nfrc-myreport-af.com
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Submitted URL: http://nfrc-myreport-af.com/
Effective URL: https://nfrc-myreport-af.com/reportStep1.php?sslchannel=true&sessionid=WS9hLBzSLhfYRgGl9achr6TorpT7VzRUXNAj48RKnl0FJVHw1HqsYj...
Submission: On June 09 via api from BE — Scanned from DE
Effective URL: https://nfrc-myreport-af.com/reportStep1.php?sslchannel=true&sessionid=WS9hLBzSLhfYRgGl9achr6TorpT7VzRUXNAj48RKnl0FJVHw1HqsYj...
Submission: On June 09 via api from BE — Scanned from DE
Form analysis 1 forms found in the DOM
Name: myForm — POST reportStep2.php?sslchannel=true&sessionid=jGfLfISFiZQUf1olD0jqEpSc6ozrzilH5TNcM7GFYbibiEEsXPaVZOkYlz9dTdZgFJJAokraOncHDYac905jCtCiETjQKt8SkaGnIfvGoy1di6cIVxyrR1fkkGsV8fTcGZ
<form action="reportStep2.php?sslchannel=true&sessionid=jGfLfISFiZQUf1olD0jqEpSc6ozrzilH5TNcM7GFYbibiEEsXPaVZOkYlz9dTdZgFJJAokraOncHDYac905jCtCiETjQKt8SkaGnIfvGoy1di6cIVxyrR1fkkGsV8fTcGZ" name="myForm" id="myForm" role="form"
class="ng-pristine ng-valid ng-valid-maxlength ng-valid-email ng-valid-required" method="post">
<input type="hidden" name="further" id="further" value="YES">
<input type="hidden" name="passed" id="passed" value="YES">
<input type="hidden" name="impact" id="impact" value="YES">
<div>
<div class="form-fieldset ng-scope">
<h4 class="velocity-opposites-transition-slideDownIn ng-binding ng-scope">Personal details</h4>
<p></p>
<div class="form-step-section-body">
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<select-input field="field" substep="substep" ctrl="ctrl" class="ng-isolate-scope">
<div class="form-input-wrapper">
<div class="form-input-wrapper-left"><label for="title">Title </label></div>
<div class="form-input-wrapper-right">
<div class="af-select">
<select name="title" id="title" class="ng-pristine ng-untouched ng-empty ng-valid ng-valid-required" required="">
<option value="" selected="selected"></option>
<option value="Mr">Mr</option>
<option value="Ms">Ms</option>
<option value="Mrs">Mrs</option>
<option value="Miss">Miss</option>
<option value="Dr">Dr</option>
</select>
</div>
<expert-checkbox field="selectCtrl.field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</select-input>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<text-input-styled field="field" class="ng-isolate-scope">
<div class="form-input-wrapper recommendedField">
<div class="form-input-wrapper-left">
<label for="first_name">First name </label> <span class="help-button af-icon-question-mark ng-scope" role="button"></span>
</div>
<div class="form-input-wrapper-right">
<input remove-illegal-chars="" limit-to="100" name="first_name" id="first_name" type="text" class="ng-pristine ng-untouched ng-empty ng-valid ng-valid-required" required="">
<expert-checkbox field="field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</text-input-styled>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<text-input-styled field="field" class="ng-isolate-scope">
<div class="form-input-wrapper">
<div class="form-input-wrapper-left"><label for="middle_name">Middle name </label></div>
<div class="form-input-wrapper-right">
<input remove-illegal-chars="" limit-to="100" id="middle_name" name="middle_name" type="text" class="ng-pristine ng-untouched ng-empty ng-valid ng-valid-required">
<expert-checkbox field="field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</text-input-styled>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<text-input-styled field="field" class="ng-isolate-scope">
<div class="form-input-wrapper recommendedField">
<div class="form-input-wrapper-left">
<label for="last_name">Last name </label> <span class="help-button af-icon-question-mark ng-scope" role="button"></span>
</div>
<div class="form-input-wrapper-right">
<input remove-illegal-chars="" limit-to="100" name="last_name" id="last_name" type="text" class="ng-pristine ng-untouched ng-empty ng-valid ng-valid-required" required="">
<expert-checkbox field="field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</text-input-styled>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<date-input field="field" class="ng-isolate-scope">
<div class="form-input-wrapper velocity-opposites-transition-slideDownIn ng-scope recommendedField">
<div class="form-input-wrapper-left">
<label for="date_of_birth5">Date of birth </label> <span class="help-button af-icon-question-mark ng-scope" role="button"></span>
</div>
<div class="form-input-wrapper-right">
<div field="field" datemultiinput="" class="ng-isolate-scope ng-empty ng-valid ng-valid-required">
<div class="af-date-input">
<div class="af-date-input-day">
<input type="text" maxlength="2" id="day" name="day" placeholder="DD" no-whitespace="" ng-trim="false" only-digits="" class="ng-pristine ng-untouched ng-valid ng-empty ng-valid-maxlength" required="">
</div>
<div class="af-date-input-month">
<div class="af-select">
<select default-option="Month" name="month" id="month" placeholder="Month" value="" class="ng-pristine ng-untouched ng-valid ng-empty" required="">
<option value="" disabled="" selected="selected">Month</option>
<option value="1">January</option>
<option value="2">February</option>
<option value="3">March</option>
<option value="4">April</option>
<option value="5">May</option>
<option value="6">June</option>
<option value="7">July</option>
<option value="8">August</option>
<option value="9">September</option>
<option value="10">October</option>
<option value="11">November</option>
<option value="12">December</option>
</select>
</div>
</div>
<div class="af-date-input-year">
<input maxlength="4" type="text" name="year" id="year" placeholder="YYYY" no-whitespace="" ng-trim="false" only-digits="" class="ng-pristine ng-untouched ng-valid ng-empty ng-valid-maxlength" required="">
</div>
</div>
<div class="error-message ng-binding ng-scope">Invalid year format.</div>
<div onclick="$('#day').val('');$('#month').val('');$('#year').val('');" class="date-reset-button ng-scope" role="button">Clear date</div>
</div>
<expert-checkbox field="field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</date-input>
</div>
</div>
</all-input-types>
</div>
</div>
</div>
<div class="form-fieldset ng-scope">
<h4 class="velocity-opposites-transition-slideDownIn ng-binding ng-scope">Contact details</h4>
<p></p>
<div class="form-step-section-body">
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<email-input-styled field="field" class="ng-isolate-scope">
<div class="form-input-wrapper recommendedField">
<div class="form-input-wrapper-left">
<label for="email">Email </label> <span class="help-button af-icon-question-mark ng-scope" role="button"></span>
<div class="input-example ng-scope">
<p>Example: john.doe@example.com</p>
</div>
</div>
<div class="form-input-wrapper-right">
<input id="email" name="email" limit-to="100" type="text" remove-ng-email-validation="" remove-illegal-chars="" class="ng-pristine ng-untouched ng-empty ng-valid-email ng-valid ng-valid-required" required="">
<expert-checkbox field="field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</email-input-styled>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<phone-number-input field="field" substep="substep" has-extension="false" class="ng-isolate-scope">
<div class="form-input-wrapper recommendedField">
<div class="form-input-wrapper-left">
<label for="mobile">Phone number </label> <span class="help-button af-icon-question-mark ng-scope" role="button"></span>
<div class="input-example ng-scope">
<p>Example: +44 2079460696</p>
</div>
</div>
<div class="form-input-wrapper-right">
<div phone-number-input-atr="" phone-number="phoneNumberInputCtrl.field.data" is-disabled="phoneNumberInputCtrl.field.disabled" has-extension="phoneNumberInputCtrl.hasExtension" field="phoneNumberInputCtrl.field"
class="ng-isolate-scope">
<div class="phone-number-input">
<div class="phone-number-input__prefix">
<span style="display:none;">
<option value="+44">๐ฌ๐ง United Kingdom + 44</option>
<option value="+353">๐ฎ๐ช Ireland + 353</option>
<option value="+93">๐ฆ๐ซ Afghanistan + 93</option>
<option value="+358">๐ฆ๐ฝ ร
land Islands + 358</option>
<option value="+355">๐ฆ๐ฑ Albania + 355</option>
<option value="+213">๐ฉ๐ฟ Algeria + 213</option>
<option value="+1684">๐ฆ๐ธ American Samoa + 1684</option>
<option value="+376">๐ฆ๐ฉ Andorra + 376</option>
<option value="+244">๐ฆ๐ด Angola + 244</option>
<option value="+1264">๐ฆ๐ฎ Anguilla + 1264</option>
<option value="+1268">๐ฆ๐ฌ Antigua and Barbuda + 1268</option>
<option value="+54">๐ฆ๐ท Argentina + 54</option>
<option value="+374">๐ฆ๐ฒ Armenia + 374</option>
<option value="+297">๐ฆ๐ผ Aruba + 297</option>
<option value="+61">๐ฆ๐บ Australia + 61</option>
<option value="+43">๐ฆ๐น Austria + 43</option>
<option value="+994">๐ฆ๐ฟ Azerbaijan + 994</option>
<option value="+1242">๐ง๐ธ Bahamas + 1242</option>
<option value="+973">๐ง๐ญ Bahrain + 973</option>
<option value="+880">๐ง๐ฉ Bangladesh + 880</option>
<option value="+1246">๐ง๐ง Barbados + 1246</option>
<option value="+375">๐ง๐พ Belarus + 375</option>
<option value="+32">๐ง๐ช Belgium + 32</option>
<option value="+501">๐ง๐ฟ Belize + 501</option>
<option value="+229">๐ง๐ฏ Benin + 229</option>
<option value="+1441">๐ง๐ฒ Bermuda + 1441</option>
<option value="+975">๐ง๐น Bhutan + 975</option>
<option value="+591">๐ง๐ด Bolivia + 591</option>
<option value="+387">๐ง๐ฆ Bosnia and Herzegovina + 387</option>
<option value="+267">๐ง๐ผ Botswana + 267</option>
<option value="+55">๐ง๐ท Brazil + 55</option>
<option value="+246">๐ฎ๐ด British Indian Ocean Territory + 246</option>
<option value="+1284">๐ป๐ฌ British Virgin Islands + 1284</option>
<option value="+673">๐ง๐ณ Brunei + 673</option>
<option value="+359">๐ง๐ฌ Bulgaria + 359</option>
<option value="+226">๐ง๐ซ Burkina Faso + 226</option>
<option value="+257">๐ง๐ฎ Burundi + 257</option>
<option value="+855">๐ฐ๐ญ Cambodia + 855</option>
<option value="+237">๐จ๐ฒ Cameroon + 237</option>
<option value="+1">๐จ๐ฆ Canada + 1</option>
<option value="+238">๐จ๐ป Cape Verde + 238</option>
<option value="+1345">๐ฐ๐พ Cayman Islands + 1345</option>
<option value="+236">๐จ๐ซ Central African Republic + 236</option>
<option value="+235">๐น๐ฉ Chad + 235</option>
<option value="+56">๐จ๐ฑ Chile + 56</option>
<option value="+86">๐จ๐ณ China + 86</option>
<option value="+61">๐จ๐ฝ Christmas Island + 61</option>
<option value="+61">๐จ๐จ Cocos (Keeling) Islands + 61</option>
<option value="+57">๐จ๐ด Colombia + 57</option>
<option value="+269">๐ฐ๐ฒ Comoros + 269</option>
<option value="+682">๐จ๐ฐ Cook Islands + 682</option>
<option value="+506">๐จ๐ท Costa Rica + 506</option>
<option value="+385">๐ญ๐ท Croatia + 385</option>
<option value="+53">๐จ๐บ Cuba + 53</option>
<option value="+5999">๐จ๐ผ Curaรงao + 5999</option>
<option value="+357">๐จ๐พ Cyprus + 357</option>
<option value="+420">๐จ๐ฟ Czech Republic + 420</option>
<option value="+243">๐จ๐ฉ DR Congo + 243</option>
<option value="+45">๐ฉ๐ฐ Denmark + 45</option>
<option value="+253">๐ฉ๐ฏ Djibouti + 253</option>
<option value="+1767">๐ฉ๐ฒ Dominica + 1767</option>
<option value="+1809">๐ฉ๐ด Dominican Republic + 1809</option>
<option value="+593">๐ช๐จ Ecuador + 593</option>
<option value="+20">๐ช๐ฌ Egypt + 20</option>
<option value="+503">๐ธ๐ป El Salvador + 503</option>
<option value="+240">๐ฌ๐ถ Equatorial Guinea + 240</option>
<option value="+291">๐ช๐ท Eritrea + 291</option>
<option value="+372">๐ช๐ช Estonia + 372</option>
<option value="+251">๐ช๐น Ethiopia + 251</option>
<option value="+500">๐ซ๐ฐ Falkland Islands + 500</option>
<option value="+298">๐ซ๐ด Faroe Islands + 298</option>
<option value="+679">๐ซ๐ฏ Fiji + 679</option>
<option value="+358">๐ซ๐ฎ Finland + 358</option>
<option value="+33">๐ซ๐ท France + 33</option>
<option value="+594">๐ฌ๐ซ French Guiana + 594</option>
<option value="+689">๐ต๐ซ French Polynesia + 689</option>
<option value="+241">๐ฌ๐ฆ Gabon + 241</option>
<option value="+220">๐ฌ๐ฒ Gambia + 220</option>
<option value="+995">๐ฌ๐ช Georgia + 995</option>
<option value="+49">๐ฉ๐ช Germany + 49</option>
<option value="+233">๐ฌ๐ญ Ghana + 233</option>
<option value="+350">๐ฌ๐ฎ Gibraltar + 350</option>
<option value="+30">๐ฌ๐ท Greece + 30</option>
<option value="+299">๐ฌ๐ฑ Greenland + 299</option>
<option value="+1473">๐ฌ๐ฉ Grenada + 1473</option>
<option value="+590">๐ฌ๐ต Guadeloupe + 590</option>
<option value="+1671">๐ฌ๐บ Guam + 1671</option>
<option value="+502">๐ฌ๐น Guatemala + 502</option>
<option value="+44">๐ฌ๐ฌ Guernsey + 44</option>
<option value="+224">๐ฌ๐ณ Guinea + 224</option>
<option value="-+245">๐ฌ๐ผ Guinea-Bissau + 245</option>
<option value="+592">๐ฌ๐พ Guyana + 592</option>
<option value="+509">๐ญ๐น Haiti + 509</option>
<option value="+504">๐ญ๐ณ Honduras + 504</option>
<option value="+852">๐ญ๐ฐ Hong Kong + 852</option>
<option value="+36">๐ญ๐บ Hungary + 36</option>
<option value="+354">๐ฎ๐ธ Iceland + 354</option>
<option value="+91">๐ฎ๐ณ India + 91</option>
<option value="+62">๐ฎ๐ฉ Indonesia + 62</option>
<option value="+98">๐ฎ๐ท Iran + 98</option>
<option value="+964">๐ฎ๐ถ Iraq + 964</option>
<option value="+44">๐ฎ๐ฒ Isle of Man + 44</option>
<option value="+972">๐ฎ๐ฑ Israel + 972</option>
<option value="+39">๐ฎ๐น Italy + 39</option>
<option value="+225">๐จ๐ฎ Ivory Coast + 225</option>
<option value="+1876">๐ฏ๐ฒ Jamaica + 1876</option>
<option value="+81">๐ฏ๐ต Japan + 81</option>
<option value="+44">๐ฏ๐ช Jersey + 44</option>
<option value="+962">๐ฏ๐ด Jordan + 962</option>
<option value="+76">๐ฐ๐ฟ Kazakhstan + 76</option>
<option value="+254">๐ฐ๐ช Kenya + 254</option>
<option value="+686">๐ฐ๐ฎ Kiribati + 686</option>
<option value="+383">๐ฝ๐ฐ Kosovo + 383</option>
<option value="+965">๐ฐ๐ผ Kuwait + 965</option>
<option value="+996">๐ฐ๐ฌ Kyrgyzstan + 996</option>
<option value="+856">๐ฑ๐ฆ Laos + 856</option>
<option value="+371">๐ฑ๐ป Latvia + 371</option>
<option value="+961">๐ฑ๐ง Lebanon + 961</option>
<option value="+266">๐ฑ๐ธ Lesotho + 266</option>
<option value="+231">๐ฑ๐ท Liberia + 231</option>
<option value="+218">๐ฑ๐พ Libya + 218</option>
<option value="+423">๐ฑ๐ฎ Liechtenstein + 423</option>
<option value="+370">๐ฑ๐น Lithuania + 370</option>
<option value="+352">๐ฑ๐บ Luxembourg + 352</option>
<option value="+853">๐ฒ๐ด Macau + 853</option>
<option value="+389">๐ฒ๐ฐ Macedonia + 389</option>
<option value="+261">๐ฒ๐ฌ Madagascar + 261</option>
<option value="+265">๐ฒ๐ผ Malawi + 265</option>
<option value="+60">๐ฒ๐พ Malaysia + 60</option>
<option value="+960">๐ฒ๐ป Maldives + 960</option>
<option value="+223">๐ฒ๐ฑ Mali + 223</option>
<option value="+356">๐ฒ๐น Malta + 356</option>
<option value="+692">๐ฒ๐ญ Marshall Islands + 692</option>
<option value="+596">๐ฒ๐ถ Martinique + 596</option>
<option value="+222">๐ฒ๐ท Mauritania + 222</option>
<option value="+230">๐ฒ๐บ Mauritius + 230</option>
<option value="+262">๐พ๐น Mayotte + 262</option>
<option value="+52">๐ฒ๐ฝ Mexico + 52</option>
<option value="+691">๐ซ๐ฒ Micronesia + 691</option>
<option value="+373">๐ฒ๐ฉ Moldova + 373</option>
<option value="+377">๐ฒ๐จ Monaco + 377</option>
<option value="+976">๐ฒ๐ณ Mongolia + 976</option>
<option value="+382">๐ฒ๐ช Montenegro + 382</option>
<option value="+1664">๐ฒ๐ธ Montserrat + 1664</option>
<option value="+212">๐ฒ๐ฆ Morocco + 212</option>
<option value="+258">๐ฒ๐ฟ Mozambique + 258</option>
<option value="+95">๐ฒ๐ฒ Myanmar + 95</option>
<option value="+264">๐ณ๐ฆ Namibia + 264</option>
<option value="+674">๐ณ๐ท Nauru + 674</option>
<option value="+977">๐ณ๐ต Nepal + 977</option>
<option value="+31">๐ณ๐ฑ Netherlands + 31</option>
<option value="+687">๐ณ๐จ New Caledonia + 687</option>
<option value="+64">๐ณ๐ฟ New Zealand + 64</option>
<option value="+505">๐ณ๐ฎ Nicaragua + 505</option>
<option value="+227">๐ณ๐ช Niger + 227</option>
<option value="+234">๐ณ๐ฌ Nigeria + 234</option>
<option value="+683">๐ณ๐บ Niue + 683</option>
<option value="+672">๐ณ๐ซ Norfolk Island + 672</option>
<option value="+850">๐ฐ๐ต North Korea + 850</option>
<option value="+1670">๐ฒ๐ต Northern Mariana Islands + 1670</option>
<option value="+47">๐ณ๐ด Norway + 47</option>
<option value="+968">๐ด๐ฒ Oman + 968</option>
<option value="+92">๐ต๐ฐ Pakistan + 92</option>
<option value="+680">๐ต๐ผ Palau + 680</option>
<option value="+970">๐ต๐ธ Palestine + 970</option>
<option value="+507">๐ต๐ฆ Panama + 507</option>
<option value="+675">๐ต๐ฌ Papua New Guinea + 675</option>
<option value="+595">๐ต๐พ Paraguay + 595</option>
<option value="+51">๐ต๐ช Peru + 51</option>
<option value="+63">๐ต๐ญ Philippines + 63</option>
<option value="+64">๐ต๐ณ Pitcairn Islands + 64</option>
<option value="+48">๐ต๐ฑ Poland + 48</option>
<option value="+351">๐ต๐น Portugal + 351</option>
<option value="+1787">๐ต๐ท Puerto Rico + 1787</option>
<option value="+974">๐ถ๐ฆ Qatar + 974</option>
<option value="+242">๐จ๐ฌ Republic of the Congo + 242</option>
<option value="+40">๐ท๐ด Romania + 40</option>
<option value="+7">๐ท๐บ Russia + 7</option>
<option value="+250">๐ท๐ผ Rwanda + 250</option>
<option value="+262">๐ท๐ช Rรฉunion + 262</option>
<option value="+590">๐ง๐ฑ Saint Barthรฉlemy + 590</option>
<option value="+1869">๐ฐ๐ณ Saint Kitts and Nevis + 1869</option>
<option value="+1758">๐ฑ๐จ Saint Lucia + 1758</option>
<option value="+590">๐ฒ๐ซ Saint Martin + 590</option>
<option value="+508">๐ต๐ฒ Saint Pierre and Miquelon + 508</option>
<option value="+1784">๐ป๐จ Saint Vincent and the Grenadines + 1784</option>
<option value="+685">๐ผ๐ธ Samoa + 685</option>
<option value="+378">๐ธ๐ฒ San Marino + 378</option>
<option value="+966">๐ธ๐ฆ Saudi Arabia + 966</option>
<option value="+221">๐ธ๐ณ Senegal + 221</option>
<option value="+381">๐ท๐ธ Serbia + 381</option>
<option value="+248">๐ธ๐จ Seychelles + 248</option>
<option value="+232">๐ธ๐ฑ Sierra Leone + 232</option>
<option value="+65">๐ธ๐ฌ Singapore + 65</option>
<option value="+1721">๐ธ๐ฝ Sint Maarten + 1721</option>
<option value="+421">๐ธ๐ฐ Slovakia + 421</option>
<option value="+386">๐ธ๐ฎ Slovenia + 386</option>
<option value="+677">๐ธ๐ง Solomon Islands + 677</option>
<option value="+252">๐ธ๐ด Somalia + 252</option>
<option value="+27">๐ฟ๐ฆ South Africa + 27</option>
<option value="+500">๐ฌ๐ธ South Georgia + 500</option>
<option value="+82">๐ฐ๐ท South Korea + 82</option>
<option value="+211">๐ธ๐ธ South Sudan + 211</option>
<option value="+34">๐ช๐ธ Spain + 34</option>
<option value="+94">๐ฑ๐ฐ Sri Lanka + 94</option>
<option value="+249">๐ธ๐ฉ Sudan + 249</option>
<option value="+597">๐ธ๐ท Suriname + 597</option>
<option value="+4779">๐ธ๐ฏ Svalbard and Jan Mayen + 4779</option>
<option value="+268">๐ธ๐ฟ Swaziland + 268</option>
<option value="+46">๐ธ๐ช Sweden + 46</option>
<option value="+41">๐จ๐ญ Switzerland + 41</option>
<option value="+963">๐ธ๐พ Syria + 963</option>
<option value="+239">๐ธ๐น Sรฃo Tomรฉ and Prรญncipe + 239</option>
<option value="+886">๐น๐ผ Taiwan + 886</option>
<option value="+992">๐น๐ฏ Tajikistan + 992</option>
<option value="+255">๐น๐ฟ Tanzania + 255</option>
<option value="+66">๐น๐ญ Thailand + 66</option>
<option value="+670">๐น๐ฑ Timor-Leste + 670</option>
<option value="+228">๐น๐ฌ Togo + 228</option>
<option value="+690">๐น๐ฐ Tokelau + 690</option>
<option value="+676">๐น๐ด Tonga + 676</option>
<option value="+1868">๐น๐น Trinidad and Tobago + 1868</option>
<option value="+216">๐น๐ณ Tunisia + 216</option>
<option value="+90">๐น๐ท Turkey + 90</option>
<option value="+993">๐น๐ฒ Turkmenistan + 993</option>
<option value="+1649">๐น๐จ Turks and Caicos Islands + 1649</option>
<option value="+688">๐น๐ป Tuvalu + 688</option>
<option value="+256">๐บ๐ฌ Uganda + 256</option>
<option value="+380">๐บ๐ฆ Ukraine + 380</option>
<option value="+971">๐ฆ๐ช United Arab Emirates + 971</option>
<option value="+1">๐บ๐ธ United States + 1</option>
<option value="+1340">๐ป๐ฎ United States Virgin Islands + 1340</option>
<option value="+598">๐บ๐พ Uruguay + 598</option>
<option value="+998">๐บ๐ฟ Uzbekistan + 998</option>
<option value="+678">๐ป๐บ Vanuatu + 678</option>
<option value="+379">๐ป๐ฆ Vatican City + 379</option>
<option value="+58">๐ป๐ช Venezuela + 58</option>
<option value="+84">๐ป๐ณ Vietnam + 84</option>
<option value="+681">๐ผ๐ซ Wallis and Futuna + 681</option>
<option value="+212">๐ช๐ญ Western Sahara + 212</option>
<option value="+967">๐พ๐ช Yemen + 967</option>
<option value="+260">๐ฟ๐ฒ Zambia + 260</option>
<option value="+263">๐ฟ๐ผ Zimbabwe + 263</option>
</span>
<select id="code1" name="code1" required="">
<option value="+44" selected="">๐ฌ๐ง +44</option>
<option value="+353">๐ฎ๐ช +353</option>
<option value="+93">๐ฆ๐ซ +93</option>
<option value="+358">๐ฆ๐ฝ +358</option>
<option value="+355">๐ฆ๐ฑ +355</option>
<option value="+213">๐ฉ๐ฟ +213</option>
<option value="+1684">๐ฆ๐ธ +1684</option>
<option value="+376">๐ฆ๐ฉ +376</option>
<option value="+244">๐ฆ๐ด +244</option>
<option value="+1264">๐ฆ๐ฎ +1264</option>
<option value="+1268">๐ฆ๐ฌ +1268</option>
<option value="+54">๐ฆ๐ท +54</option>
<option value="+374">๐ฆ๐ฒ +374</option>
<option value="+297">๐ฆ๐ผ +297</option>
<option value="+61">๐ฆ๐บ +61</option>
<option value="+43">๐ฆ๐น +43</option>
<option value="+994">๐ฆ๐ฟ +994</option>
<option value="+1242">๐ง๐ธ +1242</option>
<option value="+973">๐ง๐ญ +973</option>
<option value="+880">๐ง๐ฉ +880</option>
<option value="+1246">๐ง๐ง +1246</option>
<option value="+375">๐ง๐พ +375</option>
<option value="+32">๐ง๐ช +32</option>
<option value="+501">๐ง๐ฟ +501</option>
<option value="+229">๐ง๐ฏ +229</option>
<option value="+1441">๐ง๐ฒ +1441</option>
<option value="+975">๐ง๐น +975</option>
<option value="+591">๐ง๐ด +591</option>
<option value="+387">๐ง๐ฆ +387</option>
<option value="+267">๐ง๐ผ +267</option>
<option value="+55">๐ง๐ท +55</option>
<option value="+246">๐ฎ๐ด +246</option>
<option value="+1284">๐ป๐ฌ +1284</option>
<option value="+673">๐ง๐ณ +673</option>
<option value="+359">๐ง๐ฌ +359</option>
<option value="+226">๐ง๐ซ +226</option>
<option value="+257">๐ง๐ฎ +257</option>
<option value="+855">๐ฐ๐ญ +855</option>
<option value="+237">๐จ๐ฒ +237</option>
<option value="+1">๐จ๐ฆ +1</option>
<option value="+238">๐จ๐ป +238</option>
<option value="+1345">๐ฐ๐พ +1345</option>
<option value="+236">๐จ๐ซ +236</option>
<option value="+235">๐น๐ฉ +235</option>
<option value="+56">๐จ๐ฑ +56</option>
<option value="+86">๐จ๐ณ +86</option>
<option value="+61">๐จ๐ฝ +61</option>
<option value="+61">๐จ๐จ +61</option>
<option value="+57">๐จ๐ด +57</option>
<option value="+269">๐ฐ๐ฒ +269</option>
<option value="+682">๐จ๐ฐ +682</option>
<option value="+506">๐จ๐ท +506</option>
<option value="+385">๐ญ๐ท +385</option>
<option value="+53">๐จ๐บ +53</option>
<option value="+5999">๐จ๐ผ +5999</option>
<option value="+357">๐จ๐พ +357</option>
<option value="+420">๐จ๐ฟ +420</option>
<option value="+243">๐จ๐ฉ +243</option>
<option value="+45">๐ฉ๐ฐ +45</option>
<option value="+253">๐ฉ๐ฏ +253</option>
<option value="+1767">๐ฉ๐ฒ +1767</option>
<option value="+1809">๐ฉ๐ด +1809</option>
<option value="+593">๐ช๐จ +593</option>
<option value="+20">๐ช๐ฌ +20</option>
<option value="+503">๐ธ๐ป +503</option>
<option value="+240">๐ฌ๐ถ +240</option>
<option value="+291">๐ช๐ท +291</option>
<option value="+372">๐ช๐ช +372</option>
<option value="+251">๐ช๐น +251</option>
<option value="+500">๐ซ๐ฐ +500</option>
<option value="+298">๐ซ๐ด +298</option>
<option value="+679">๐ซ๐ฏ +679</option>
<option value="+358">๐ซ๐ฎ +358</option>
<option value="+33">๐ซ๐ท +33</option>
<option value="+594">๐ฌ๐ซ +594</option>
<option value="+689">๐ต๐ซ +689</option>
<option value="+241">๐ฌ๐ฆ +241</option>
<option value="+220">๐ฌ๐ฒ +220</option>
<option value="+995">๐ฌ๐ช +995</option>
<option value="+49">๐ฉ๐ช +49</option>
<option value="+233">๐ฌ๐ญ +233</option>
<option value="+350">๐ฌ๐ฎ +350</option>
<option value="+30">๐ฌ๐ท +30</option>
<option value="+299">๐ฌ๐ฑ +299</option>
<option value="+1473">๐ฌ๐ฉ +1473</option>
<option value="+590">๐ฌ๐ต +590</option>
<option value="+1671">๐ฌ๐บ +1671</option>
<option value="+502">๐ฌ๐น +502</option>
<option value="+44">๐ฌ๐ฌ +44</option>
<option value="+224">๐ฌ๐ณ +224</option>
<option value="-+245">๐ฌ๐ผ +245</option>
<option value="+592">๐ฌ๐พ +592</option>
<option value="+509">๐ญ๐น +509</option>
<option value="+504">๐ญ๐ณ +504</option>
<option value="+852">๐ญ๐ฐ +852</option>
<option value="+36">๐ญ๐บ +36</option>
<option value="+354">๐ฎ๐ธ +354</option>
<option value="+91">๐ฎ๐ณ +91</option>
<option value="+62">๐ฎ๐ฉ +62</option>
<option value="+98">๐ฎ๐ท +98</option>
<option value="+964">๐ฎ๐ถ +964</option>
<option value="+44">๐ฎ๐ฒ +44</option>
<option value="+972">๐ฎ๐ฑ +972</option>
<option value="+39">๐ฎ๐น +39</option>
<option value="+225">๐จ๐ฎ +225</option>
<option value="+1876">๐ฏ๐ฒ +1876</option>
<option value="+81">๐ฏ๐ต +81</option>
<option value="+44">๐ฏ๐ช +44</option>
<option value="+962">๐ฏ๐ด +962</option>
<option value="+76">๐ฐ๐ฟ +76</option>
<option value="+254">๐ฐ๐ช +254</option>
<option value="+686">๐ฐ๐ฎ +686</option>
<option value="+383">๐ฝ๐ฐ +383</option>
<option value="+965">๐ฐ๐ผ +965</option>
<option value="+996">๐ฐ๐ฌ +996</option>
<option value="+856">๐ฑ๐ฆ +856</option>
<option value="+371">๐ฑ๐ป +371</option>
<option value="+961">๐ฑ๐ง +961</option>
<option value="+266">๐ฑ๐ธ +266</option>
<option value="+231">๐ฑ๐ท +231</option>
<option value="+218">๐ฑ๐พ +218</option>
<option value="+423">๐ฑ๐ฎ +423</option>
<option value="+370">๐ฑ๐น +370</option>
<option value="+352">๐ฑ๐บ +352</option>
<option value="+853">๐ฒ๐ด +853</option>
<option value="+389">๐ฒ๐ฐ +389</option>
<option value="+261">๐ฒ๐ฌ +261</option>
<option value="+265">๐ฒ๐ผ +265</option>
<option value="+60">๐ฒ๐พ +60</option>
<option value="+960">๐ฒ๐ป +960</option>
<option value="+223">๐ฒ๐ฑ +223</option>
<option value="+356">๐ฒ๐น +356</option>
<option value="+692">๐ฒ๐ญ +692</option>
<option value="+596">๐ฒ๐ถ +596</option>
<option value="+222">๐ฒ๐ท +222</option>
<option value="+230">๐ฒ๐บ +230</option>
<option value="+262">๐พ๐น +262</option>
<option value="+52">๐ฒ๐ฝ +52</option>
<option value="+691">๐ซ๐ฒ +691</option>
<option value="+373">๐ฒ๐ฉ +373</option>
<option value="+377">๐ฒ๐จ +377</option>
<option value="+976">๐ฒ๐ณ +976</option>
<option value="+382">๐ฒ๐ช +382</option>
<option value="+1664">๐ฒ๐ธ +1664</option>
<option value="+212">๐ฒ๐ฆ +212</option>
<option value="+258">๐ฒ๐ฟ +258</option>
<option value="+95">๐ฒ๐ฒ +95</option>
<option value="+264">๐ณ๐ฆ +264</option>
<option value="+674">๐ณ๐ท +674</option>
<option value="+977">๐ณ๐ต +977</option>
<option value="+31">๐ณ๐ฑ +31</option>
<option value="+687">๐ณ๐จ +687</option>
<option value="+64">๐ณ๐ฟ +64</option>
<option value="+505">๐ณ๐ฎ +505</option>
<option value="+227">๐ณ๐ช +227</option>
<option value="+234">๐ณ๐ฌ +234</option>
<option value="+683">๐ณ๐บ +683</option>
<option value="+672">๐ณ๐ซ +672</option>
<option value="+850">๐ฐ๐ต +850</option>
<option value="+1670">๐ฒ๐ต +1670</option>
<option value="+47">๐ณ๐ด +47</option>
<option value="+968">๐ด๐ฒ +968</option>
<option value="+92">๐ต๐ฐ +92</option>
<option value="+680">๐ต๐ผ +680</option>
<option value="+970">๐ต๐ธ +970</option>
<option value="+507">๐ต๐ฆ +507</option>
<option value="+675">๐ต๐ฌ +675</option>
<option value="+595">๐ต๐พ +595</option>
<option value="+51">๐ต๐ช +51</option>
<option value="+63">๐ต๐ญ +63</option>
<option value="+64">๐ต๐ณ +64</option>
<option value="+48">๐ต๐ฑ +48</option>
<option value="+351">๐ต๐น +351</option>
<option value="+1787">๐ต๐ท +1787</option>
<option value="+974">๐ถ๐ฆ +974</option>
<option value="+242">๐จ๐ฌ +242</option>
<option value="+40">๐ท๐ด +40</option>
<option value="+7">๐ท๐บ +7</option>
<option value="+250">๐ท๐ผ +250</option>
<option value="+262">๐ท๐ช +262</option>
<option value="+590">๐ง๐ฑ +590</option>
<option value="+1869">๐ฐ๐ณ +1869</option>
<option value="+1758">๐ฑ๐จ +1758</option>
<option value="+590">๐ฒ๐ซ +590</option>
<option value="+508">๐ต๐ฒ +508</option>
<option value="+1784">๐ป๐จ +1784</option>
<option value="+685">๐ผ๐ธ +685</option>
<option value="+378">๐ธ๐ฒ +378</option>
<option value="+966">๐ธ๐ฆ +966</option>
<option value="+221">๐ธ๐ณ +221</option>
<option value="+381">๐ท๐ธ +381</option>
<option value="+248">๐ธ๐จ +248</option>
<option value="+232">๐ธ๐ฑ +232</option>
<option value="+65">๐ธ๐ฌ +65</option>
<option value="+1721">๐ธ๐ฝ +1721</option>
<option value="+421">๐ธ๐ฐ +421</option>
<option value="+386">๐ธ๐ฎ +386</option>
<option value="+677">๐ธ๐ง +677</option>
<option value="+252">๐ธ๐ด +252</option>
<option value="+27">๐ฟ๐ฆ +27</option>
<option value="+500">๐ฌ๐ธ +500</option>
<option value="+82">๐ฐ๐ท +82</option>
<option value="+211">๐ธ๐ธ +211</option>
<option value="+34">๐ช๐ธ +34</option>
<option value="+94">๐ฑ๐ฐ +94</option>
<option value="+249">๐ธ๐ฉ +249</option>
<option value="+597">๐ธ๐ท +597</option>
<option value="+4779">๐ธ๐ฏ +4779</option>
<option value="+268">๐ธ๐ฟ +268</option>
<option value="+46">๐ธ๐ช +46</option>
<option value="+41">๐จ๐ญ +41</option>
<option value="+963">๐ธ๐พ +963</option>
<option value="+239">๐ธ๐น +239</option>
<option value="+886">๐น๐ผ +886</option>
<option value="+992">๐น๐ฏ +992</option>
<option value="+255">๐น๐ฟ +255</option>
<option value="+66">๐น๐ญ +66</option>
<option value="+670">๐น๐ฑ +670</option>
<option value="+228">๐น๐ฌ +228</option>
<option value="+690">๐น๐ฐ +690</option>
<option value="+676">๐น๐ด +676</option>
<option value="+1868">๐น๐น +1868</option>
<option value="+216">๐น๐ณ +216</option>
<option value="+90">๐น๐ท +90</option>
<option value="+993">๐น๐ฒ +993</option>
<option value="+1649">๐น๐จ +1649</option>
<option value="+688">๐น๐ป +688</option>
<option value="+256">๐บ๐ฌ +256</option>
<option value="+380">๐บ๐ฆ +380</option>
<option value="+971">๐ฆ๐ช +971</option>
<option value="+1">๐บ๐ธ +1</option>
<option value="+1340">๐ป๐ฎ +1340</option>
<option value="+598">๐บ๐พ +598</option>
<option value="+998">๐บ๐ฟ +998</option>
<option value="+678">๐ป๐บ +678</option>
<option value="+379">๐ป๐ฆ +379</option>
<option value="+58">๐ป๐ช +58</option>
<option value="+84">๐ป๐ณ +84</option>
<option value="+681">๐ผ๐ซ +681</option>
<option value="+212">๐ช๐ญ +212</option>
<option value="+967">๐พ๐ช +967</option>
<option value="+260">๐ฟ๐ฒ +260</option>
<option value="+263">๐ฟ๐ผ +263</option>
</select>
</div>
<div class="phone-number-input__number">
<input class="register-phone-number-input-2 ng-pristine ng-untouched ng-empty ng-valid ng-valid-required" type="text" only-digits="" no-whitespace="" id="mobile" name="mobile" required="" ng-trim="false">
</div>
</div>
<div class="error-message"><span class="af-icon-exclamation-mark"></span> <span>Number cannot be empty.</span></div>
</div>
<expert-checkbox field="phoneNumberInputCtrl.field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</phone-number-input>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<phone-number-input field="field" substep="substep" has-extension="true" class="ng-isolate-scope">
<div class="form-input-wrapper recommendedField">
<div class="form-input-wrapper-left">
<label for="landline7">Landline </label> <span class="help-button af-icon-question-mark ng-scope" role="button"></span>
<div class="input-example ng-scope">
<p>Example: +44 2079460696 1234</p>
</div>
</div>
<div class="form-input-wrapper-right">
<div phone-number-input-atr="" phone-number="phoneNumberInputCtrl.field.data" is-disabled="phoneNumberInputCtrl.field.disabled" has-extension="phoneNumberInputCtrl.hasExtension" field="phoneNumberInputCtrl.field"
class="ng-isolate-scope">
<div class="phone-number-input">
<div class="phone-number-input__prefix">
<select id="code2" name="code2" xrequired="">
<option value="+44" selected="">๐ฌ๐ง +44</option>
<option value="+353">๐ฎ๐ช +353</option>
<option value="+93">๐ฆ๐ซ +93</option>
<option value="+358">๐ฆ๐ฝ +358</option>
<option value="+355">๐ฆ๐ฑ +355</option>
<option value="+213">๐ฉ๐ฟ +213</option>
<option value="+1684">๐ฆ๐ธ +1684</option>
<option value="+376">๐ฆ๐ฉ +376</option>
<option value="+244">๐ฆ๐ด +244</option>
<option value="+1264">๐ฆ๐ฎ +1264</option>
<option value="+1268">๐ฆ๐ฌ +1268</option>
<option value="+54">๐ฆ๐ท +54</option>
<option value="+374">๐ฆ๐ฒ +374</option>
<option value="+297">๐ฆ๐ผ +297</option>
<option value="+61">๐ฆ๐บ +61</option>
<option value="+43">๐ฆ๐น +43</option>
<option value="+994">๐ฆ๐ฟ +994</option>
<option value="+1242">๐ง๐ธ +1242</option>
<option value="+973">๐ง๐ญ +973</option>
<option value="+880">๐ง๐ฉ +880</option>
<option value="+1246">๐ง๐ง +1246</option>
<option value="+375">๐ง๐พ +375</option>
<option value="+32">๐ง๐ช +32</option>
<option value="+501">๐ง๐ฟ +501</option>
<option value="+229">๐ง๐ฏ +229</option>
<option value="+1441">๐ง๐ฒ +1441</option>
<option value="+975">๐ง๐น +975</option>
<option value="+591">๐ง๐ด +591</option>
<option value="+387">๐ง๐ฆ +387</option>
<option value="+267">๐ง๐ผ +267</option>
<option value="+55">๐ง๐ท +55</option>
<option value="+246">๐ฎ๐ด +246</option>
<option value="+1284">๐ป๐ฌ +1284</option>
<option value="+673">๐ง๐ณ +673</option>
<option value="+359">๐ง๐ฌ +359</option>
<option value="+226">๐ง๐ซ +226</option>
<option value="+257">๐ง๐ฎ +257</option>
<option value="+855">๐ฐ๐ญ +855</option>
<option value="+237">๐จ๐ฒ +237</option>
<option value="+1">๐จ๐ฆ +1</option>
<option value="+238">๐จ๐ป +238</option>
<option value="+1345">๐ฐ๐พ +1345</option>
<option value="+236">๐จ๐ซ +236</option>
<option value="+235">๐น๐ฉ +235</option>
<option value="+56">๐จ๐ฑ +56</option>
<option value="+86">๐จ๐ณ +86</option>
<option value="+61">๐จ๐ฝ +61</option>
<option value="+61">๐จ๐จ +61</option>
<option value="+57">๐จ๐ด +57</option>
<option value="+269">๐ฐ๐ฒ +269</option>
<option value="+682">๐จ๐ฐ +682</option>
<option value="+506">๐จ๐ท +506</option>
<option value="+385">๐ญ๐ท +385</option>
<option value="+53">๐จ๐บ +53</option>
<option value="+5999">๐จ๐ผ +5999</option>
<option value="+357">๐จ๐พ +357</option>
<option value="+420">๐จ๐ฟ +420</option>
<option value="+243">๐จ๐ฉ +243</option>
<option value="+45">๐ฉ๐ฐ +45</option>
<option value="+253">๐ฉ๐ฏ +253</option>
<option value="+1767">๐ฉ๐ฒ +1767</option>
<option value="+1809">๐ฉ๐ด +1809</option>
<option value="+593">๐ช๐จ +593</option>
<option value="+20">๐ช๐ฌ +20</option>
<option value="+503">๐ธ๐ป +503</option>
<option value="+240">๐ฌ๐ถ +240</option>
<option value="+291">๐ช๐ท +291</option>
<option value="+372">๐ช๐ช +372</option>
<option value="+251">๐ช๐น +251</option>
<option value="+500">๐ซ๐ฐ +500</option>
<option value="+298">๐ซ๐ด +298</option>
<option value="+679">๐ซ๐ฏ +679</option>
<option value="+358">๐ซ๐ฎ +358</option>
<option value="+33">๐ซ๐ท +33</option>
<option value="+594">๐ฌ๐ซ +594</option>
<option value="+689">๐ต๐ซ +689</option>
<option value="+241">๐ฌ๐ฆ +241</option>
<option value="+220">๐ฌ๐ฒ +220</option>
<option value="+995">๐ฌ๐ช +995</option>
<option value="+49">๐ฉ๐ช +49</option>
<option value="+233">๐ฌ๐ญ +233</option>
<option value="+350">๐ฌ๐ฎ +350</option>
<option value="+30">๐ฌ๐ท +30</option>
<option value="+299">๐ฌ๐ฑ +299</option>
<option value="+1473">๐ฌ๐ฉ +1473</option>
<option value="+590">๐ฌ๐ต +590</option>
<option value="+1671">๐ฌ๐บ +1671</option>
<option value="+502">๐ฌ๐น +502</option>
<option value="+44">๐ฌ๐ฌ +44</option>
<option value="+224">๐ฌ๐ณ +224</option>
<option value="-+245">๐ฌ๐ผ +245</option>
<option value="+592">๐ฌ๐พ +592</option>
<option value="+509">๐ญ๐น +509</option>
<option value="+504">๐ญ๐ณ +504</option>
<option value="+852">๐ญ๐ฐ +852</option>
<option value="+36">๐ญ๐บ +36</option>
<option value="+354">๐ฎ๐ธ +354</option>
<option value="+91">๐ฎ๐ณ +91</option>
<option value="+62">๐ฎ๐ฉ +62</option>
<option value="+98">๐ฎ๐ท +98</option>
<option value="+964">๐ฎ๐ถ +964</option>
<option value="+44">๐ฎ๐ฒ +44</option>
<option value="+972">๐ฎ๐ฑ +972</option>
<option value="+39">๐ฎ๐น +39</option>
<option value="+225">๐จ๐ฎ +225</option>
<option value="+1876">๐ฏ๐ฒ +1876</option>
<option value="+81">๐ฏ๐ต +81</option>
<option value="+44">๐ฏ๐ช +44</option>
<option value="+962">๐ฏ๐ด +962</option>
<option value="+76">๐ฐ๐ฟ +76</option>
<option value="+254">๐ฐ๐ช +254</option>
<option value="+686">๐ฐ๐ฎ +686</option>
<option value="+383">๐ฝ๐ฐ +383</option>
<option value="+965">๐ฐ๐ผ +965</option>
<option value="+996">๐ฐ๐ฌ +996</option>
<option value="+856">๐ฑ๐ฆ +856</option>
<option value="+371">๐ฑ๐ป +371</option>
<option value="+961">๐ฑ๐ง +961</option>
<option value="+266">๐ฑ๐ธ +266</option>
<option value="+231">๐ฑ๐ท +231</option>
<option value="+218">๐ฑ๐พ +218</option>
<option value="+423">๐ฑ๐ฎ +423</option>
<option value="+370">๐ฑ๐น +370</option>
<option value="+352">๐ฑ๐บ +352</option>
<option value="+853">๐ฒ๐ด +853</option>
<option value="+389">๐ฒ๐ฐ +389</option>
<option value="+261">๐ฒ๐ฌ +261</option>
<option value="+265">๐ฒ๐ผ +265</option>
<option value="+60">๐ฒ๐พ +60</option>
<option value="+960">๐ฒ๐ป +960</option>
<option value="+223">๐ฒ๐ฑ +223</option>
<option value="+356">๐ฒ๐น +356</option>
<option value="+692">๐ฒ๐ญ +692</option>
<option value="+596">๐ฒ๐ถ +596</option>
<option value="+222">๐ฒ๐ท +222</option>
<option value="+230">๐ฒ๐บ +230</option>
<option value="+262">๐พ๐น +262</option>
<option value="+52">๐ฒ๐ฝ +52</option>
<option value="+691">๐ซ๐ฒ +691</option>
<option value="+373">๐ฒ๐ฉ +373</option>
<option value="+377">๐ฒ๐จ +377</option>
<option value="+976">๐ฒ๐ณ +976</option>
<option value="+382">๐ฒ๐ช +382</option>
<option value="+1664">๐ฒ๐ธ +1664</option>
<option value="+212">๐ฒ๐ฆ +212</option>
<option value="+258">๐ฒ๐ฟ +258</option>
<option value="+95">๐ฒ๐ฒ +95</option>
<option value="+264">๐ณ๐ฆ +264</option>
<option value="+674">๐ณ๐ท +674</option>
<option value="+977">๐ณ๐ต +977</option>
<option value="+31">๐ณ๐ฑ +31</option>
<option value="+687">๐ณ๐จ +687</option>
<option value="+64">๐ณ๐ฟ +64</option>
<option value="+505">๐ณ๐ฎ +505</option>
<option value="+227">๐ณ๐ช +227</option>
<option value="+234">๐ณ๐ฌ +234</option>
<option value="+683">๐ณ๐บ +683</option>
<option value="+672">๐ณ๐ซ +672</option>
<option value="+850">๐ฐ๐ต +850</option>
<option value="+1670">๐ฒ๐ต +1670</option>
<option value="+47">๐ณ๐ด +47</option>
<option value="+968">๐ด๐ฒ +968</option>
<option value="+92">๐ต๐ฐ +92</option>
<option value="+680">๐ต๐ผ +680</option>
<option value="+970">๐ต๐ธ +970</option>
<option value="+507">๐ต๐ฆ +507</option>
<option value="+675">๐ต๐ฌ +675</option>
<option value="+595">๐ต๐พ +595</option>
<option value="+51">๐ต๐ช +51</option>
<option value="+63">๐ต๐ญ +63</option>
<option value="+64">๐ต๐ณ +64</option>
<option value="+48">๐ต๐ฑ +48</option>
<option value="+351">๐ต๐น +351</option>
<option value="+1787">๐ต๐ท +1787</option>
<option value="+974">๐ถ๐ฆ +974</option>
<option value="+242">๐จ๐ฌ +242</option>
<option value="+40">๐ท๐ด +40</option>
<option value="+7">๐ท๐บ +7</option>
<option value="+250">๐ท๐ผ +250</option>
<option value="+262">๐ท๐ช +262</option>
<option value="+590">๐ง๐ฑ +590</option>
<option value="+1869">๐ฐ๐ณ +1869</option>
<option value="+1758">๐ฑ๐จ +1758</option>
<option value="+590">๐ฒ๐ซ +590</option>
<option value="+508">๐ต๐ฒ +508</option>
<option value="+1784">๐ป๐จ +1784</option>
<option value="+685">๐ผ๐ธ +685</option>
<option value="+378">๐ธ๐ฒ +378</option>
<option value="+966">๐ธ๐ฆ +966</option>
<option value="+221">๐ธ๐ณ +221</option>
<option value="+381">๐ท๐ธ +381</option>
<option value="+248">๐ธ๐จ +248</option>
<option value="+232">๐ธ๐ฑ +232</option>
<option value="+65">๐ธ๐ฌ +65</option>
<option value="+1721">๐ธ๐ฝ +1721</option>
<option value="+421">๐ธ๐ฐ +421</option>
<option value="+386">๐ธ๐ฎ +386</option>
<option value="+677">๐ธ๐ง +677</option>
<option value="+252">๐ธ๐ด +252</option>
<option value="+27">๐ฟ๐ฆ +27</option>
<option value="+500">๐ฌ๐ธ +500</option>
<option value="+82">๐ฐ๐ท +82</option>
<option value="+211">๐ธ๐ธ +211</option>
<option value="+34">๐ช๐ธ +34</option>
<option value="+94">๐ฑ๐ฐ +94</option>
<option value="+249">๐ธ๐ฉ +249</option>
<option value="+597">๐ธ๐ท +597</option>
<option value="+4779">๐ธ๐ฏ +4779</option>
<option value="+268">๐ธ๐ฟ +268</option>
<option value="+46">๐ธ๐ช +46</option>
<option value="+41">๐จ๐ญ +41</option>
<option value="+963">๐ธ๐พ +963</option>
<option value="+239">๐ธ๐น +239</option>
<option value="+886">๐น๐ผ +886</option>
<option value="+992">๐น๐ฏ +992</option>
<option value="+255">๐น๐ฟ +255</option>
<option value="+66">๐น๐ญ +66</option>
<option value="+670">๐น๐ฑ +670</option>
<option value="+228">๐น๐ฌ +228</option>
<option value="+690">๐น๐ฐ +690</option>
<option value="+676">๐น๐ด +676</option>
<option value="+1868">๐น๐น +1868</option>
<option value="+216">๐น๐ณ +216</option>
<option value="+90">๐น๐ท +90</option>
<option value="+993">๐น๐ฒ +993</option>
<option value="+1649">๐น๐จ +1649</option>
<option value="+688">๐น๐ป +688</option>
<option value="+256">๐บ๐ฌ +256</option>
<option value="+380">๐บ๐ฆ +380</option>
<option value="+971">๐ฆ๐ช +971</option>
<option value="+1">๐บ๐ธ +1</option>
<option value="+1340">๐ป๐ฎ +1340</option>
<option value="+598">๐บ๐พ +598</option>
<option value="+998">๐บ๐ฟ +998</option>
<option value="+678">๐ป๐บ +678</option>
<option value="+379">๐ป๐ฆ +379</option>
<option value="+58">๐ป๐ช +58</option>
<option value="+84">๐ป๐ณ +84</option>
<option value="+681">๐ผ๐ซ +681</option>
<option value="+212">๐ช๐ญ +212</option>
<option value="+967">๐พ๐ช +967</option>
<option value="+260">๐ฟ๐ฒ +260</option>
<option value="+263">๐ฟ๐ผ +263</option>
</select>
</div>
<div class="phone-number-input__number">
<input class="register-phone-number-input-2 ng-pristine ng-untouched ng-empty ng-valid ng-valid-required" type="text" only-digits="" no-whitespace="" id="landline" name="landline" xrequired="" ng-trim="false">
</div>
<div class="phone-number-input__extension ng-scope">
<input class="register-phone-number-input-3 ng-pristine ng-untouched ng-valid ng-empty ng-valid-maxlength" placeholder="ext" maxlength="8" type="text" only-digits="" no-whitespace="" id="landline_extension"
name="landline_extension" xrequired="" ng-trim="false">
</div>
</div>
<div class="error-message"><span class="af-icon-exclamation-mark"></span> <span>Number cannot be empty.</span></div>
</div>
<expert-checkbox field="phoneNumberInputCtrl.field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</phone-number-input>
</div>
</div>
</all-input-types>
</div>
</div>
</div>
<div class="form-fieldset ng-scope">
<h4 class="velocity-opposites-transition-slideDownIn ng-binding ng-scope">Address</h4>
<p></p>
<div class="form-step-section-body">
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<select-input field="field" substep="substep" ctrl="ctrl" class="ng-isolate-scope">
<div class="form-input-wrapper recommendedField">
<div class="form-input-wrapper-left">
<label for="country">Country </label> <span class="help-button af-icon-question-mark ng-scope" role="button"></span>
</div>
<div class="form-input-wrapper-right">
<div class="af-select">
<select id="country" name="country" required="" class="ng-pristine ng-untouched ng-empty ng-valid ng-valid-required">
<option value="" selected="selected"></option>
<option value="England">England</option>
<option value="Northern Ireland">Northern Ireland</option>
<option value="Scotland">Scotland</option>
<option value="Wales">Wales</option>
<option value="Afghanistan">Afghanistan</option>
<option value="Albania">Albania</option>
<option value="Algeria">Algeria</option>
<option value="Andorra">Andorra</option>
<option value="Angola">Angola</option>
<option value="Anguilla">Anguilla</option>
<option value="Antigua and Barbuda">Antigua and Barbuda</option>
<option value="Argentina">Argentina</option>
<option value="Armenia">Armenia</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="Bosnia and Herzegovina">Bosnia and Herzegovina</option>
<option value="Botswana">Botswana</option>
<option value="Brazil">Brazil</option>
<option value="British Virgin Islands">British Virgin Islands</option>
<option value="Brunei">Brunei</option>
<option value="Bulgaria">Bulgaria</option>
<option value="Burkina Faso">Burkina Faso</option>
<option value="Burma">Burma</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="Colombia">Colombia</option>
<option value="Comoros">Comoros</option>
<option value="Congo">Congo</option>
<option value="Congo, Democratic Republic of (Zaire)"> Congo, Democratic Republic of (Zaire) </option>
<option value="Costa Rica">Costa Rica</option>
<option value="Croatia">Croatia</option>
<option value="Cuba">Cuba</option>
<option value="Cyprus">Cyprus</option>
<option value="Cyprus (northern part of Cyprus)"> Cyprus (northern part of Cyprus) </option>
<option value="Czech Republic">Czech Republic</option>
<option value="Denmark">Denmark</option>
<option value="Djibouti">Djibouti</option>
<option value="Dominica, Commonwealth of">Dominica, Commonwealth of</option>
<option value="Dominican Republic">Dominican Republic</option>
<option value="East Timor Democratic Republic"> East Timor Democratic 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="Ethiopia">Ethiopia</option>
<option value="Falkland Islands">Falkland Islands</option>
<option value="Faroes, The">Faroes, The</option>
<option value="Fiji">Fiji</option>
<option value="Finland">Finland</option>
<option value="France">France</option>
<option value="Gabon">Gabon</option>
<option value="Gambia, The">Gambia, The</option>
<option value="Georgia">Georgia</option>
<option value="Germany">Germany</option>
<option value="Ghana">Ghana</option>
<option value="Greece">Greece</option>
<option value="Greenland">Greenland</option>
<option value="Grenada">Grenada</option>
<option value="Guatemala">Guatemala</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="Honduras">Honduras</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="Israel">Israel</option>
<option value="Italy">Italy</option>
<option value="Ivory Coast">Ivory Coast</option>
<option value="Jamaica">Jamaica</option>
<option value="Japan">Japan</option>
<option value="Jordan">Jordan</option>
<option value="Kazakhstan">Kazakhstan</option>
<option value="Kenya">Kenya</option>
<option value="Kiribati">Kiribati</option>
<option value="Korea, DPR (North Korea)">Korea, DPR (North Korea)</option>
<option value="Korea, Republic of (South Korea)"> Korea, Republic of (South Korea) </option>
<option value="Kosovo">Kosovo</option>
<option value="Kuwait">Kuwait</option>
<option value="Kyrgyzstan">Kyrgyzstan</option>
<option value="Laos">Laos</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="Luxemburg">Luxemburg</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="Mauritania">Mauritania</option>
<option value="Mauritius">Mauritius</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="Namibia">Namibia</option>
<option value="Nauru">Nauru</option>
<option value="Nepal">Nepal</option>
<option value="Netherlands">Netherlands</option>
<option value="Netherlands Antilles">Netherlands Antilles</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="Norway">Norway</option>
<option value="Oman">Oman</option>
<option value="Pakistan">Pakistan</option>
<option value="Palau">Palau</option>
<option value="Palestine">Palestine</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, Henderson, Ducie & Oeno"> Pitcairn, Henderson, Ducie & Oeno </option>
<option value="Poland">Poland</option>
<option value="Portugal">Portugal</option>
<option value="Qatar">Qatar</option>
<option value="Romania">Romania</option>
<option value="Russian Federation">Russian Federation</option>
<option value="Rwanda">Rwanda</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="Slovak Republic">Slovak Republic</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 and Sandwich Islands"> South Georgia and Sandwich Islands </option>
<option value="Spain">Spain</option>
<option value="Sri Lanka">Sri Lanka</option>
<option value="St Helena">St Helena</option>
<option value="St Kitts and Nevis">St Kitts and Nevis</option>
<option value="St Lucia">St Lucia</option>
<option value="St Vincent">St Vincent</option>
<option value="Sudan">Sudan</option>
<option value="Suriname">Suriname</option>
<option value="Swaziland">Swaziland</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="Togo">Togo</option>
<option value="Tonga">Tonga</option>
<option value="Trinidad and Tobago">Trinidad and Tobago</option>
<option value="Tristan da Cunha">Tristan da Cunha</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 States">United States</option>
<option value="Uruguay">Uruguay</option>
<option value="Uzbekistan">Uzbekistan</option>
<option value="Vanuatu">Vanuatu</option>
<option value="Vatican City">Vatican City</option>
<option value="Venezuela">Venezuela</option>
<option value="Vietnam">Vietnam</option>
<option value="Yemen">Yemen</option>
<option value="Zambia">Zambia</option>
</select>
</div>
<expert-checkbox field="selectCtrl.field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</select-input>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<post-code-input field="field" substep="substep" class="ng-isolate-scope">
<div class="af-post-code-input">
<div class="form-input-wrapper recommendedField">
<div class="form-input-wrapper-left">
<label for="post_code">Postcode </label> <span class="help-button af-icon-question-mark ng-scope" role="button"></span>
<div class="input-example ng-scope">
<p>Example: N8 7AJ</p>
</div>
</div>
<div class="form-input-wrapper-right">
<input validate-post-code="" style="text-transform: uppercase;" limit-to="100" name="post_code" id="post_code" type="text" ng-trim="false" required="" class="ng-pristine ng-untouched ng-empty ng-valid ng-valid-required">
<expert-checkbox field="postCodeCtrl.field" substep="postCodeCtrl.substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</div>
</post-code-input>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<text-input-styled field="field" class="ng-isolate-scope">
<div class="form-input-wrapper recommendedField">
<div class="form-input-wrapper-left">
<label for="address">Street / Address line 1 </label>
<span class="help-button af-icon-question-mark ng-scope" role="button"></span>
</div>
<div class="form-input-wrapper-right">
<input remove-illegal-chars="" limit-to="100" name="address" id="address" type="text" required="" class="ng-pristine ng-untouched ng-empty ng-valid ng-valid-required">
<expert-checkbox field="field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</text-input-styled>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<text-input-styled field="field" class="ng-isolate-scope">
<div class="form-input-wrapper">
<div class="form-input-wrapper-left"><label for="address2">Address line 2 </label></div>
<div class="form-input-wrapper-right">
<input remove-illegal-chars="" limit-to="100" id="address2" name="address2" type="text" class="ng-pristine ng-untouched ng-empty ng-valid ng-valid-required">
<expert-checkbox field="field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</text-input-styled>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<text-input-styled field="field" class="ng-isolate-scope">
<div class="form-input-wrapper">
<div class="form-input-wrapper-left"><label for="address3">Address line 3 </label></div>
<div class="form-input-wrapper-right">
<input remove-illegal-chars="" limit-to="100" id="address3" name="address3" type="text" class="ng-pristine ng-untouched ng-empty ng-valid ng-valid-required">
<expert-checkbox field="field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</text-input-styled>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<text-input-styled field="field" class="ng-isolate-scope">
<div class="form-input-wrapper">
<div class="form-input-wrapper-left"><label for="address4">Address line 4 </label></div>
<div class="form-input-wrapper-right">
<input remove-illegal-chars="" limit-to="100" id="address4" name="address4" type="text" class="ng-pristine ng-untouched ng-empty ng-valid ng-valid-required">
<expert-checkbox field="field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</text-input-styled>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<text-input-styled field="field" class="ng-isolate-scope">
<div class="form-input-wrapper">
<div class="form-input-wrapper-left"><label for="locality">Locality </label></div>
<div class="form-input-wrapper-right">
<input remove-illegal-chars="" limit-to="100" id="locality" name="locality" type="text" class="ng-pristine ng-untouched ng-empty ng-valid ng-valid-required">
<expert-checkbox field="field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</text-input-styled>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<text-input-styled field="field" class="ng-isolate-scope">
<div class="form-input-wrapper recommendedField">
<div class="form-input-wrapper-left">
<label for="city">Town/City </label> <span class="help-button af-icon-question-mark ng-scope" role="button"></span>
</div>
<div class="form-input-wrapper-right">
<input remove-illegal-chars="" limit-to="100" name="city" id="city" type="text" required="" class="ng-pristine ng-untouched ng-empty ng-valid ng-valid-required">
<expert-checkbox field="field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</text-input-styled>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<text-input-styled field="field" class="ng-isolate-scope">
<div class="form-input-wrapper">
<div class="form-input-wrapper-left"><label for="county">County </label></div>
<div class="form-input-wrapper-right">
<input remove-illegal-chars="" limit-to="100" id="county" name="county" type="text" required="" class="ng-pristine ng-untouched ng-empty ng-valid ng-valid-required">
<expert-checkbox field="field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</text-input-styled>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div></div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div></div>
</div>
</all-input-types>
</div>
</div>
</div>
<div class="form-fieldset ng-scope">
<h4 class="velocity-opposites-transition-slideDownIn ng-binding ng-scope">Demographics</h4>
<p> It is important that we understand the profile of victims of crime. By providing us with a few simple details, we will be able to better reflect the impact of fraud and cyber crime on society. We would also like to know how you or the
victim heard about Action Fraud. This information is used anonymously for statistical purposes only. </p>
<div class="form-step-section-body">
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<select-input field="field" substep="substep" ctrl="ctrl" class="ng-isolate-scope">
<div class="form-input-wrapper">
<div class="form-input-wrapper-left"><label for="gender">Gender </label></div>
<div class="form-input-wrapper-right">
<div class="af-select">
<select name="gender" id="gender" required="" class="ng-pristine ng-untouched ng-empty ng-valid ng-valid-required">
<option value="" selected="selected"></option>
<option value="Male">Male</option>
<option value="Female">Female</option>
<option value="Transgender">Transgender</option>
<option value="Unknown">Unknown</option>
</select>
</div>
<expert-checkbox field="selectCtrl.field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</select-input>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<select-input field="field" substep="substep" ctrl="ctrl" class="ng-isolate-scope">
<div class="form-input-wrapper">
<div class="form-input-wrapper-left"><label for="heritage">Ethnic heritage </label></div>
<div class="form-input-wrapper-right">
<div class="af-select">
<select id="heritage" name="heritage" required="" class="ng-pristine ng-untouched ng-empty ng-valid ng-valid-required">
<option value="" selected="selected"></option>
<option value="Arab">Arab</option>
<option value="Asian / Asian - British - Bangladeshi"> Asian / Asian - British - Bangladeshi </option>
<option value="Asian / Asian - British - Chinese"> Asian / Asian - British - Chinese </option>
<option value="Asian / Asian - British - Indian"> Asian / Asian - British - Indian </option>
<option value="Asian / Asian - British - Other"> Asian / Asian - British - Other </option>
<option value="Asian / Asian - British - Pakistani"> Asian / Asian - British - Pakistani </option>
<option value="Black / African / Caribbean / Black British - African"> Black / African / Caribbean / Black British - African </option>
<option value="Black / African / Caribbean / Black British - Caribbean"> Black / African / Caribbean / Black British - Caribbean </option>
<option value="Black / African / Caribbean / Black British - Other"> Black / African / Caribbean / Black British - Other </option>
<option value="Mixed - Other">Mixed - Other</option>
<option value="Mixed - White and Asian">Mixed - White and Asian</option>
<option value="Mixed - White and Black African"> Mixed - White and Black African </option>
<option value="Mixed - White and Black Caribbean"> Mixed - White and Black Caribbean </option>
<option value="White - English, Welsh, Scottish, Northern Irish, British"> White - English, Welsh, Scottish, Northern Irish, British </option>
<option value="White - Irish">White - Irish</option>
<option value="White - Other">White - Other</option>
<option value="Other ethnic group">Other ethnic group</option>
</select>
</div>
<expert-checkbox field="selectCtrl.field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</select-input>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<select-input field="field" substep="substep" ctrl="ctrl" class="ng-isolate-scope">
<div class="form-input-wrapper">
<div class="form-input-wrapper-left">
<label for="how_did_you_learn_about_action_fraud">How did you hear about Action Fraud? </label>
</div>
<div class="form-input-wrapper-right">
<div class="af-select">
<select name="how_did_you_learn_about_action_fraud" id="how_did_you_learn_about_action_fraud" required="" class="ng-pristine ng-untouched ng-empty ng-valid ng-valid-required">
<option value="" selected="selected"></option>
<option value="Bank">Bank</option>
<option value="Business link">Business link</option>
<option value="Citizen Advice Bureau">Citizen Advice Bureau</option>
<option value="Consumer Direct">Consumer Direct</option>
<option value="Crimestoppers">Crimestoppers</option>
<option value="Gov.UK">Gov.UK</option>
<option value="Doctors Surgery">Doctors Surgery</option>
<option value="Family">Family</option>
<option value="Friend">Friend</option>
<option value="Local Council">Local Council</option>
<option value="Newspaper">Newspaper</option>
<option value="Other">Other</option>
<option value="Police">Police</option>
<option value="Poster or Leaflet">Poster or Leaflet</option>
<option value="Radio">Radio</option>
<option value="TV">TV</option>
<option value="Victim Support">Victim Support</option>
<option value="Website other">Website other</option>
</select>
</div>
<expert-checkbox field="selectCtrl.field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message"><span class="af-icon-exclamation-mark"></span><span>This field is required.</span></div>
</div>
</div>
</select-input>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<radio-input-styled field="field" substep="substep" ctrl="ctrl" class="ng-isolate-scope">
<div class="form-input-wrapper ng-scope">
<div class="form-input-wrapper-left">
<label for="are_you_interested_in_further_contact_for_case_study_purposes19"> Are you interested in further contact for case study purposes? </label>
</div>
<div class="form-input-wrapper-right">
<md-radio-group class="radio-horizontal ng-pristine ng-untouched ng-valid _md ng-empty" id="are_you_interested_in_further_contact_for_case_study_purposes19" role="radiogroup">
<md-radio-button onclick="$('.further').removeClass('md-checked');$(this).addClass('md-checked');$('#further').val('YES');" class="md-checked further" id="radio_491" role="radio" value="yes">
<div class="md-container md-ink-ripple">
<div class="md-off"></div>
<div class="md-on"></div>
</div>
<div class="md-label"><span class="ng-binding ng-scope"> YES </span></div>
</md-radio-button>
<md-radio-button onclick="$('.further').removeClass('md-checked');$(this).addClass('md-checked');$('#further').val('NO');" class="further" id="radio_492" role="radio" value="no">
<div class="md-container md-ink-ripple">
<div class="md-off"></div>
<div class="md-on"></div>
</div>
<div class="md-label"><span class="ng-binding ng-scope"> NO </span></div>
</md-radio-button>
</md-radio-group>
<expert-checkbox field="radioCtrl.field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message">
<span class="af-icon-exclamation-mark"></span>
<ul></ul>
</div>
</div>
</div>
</radio-input-styled>
</div>
</div>
</all-input-types>
</div>
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<radio-input-styled field="field" substep="substep" ctrl="ctrl" class="ng-isolate-scope">
<div class="form-input-wrapper ng-scope">
<div class="form-input-wrapper-left">
<label for="pass_to_local_victim_care_service561"> Would you like your details passed to your local victim care service? </label>
</div>
<div class="form-input-wrapper-right">
<md-radio-group class="radio-horizontal ng-pristine ng-untouched ng-valid _md ng-not-empty" id="pass_to_local_victim_care_service561" role="radiogroup">
<md-radio-button onclick="$('.passed').removeClass('md-checked');$(this).addClass('md-checked');$('#passed').val('NO');" class="ng-scope md-checked passed" id="radio_493" role="radio" value="yes">
<div class="md-container md-ink-ripple">
<div class="md-off"></div>
<div class="md-on"></div>
</div>
<div class="md-label"><span class="ng-binding ng-scope"> YES </span></div>
</md-radio-button>
<md-radio-button onclick="$('.passed').removeClass('md-checked');$(this).addClass('md-checked');$('#passed').val('NO');" class="passed" id="radio_494" role="radio" value="no">
<div class="md-container md-ink-ripple">
<div class="md-off"></div>
<div class="md-on"></div>
</div>
<div class="md-label"><span class="ng-binding ng-scope"> NO </span></div>
</md-radio-button>
</md-radio-group>
<expert-checkbox field="radioCtrl.field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message">
<span class="af-icon-exclamation-mark"></span>
<ul></ul>
</div>
</div>
</div>
</radio-input-styled>
</div>
</div>
</all-input-types>
</div>
</div>
</div>
<div class="form-fieldset ng-scope">
<h4 class="velocity-opposites-transition-slideDownIn ng-binding ng-scope">Impact Assessment</h4>
<p>We use this information to improve victim support services and enable providers to tailor their response.</p>
<div class="form-step-section-body">
<div>
<all-input-types field="field" field-set="fieldSet" substep="substep[0]" class="ng-isolate-scope">
<div on="field.type" class="velocity-opposites-transition-slideDownIn ng-scope">
<div>
<radio-input-styled field="field" substep="substep" ctrl="ctrl" class="ng-isolate-scope">
<div class="form-input-wrapper ng-scope">
<div class="form-input-wrapper-left"><label for="agrees_with_self_assessment904">Do you agree to take this survey? </label></div>
<div class="form-input-wrapper-right">
<md-radio-group class="radio-horizontal ng-pristine ng-untouched ng-valid _md ng-not-empty" id="agrees_with_self_assessment904" role="radiogroup">
<md-radio-button onclick="$('.impact').removeClass('md-checked');$(this).addClass('md-checked');$('#impact').val('NO');" class="ng-scope md-checked impact" id="radio_495" role="radio" value="yes">
<div class="md-container md-ink-ripple">
<div class="md-off"></div>
<div class="md-on"></div>
</div>
<div class="md-label"><span class="ng-binding ng-scope"> YES </span></div>
</md-radio-button>
<md-radio-button onclick="$('.impact').removeClass('md-checked');$(this).addClass('md-checked');$('#impact').val('NO');" class="impact" id="radio_496" role="radio" value="no">
<div class="md-container md-ink-ripple">
<div class="md-off"></div>
<div class="md-on"></div>
</div>
<div class="md-label"><span class="ng-binding ng-scope"> NO </span></div>
</md-radio-button>
</md-radio-group>
<expert-checkbox field="radioCtrl.field" substep="substep" af-store-field="" class="ng-isolate-scope hidden"></expert-checkbox>
<div class="error-message">
<span class="af-icon-exclamation-mark"></span>
<ul></ul>
</div>
</div>
</div>
</radio-input-styled>
</div>
</div>
</all-input-types>
</div>
</div>
</div>
</div>
</form>Text Content
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Registering your email address will allow us to provide you with an enhanced service. Pre-populated fields are taken from your account settings and can only be updated within "My profile" My profile PERSONAL DETAILS Title Mr Ms Mrs Miss Dr This field is required. First name This field is required. Middle name This field is required. Last name This field is required. Date of birth Month January February March April May June July August September October November December Invalid year format. Clear date This field is required. CONTACT DETAILS Email Example: john.doe@example.com This field is required. 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