ask.bharti-axalife.com Open in urlscan Pro
61.95.172.205  Public Scan

Form analysis
1 forms found in the DOM

Name: langform — POST message

<form id="langform" autocomplete="off" name="langform" class="form-signin" action="message" method="POST" onsubmit="return validateLangSelection();">
  <!-- Content section start here -->
  <div class="container-fluid contMainSec SelectLangMainCont BtmFtr">
    <div class="row">
      <div class="container-fluid WebDisplay">
        <div class="row">
          <div class="TopHeaderBanner">
            <div class="container">
              <div class="row">
                <h1 class="text-center pad0 WTxt FFM">Bharti AXA Video PIVC</h1>
                <h3 class="text-center LBTxt FFSM MT10px">Thank you for choosing Bharti AXA Life Insurance as your preferred life insurance.</h3>
                <p class="commHdg text-center pad0 WTxt FFL MT15px">Welcome to Bharti AXA Life Insurance pre-issuance verification process and this will take only few minutes. Please click on <strong>"Agree"</strong> button if details provided on
                  screen are correct else click on <strong>"Disagree"</strong> button.</p>
              </div>
            </div>
          </div>
        </div>
      </div>
      <div class="container-fluid padTopBtm10 MainContentDiv">
        <div class="row">
          <div class="container">
            <div class="row FlexDiv">
              <div class="col-lg-4 col-md-4 col-sm-5 col-xs-12">
                <div class="SelectLang_Sec">
                  <img src="images/selectLangImg.png" class="img-responsive center-block">
                </div>
              </div>
              <div class="col-lg-8 col-md-8 col-sm-7 col-xs-12 MT10px">
                <h4 class="commHdg text-center">Select Language</h4>
                <div class="SelectLang_opt" id="selectLang">
                  <ul>
                    <li>
                      <input class="LanguageInputBtn" type="radio" name="ddlLang" id="lang1" value="en">
                      <label for="lang1">English</label>
                    </li>
                    <li>
                      <input class="LanguageInputBtn" type="radio" name="ddlLang" id="lang2" value="hi">
                      <label for="lang2">हिंदी</label>
                    </li>
                    <li>
                      <input class="LanguageInputBtn" type="radio" name="ddlLang" id="lang3" value="ma">
                      <label for="lang3">मराठी</label>
                    </li>
                    <li>
                      <input class="LanguageInputBtn" type="radio" name="ddlLang" id="lang4" value="gu">
                      <label for="lang4">ગુજરાતી</label>
                    </li>
                    <li>
                      <input class="LanguageInputBtn" type="radio" name="ddlLang" id="lang5" value="tm">
                      <label for="lang5">தமிழ்</label>
                    </li>
                    <li>
                      <input class="LanguageInputBtn" type="radio" name="ddlLang" id="lang6" value="bn">
                      <label for="lang6">বাঙালি</label>
                    </li>
                  </ul>
                </div>
                <div id="divError" hidden="true">
                  <label class="fullwidth100 text-center MT20px" style="color:red;">Select your preferred language</label>
                </div>
                <!-- <div id="divLoader" hidden="true" align="center">
									<img src="images/loading.gif" class="img-responsive" width="50%" height="50%">
								</div> -->
                <div id="divLoader" hidden="true" align="center">
                  <div class="loader">
                  </div>
                  <div class="loadertext">
                    <br><br>
                    <label class="commHdg text-center">Fetching Proposal Information...</label>
                  </div>
                </div>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
  </div>
  <!-- Content section end here -->
  <!-- footer section start here -->
  <div class="container-fluid footerSecBtn SubmitBtnDiv">
    <div class="row footerBtn">
      <div class="container">
        <div class="row">
          <div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 text-center threeBtn">
            <!-- <input type="submit" class="CommonBtn RedBtn" value="Proceed" id="buttonSubmit"> -->
            <input type="submit" class="CommonBtn RedBtn" value="Initiate WebPIVC" id="buttonSubmit">
          </div>
        </div>
      </div>
    </div>
  </div>
  <!-- footer section end here -->
</form>

Text Content

   
 * Language Selection




BHARTI AXA VIDEO PIVC


THANK YOU FOR CHOOSING BHARTI AXA LIFE INSURANCE AS YOUR PREFERRED LIFE
INSURANCE.

Welcome to Bharti AXA Life Insurance pre-issuance verification process and this
will take only few minutes. Please click on "Agree" button if details provided
on screen are correct else click on "Disagree" button.

SELECT LANGUAGE

 * English
 * हिंदी
 * मराठी
 * ગુજરાતી
 * தமிழ்
 * বাঙালি

Select your preferred language


Fetching Proposal Information...