_select' tabindex='109' aria-describedby=\"gfield_description_97_100\"  aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select the option<\/option><option value='Complaint' >Complaint<\/option><option value='Review' >Review<\/option><option value='Recommendation' >Recommendation<\/option><\/select><\/div><div class='gfield_description' id='gfield_description_97_100'>Please select the type of Complaint : <\/div><\/li><li id=\"field_97_111\"  class=\"gfield gfield_contains_required field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_111\"><label class='gfield_label'  >Is it Policy Related ?<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_97_111'>\n\t\t\t<li class='gchoice gchoice_97_111_0'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_111' type='radio' value='Yes'  id='choice_97_111_0' tabindex='110'   \/>\n\t\t\t\t<label for='choice_97_111_0' id='label_97_111_0'>Yes<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_97_111_1'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_111' type='radio' value='No'  id='choice_97_111_1' tabindex='111'   \/>\n\t\t\t\t<label for='choice_97_111_1' id='label_97_111_1'>No<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_97_117\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_117\"><label class='gfield_label'  >Is it Motor or Property Related?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_97_117'>\n\t\t\t<li class='gchoice gchoice_97_117_0'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_117' type='radio' value='Motor'  id='choice_97_117_0' tabindex='112'   \/>\n\t\t\t\t<label for='choice_97_117_0' id='label_97_117_0'>Motor<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_97_117_1'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_117' type='radio' value='Property'  id='choice_97_117_1' tabindex='113'   \/>\n\t\t\t\t<label for='choice_97_117_1' id='label_97_117_1'>Property<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_97_118\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_118\"><label class='gfield_label'  >Is it Annuity or Life Related?<\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_97_118'>\n\t\t\t<li class='gchoice gchoice_97_118_0'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_118' type='radio' value='Annuity'  id='choice_97_118_0' tabindex='114'   \/>\n\t\t\t\t<label for='choice_97_118_0' id='label_97_118_0'>Annuity<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_97_118_1'>\n\t\t\t\t<input autocomplete=\"off\"  name='input_118' type='radio' value='Life'  id='choice_97_118_1' tabindex='115'   \/>\n\t\t\t\t<label for='choice_97_118_1' id='label_97_118_1'>Life<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_97_116\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_116\"><label class='gfield_label' for='input_97_116' >Please Enter Policy Number<\/label><div class='ginput_container ginput_container_text'><input autocomplete=\"off\"  name='input_116' id='input_97_116' type='text' value='' class='medium'  aria-describedby=\"gfield_description_97_116\" tabindex='116'   aria-invalid=\"false\"   \/> <\/div><div class='gfield_description' id='gfield_description_97_116'>Please Enter ONLY Policy Number.<\/div><\/li><li id=\"field_97_102\"  class=\"gfield field_sublabel_below field_description_below gfield_visibility_visible\"  data-js-reload=\"field_97_102\"><label class='gfield_label' for='input_97_102' >Details of Feedback<\/label><div class='ginput_container ginput_container_textarea'><div id=\"wp-input_97_102-wrap\" class=\"wp-core-ui wp-editor-wrap tmce-active\"><link rel='stylesheet' id='dashicons-css' href='https:\/\/gulf.adept.sr\/forms\/wp-includes\/css\/dashicons.min.css?ver=7.0.6' media='all' \/>\n<link rel='stylesheet' id='editor-buttons-css' href='https:\/\/gulf.adept.sr\/forms\/wp-includes\/css\/editor.min.css?ver=7.0.6' media='all' \/>\n<div id=\"wp-input_97_102-editor-container\" class=\"wp-editor-container\"><textarea autocomplete=\"off\"  class=\"medium wp-editor-area\" style=\"height: 180px\" tabindex=\"118\" autocomplete=\"off\" cols=\"40\" name=\"input_102\" id=\"input_97_102\"><\/textarea><\/div>\n<\/div>\n\n<\/div><div class='gfield_description' id='gfield_description_97_102'>Please enter the details of your Complaint.<\/div><\/li><\/ul><\/div>\n        <div class='gform_footer top_label'> <input type='submit' id='gform_submit_button_97' class='gform_button button' value='Submit' tabindex='119' onclick='if(window[\"gf_submitting_97\"]){return false;}  if( !jQuery(\"#gform_97\")[0].checkValidity || 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name='gform_source_page_number_97' id='gform_source_page_number_97' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            \n        <\/div>\n                        <\/form>\n                        <\/div><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Feedback 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