forms.sbc08.com Open in urlscan Pro
37.97.66.118  Public Scan

Form analysis
1 forms found in the DOM

POST

<form id="sb_form" onsubmit="process(); return false;" method="post">
  <table class="t" width="100%" cellpadding="0" cellspacing="0">
    <tbody>
      <tr>
        <td id="innerForm" width="100%">
          <table class="t" width="100%" cellpadding="0" cellspacing="0">
            <style type="text/css">
              input::-webkit-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input:-moz-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input::-moz-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input:-ms-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input::-ms-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }
            </style>
            <tbody>
              <tr>
                <td>
                  <table class="t" width="100%" cellpadding="0" cellspacing="0">
                    <tbody>
                      <tr>
                        <td style="padding-top: 10px; padding-bottom: 10px;"><span style="display: flex;flex-direction: row;">
                            <div>
                              <p style="color: #0595d6;
        font-size: 17px;
        font-family: 'Arial';
        font-style: inherit;
        font-weight: inherit;line-height: 26px;text-align: left;
        margin: 0;mso-line-height-rule: exactly;"><span style="font-size: 14px; font-family: Arial, Verdana, sans-serif; line-height: 26px; mso-line-height-rule: exactly;">Civilité</span></p>
                            </div>
                            <div style="font-size: 13px;margin-left: 5px;font-family:Arial, Verdana, sans-serif;
          color:#0595d6;">*</div>
                          </span>
                          <div style="width: 100%; display: flex; flex-direction: row;
            flex-wrap: wrap; padding-top: 5px;">
                            <div style="margin-bottom: 13px; display: flex; flex-direction: row;">
                              <label class="control control--radio">
                                <input type="radio" value="Madame" name="CIVILITY_ID" required="true">
                                <div class="control__indicator" style="
        border: 1px solid #0595d6;
        background-color: #f8f8f8;"></div>
                              </label>
                              <label style="padding-top: 7px;margin-right: 10px;color:#0595d6;
                  font-family: Arial, Verdana, sans-serif;font-size:12px;">Madame </label>
                            </div>
                            <div style="margin-bottom: 13px; display: flex; flex-direction: row;">
                              <label class="control control--radio">
                                <input type="radio" value="Monsieur" name="CIVILITY_ID" required="true">
                                <div class="control__indicator" style="
        border: 1px solid #0595d6;
        background-color: #f8f8f8;"></div>
                              </label>
                              <label style="padding-top: 7px;margin-right: 10px;color:#0595d6;
                  font-family: Arial, Verdana, sans-serif;font-size:12px;">Monsieur </label>
                            </div>
                          </div>
                        </td>
                      </tr>
                    </tbody>
                  </table>
                </td>
              </tr>
            </tbody>
          </table>
          <table class="t" width="100%" cellpadding="0" cellspacing="0">
            <style type="text/css">
              input::-webkit-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input:-moz-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input::-moz-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input:-ms-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input::-ms-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }
            </style>
            <tbody>
              <tr>
                <td>
                  <table class="t" width="100%" cellpadding="0" cellspacing="0">
                    <tbody>
                      <tr>
                        <td style="padding-top: 10px; padding-bottom: 10px;"><span style="display: flex;flex-direction: row;">
                            <div>
                              <p style="color: #0595d6;
        font-size: 17px;
        font-family: 'Arial';
        font-style: inherit;
        font-weight: inherit;line-height: 26px;text-align: left;
        margin: 0;mso-line-height-rule: exactly;"><span style="font-size: 14px; font-family: Arial, Verdana, sans-serif; line-height: 26px; mso-line-height-rule: exactly;">Prénom</span></p>
                            </div>
                            <div style="font-size: 13px;margin-left: 5px;font-family:Arial, Verdana, sans-serif;
          color:#0595d6;">*</div>
                          </span><input type="text" name="FIRSTNAME_ID" style="
        border: 1px solid #0595d6;
        background-color: #f8f8f8;height: 35px;
      margin: 5px 0 10px 0;
      font-size: 0.9em;
      padding-left: 5px;
      border-radius: 4px;
      -webkit-border-radius: 4px;
      -moz-border-radius: 4px;
      -webkit-box-sizing: border-box;
      box-sizing: border-box;
      text-indent: 5px;width: 100%;" required="true"></td>
                      </tr>
                    </tbody>
                  </table>
                </td>
              </tr>
            </tbody>
          </table>
          <table class="t" width="100%" cellpadding="0" cellspacing="0">
            <style type="text/css">
              input::-webkit-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input:-moz-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input::-moz-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input:-ms-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input::-ms-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }
            </style>
            <tbody>
              <tr>
                <td>
                  <table class="t" width="100%" cellpadding="0" cellspacing="0">
                    <tbody>
                      <tr>
                        <td style="padding-top: 10px; padding-bottom: 10px;"><span style="display: flex;flex-direction: row;">
                            <div>
                              <p style="color: #0595d6;
        font-size: 17px;
        font-family: 'Arial';
        font-style: inherit;
        font-weight: inherit;line-height: 26px;text-align: left;
        margin: 0;mso-line-height-rule: exactly;"><span style="font-size: 14px; font-family: Arial, Verdana, sans-serif; line-height: 26px; mso-line-height-rule: exactly;">Nom</span></p>
                            </div>
                            <div style="font-size: 13px;margin-left: 5px;font-family:Arial, Verdana, sans-serif;
          color:#0595d6;">*</div>
                          </span><input type="text" name="LASTNAME_ID" style="
        border: 1px solid #0595d6;
        background-color: #f8f8f8;height: 35px;
      margin: 5px 0 10px 0;
      font-size: 0.9em;
      padding-left: 5px;
      border-radius: 4px;
      -webkit-border-radius: 4px;
      -moz-border-radius: 4px;
      -webkit-box-sizing: border-box;
      box-sizing: border-box;
      text-indent: 5px;width: 100%;" required="true"></td>
                      </tr>
                    </tbody>
                  </table>
                </td>
              </tr>
            </tbody>
          </table>
          <table class="t" width="100%" cellpadding="0" cellspacing="0">
            <style type="text/css">
              input::-webkit-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input:-moz-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input::-moz-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input:-ms-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input::-ms-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }
            </style>
            <tbody>
              <tr>
                <td>
                  <table class="t" width="100%" cellpadding="0" cellspacing="0">
                    <tbody>
                      <tr>
                        <td style="padding-top: 10px; padding-bottom: 10px;"><span style="display: flex;flex-direction: row;">
                            <div>
                              <p style="color: #0595d6;
        font-size: 17px;
        font-family: 'Arial';
        font-style: inherit;
        font-weight: inherit;line-height: 26px;text-align: left;
        margin: 0;mso-line-height-rule: exactly;"><span style="font-size: 14px; font-family: Arial, Verdana, sans-serif; line-height: 26px; mso-line-height-rule: exactly;">Email</span></p>
                            </div>
                            <div style="font-size: 13px;margin-left: 5px;font-family:Arial, Verdana, sans-serif;
          color:#0595d6;">*</div>
                          </span><input type="email" name="email" style="
        border: 1px solid #0595d6;
        background-color: #f8f8f8;height: 35px;
      margin: 5px 0 10px 0;
      font-size: 0.9em;
      padding-left: 5px;
      border-radius: 4px;
      -webkit-border-radius: 4px;
      -moz-border-radius: 4px;
      -webkit-box-sizing: border-box;
      box-sizing: border-box;
      text-indent: 5px;width: 100%;" required="true"></td>
                      </tr>
                    </tbody>
                  </table>
                </td>
              </tr>
            </tbody>
          </table>
          <table class="t" width="100%" cellpadding="0" cellspacing="0">
            <style type="text/css">
              input::-webkit-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input:-moz-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input::-moz-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input:-ms-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input::-ms-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }
            </style>
            <tbody>
              <tr>
                <td>
                  <table class="t" width="100%" cellpadding="0" cellspacing="0">
                    <tbody>
                      <tr>
                        <td style="padding-top: 10px; padding-bottom: 10px;"><span style="display: flex;flex-direction: row;">
                            <div>
                              <p style="color: #0595d6;
        font-size: 17px;
        font-family: 'Arial';
        font-style: inherit;
        font-weight: inherit;line-height: 26px;text-align: left;
        margin: 0;mso-line-height-rule: exactly;"><span style="font-size: 14px; font-family: Arial, Verdana, sans-serif; line-height: 26px; mso-line-height-rule: exactly;">Société</span></p>
                            </div>
                            <div style="font-size: 13px;margin-left: 5px;font-family:Arial, Verdana, sans-serif;
          color:#0595d6;">*</div>
                          </span><input type="text" name="771ce3g95xik0vqdl61d2c" style="
        border: 1px solid #0595d6;
        background-color: #f8f8f8;height: 35px;
      margin: 5px 0 10px 0;
      font-size: 0.9em;
      padding-left: 5px;
      border-radius: 4px;
      -webkit-border-radius: 4px;
      -moz-border-radius: 4px;
      -webkit-box-sizing: border-box;
      box-sizing: border-box;
      text-indent: 5px;width: 100%;" required="true"></td>
                      </tr>
                    </tbody>
                  </table>
                </td>
              </tr>
            </tbody>
          </table>
          <table class="t" width="100%" cellpadding="0" cellspacing="0">
            <style type="text/css">
              input::-webkit-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input:-moz-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input::-moz-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input:-ms-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input::-ms-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }
            </style>
            <tbody>
              <tr>
                <td>
                  <table class="t" width="100%" cellpadding="0" cellspacing="0">
                    <tbody>
                      <tr>
                        <td style="padding-top: 10px; padding-bottom: 10px;"><span style="display: flex;flex-direction: row;">
                            <div>
                              <p style="color: #0595d6;
        font-size: 17px;
        font-family: 'Arial';
        font-style: inherit;
        font-weight: inherit;line-height: 26px;text-align: left;
        margin: 0;mso-line-height-rule: exactly;"><span style="font-size: 14px; font-family: Arial, Verdana, sans-serif; line-height: 26px; mso-line-height-rule: exactly;">Département de la société<br></span></p>
                            </div>
                            <div style="font-size: 13px;margin-left: 5px;font-family:Arial, Verdana, sans-serif;
          color:#0595d6;">*</div>
                          </span>
                          <div style="width: 100%; display: flex; flex-direction: row;
            flex-wrap: wrap; padding-top: 5px;">
                            <div style="margin-bottom: 13px; display: flex; flex-direction: row;">
                              <label class="control control--checkbox">
                                <input type="checkbox" value="Paris (75)" name="3n63gd0cf74navp6el93s" required="true" onclick="updateRequirements(this.name)">
                                <div class="control__indicator" style="
        border: 1px solid #0595d6;
        background-color: #f8f8f8;"></div>
                              </label>
                              <label style="padding-top: 7px;margin-right: 10px;color:#0595d6;
                  font-family: Arial, Verdana, sans-serif;font-size:12px;">Paris (75) </label>
                            </div>
                            <div style="margin-bottom: 13px; display: flex; flex-direction: row;">
                              <label class="control control--checkbox">
                                <input type="checkbox" value="Seine et Marne (77)" name="3n63gd0cf74navp6el93s" required="true" onclick="updateRequirements(this.name)">
                                <div class="control__indicator" style="
        border: 1px solid #0595d6;
        background-color: #f8f8f8;"></div>
                              </label>
                              <label style="padding-top: 7px;margin-right: 10px;color:#0595d6;
                  font-family: Arial, Verdana, sans-serif;font-size:12px;">Seine et Marne (77) </label>
                            </div>
                            <div style="margin-bottom: 13px; display: flex; flex-direction: row;">
                              <label class="control control--checkbox">
                                <input type="checkbox" value="Yvelines (78)" name="3n63gd0cf74navp6el93s" required="true" onclick="updateRequirements(this.name)">
                                <div class="control__indicator" style="
        border: 1px solid #0595d6;
        background-color: #f8f8f8;"></div>
                              </label>
                              <label style="padding-top: 7px;margin-right: 10px;color:#0595d6;
                  font-family: Arial, Verdana, sans-serif;font-size:12px;">Yvelines (78) </label>
                            </div>
                            <div style="margin-bottom: 13px; display: flex; flex-direction: row;">
                              <label class="control control--checkbox">
                                <input type="checkbox" value="Essonne (91)" name="3n63gd0cf74navp6el93s" required="true" onclick="updateRequirements(this.name)">
                                <div class="control__indicator" style="
        border: 1px solid #0595d6;
        background-color: #f8f8f8;"></div>
                              </label>
                              <label style="padding-top: 7px;margin-right: 10px;color:#0595d6;
                  font-family: Arial, Verdana, sans-serif;font-size:12px;">Essonne (91) </label>
                            </div>
                            <div style="margin-bottom: 13px; display: flex; flex-direction: row;">
                              <label class="control control--checkbox">
                                <input type="checkbox" value="Hauts-de-Seine (92)" name="3n63gd0cf74navp6el93s" required="true" onclick="updateRequirements(this.name)">
                                <div class="control__indicator" style="
        border: 1px solid #0595d6;
        background-color: #f8f8f8;"></div>
                              </label>
                              <label style="padding-top: 7px;margin-right: 10px;color:#0595d6;
                  font-family: Arial, Verdana, sans-serif;font-size:12px;">Hauts-de-Seine (92) </label>
                            </div>
                            <div style="margin-bottom: 13px; display: flex; flex-direction: row;">
                              <label class="control control--checkbox">
                                <input type="checkbox" value="Seine-Saint-Denis (93)" name="3n63gd0cf74navp6el93s" required="true" onclick="updateRequirements(this.name)">
                                <div class="control__indicator" style="
        border: 1px solid #0595d6;
        background-color: #f8f8f8;"></div>
                              </label>
                              <label style="padding-top: 7px;margin-right: 10px;color:#0595d6;
                  font-family: Arial, Verdana, sans-serif;font-size:12px;">Seine-Saint-Denis (93) </label>
                            </div>
                            <div style="margin-bottom: 13px; display: flex; flex-direction: row;">
                              <label class="control control--checkbox">
                                <input type="checkbox" value="Val de Marne (94)" name="3n63gd0cf74navp6el93s" required="true" onclick="updateRequirements(this.name)">
                                <div class="control__indicator" style="
        border: 1px solid #0595d6;
        background-color: #f8f8f8;"></div>
                              </label>
                              <label style="padding-top: 7px;margin-right: 10px;color:#0595d6;
                  font-family: Arial, Verdana, sans-serif;font-size:12px;">Val de Marne (94) </label>
                            </div>
                            <div style="margin-bottom: 13px; display: flex; flex-direction: row;">
                              <label class="control control--checkbox">
                                <input type="checkbox" value="Val d'Oise (95)" name="3n63gd0cf74navp6el93s" required="true" onclick="updateRequirements(this.name)">
                                <div class="control__indicator" style="
        border: 1px solid #0595d6;
        background-color: #f8f8f8;"></div>
                              </label>
                              <label style="padding-top: 7px;margin-right: 10px;color:#0595d6;
                  font-family: Arial, Verdana, sans-serif;font-size:12px;">Val d'Oise (95) </label>
                            </div>
                          </div>
                        </td>
                      </tr>
                    </tbody>
                  </table>
                </td>
              </tr>
            </tbody>
          </table>
          <table class="t" width="100%" cellpadding="0" cellspacing="0" style="display:none;">
            <style type="text/css">
              input::-webkit-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input:-moz-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input::-moz-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input:-ms-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }

              input::-ms-input-placeholder {
                color: #848484;
                opacity: 0.6;
              }
            </style>
            <tbody>
              <tr>
                <td>
                  <table class="t" width="100%" cellpadding="0" cellspacing="0">
                    <tbody>
                      <tr>
                        <td style="padding-top: 10px; padding-bottom: 10px;"><span style="display: flex;flex-direction: row;">
                            <div></div>
                          </span><input type="hidden" name="hm6v0jvryior0gxf41p9qg" value="inscription via formulaire"></td>
                      </tr>
                    </tbody>
                  </table>
                </td>
              </tr>
            </tbody>
          </table>
          <table class="t" width="100%" cellpadding="0" cellspacing="0" style="margin-top:7px">
            <tbody>
              <tr>
                <td align="center">
                  <div id="div-submitInput" style="display:flex; flex-direction:row;justify-content:center">
                    <button id="submitInput" type="submit" value="VALIDER" class="mobile-FW"
                      style="border-style:solid;text-align:center;color:#ffffff;border-color:#ffffff;border-width:1px;border-radius:9px;text-decoration:none;display:block;font-family:'Arial';font-style:inherit;font-weight:inherit;font-size:15px;background-color:#0595d6;cursor:pointer;"><span
                        style="display:block;padding:15px 25px;"><span style="line-height:14px;margin:0px;"><span style="font-size:14px;line-height:14px;"><strong style="line-height:14px;"><span
                                style="line-height:14px;">VALIDER</span></strong></span></span>
                      </span></button>
                    <div class="loader" style="display:none"></div>
                  </div>
                </td>
              </tr>
            </tbody>
          </table>
        </td>
      </tr>
    </tbody>
  </table>
</form>

Text Content

JE SOUHAITE M'ABONNER À LA NEWSLETTER


« 3 MINUTES ENTREPRISES »


ÉDITION ILE-DE-FRANCE

L’Assurance Maladie et sa branche risques professionnels propose un panorama
mensuel de sujets dédiés à l’entreprise. 

 

Avec « 3 minutes entreprises », retrouvez de l'actualité réglementaire, des
conseils en matière de prévention des risques professionnels, de nouvelles
offres de service, de gestion des arrêts de travail et de vos cotisations, ainsi
que des témoignages d’entreprises.

 

Sa déclinaison régionale permet de diffuser une information de proximité, des
événements et des offres d’accompagnement des CPAM d'Ile-de-France et de la
Cramif.


 

Civilité

*

Madame

Monsieur

Prénom

*

Nom

*

Email

*

Société

*

Département de la société


*

Paris (75)

Seine et Marne (77)

Yvelines (78)

Essonne (91)

Hauts-de-Seine (92)

Seine-Saint-Denis (93)

Val de Marne (94)

Val d'Oise (95)



VALIDER


En soumettant ce formulaire, j'accepte que l'e-mail saisi soit utilisé par les
CPAM des département d'Ile-de-France pour m'adresser la lettre d'informations 3
minutes entreprises. Vous pourrez vous désinscrire à tout moment à l'aide des
liens de désinscription contenus dans chaque newsletter.

* Champs obligatoires