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193.58.223.224  Public Scan

Form analysis
1 forms found in the DOM

Name: loginForm —

<form id="loginForm" name="loginForm" ng-submit="loginCtrl.isNegativeBin ? '' : loginCtrl.login()" novalidate="" class="ng-pristine ng-valid-mask ng-invalid ng-invalid-required ng-valid-minlength ng-valid-maxlength">
  <div class="form-signin">
    <span ng-bind-html="appCtrl.blocks.identificationIntroductionSaisieBin" class="ng-binding">To find out about the assistance services associated with your card or request assistance certificate, enter the first 9 digits* of your card below:</span>
    <div id="loginInput" class="card-form row">
      <div class="col-sm-offset-1 col-md-10 col-sm-10 col-xs-12 gutter-sm" ng-class="{ 'has-error' : loginForm.$invalid &amp;&amp; !loginForm.cardNumber.$pristine }">
        <input type="tel" ng-model="loginCtrl.cardNumber" ng-change="loginCtrl.changeBinClean()" class="form-control card-number ng-pristine ng-untouched ng-valid-mask ng-empty ng-invalid ng-invalid-required ng-valid-minlength ng-valid-maxlength"
          name="cardNumber" required="" ng-maxlength="12" ng-minlength="9" move-next-on-maxlength="" ui-mask="9999 9999 9" ui-options="loginCtrl.maskOption" ng-model-options="{ debounce: 500 }" placeholder="____ ____ _" aria-invalid="true">
      </div>
    </div>
    <div>
      <p ng-show="loginCtrl.hasMultiContracts" ng-bind-html="appCtrl.blocks.identificationIntroductionChoixTypeDeCarte" class="ng-binding ng-hide" aria-hidden="true">To specify the contract associated with your card, please select the card type:</p>
      <md-radio-group md-no-ink="" ng-show="loginCtrl.hasMultiContracts" ng-model="loginCtrl.typeCard" class="ng-pristine ng-untouched ng-valid _md ng-empty ng-hide" role="radiogroup" tabindex="0" aria-hidden="true" aria-invalid="false">
        <!-- ngRepeat: type in loginCtrl.typeCardList -->
      </md-radio-group>
    </div>
    <p> <small ng-bind-html="appCtrl.blocks.identificationIntroductionAideSaisieBin" class="ng-binding">* By entering only the first 9 digits, your card's security is protected.</small> </p>
    <p class="error alert ng-binding ng-hide" ng-show="loginForm.$invalid &amp;&amp; !loginForm.$error.pattern &amp;&amp; !loginForm.cardNumber.$pristine " aria-hidden="true"> The first 9 digits of your card are required. </p>
    <p class="error ng-binding ng-hide" ng-show="loginForm.$error.pattern &amp;&amp; !loginForm.cardNumber.$pristine" aria-hidden="true"> Invalid entry: only figures are authorized. </p>
    <!--<div class="alert bank-select-container" ng-if="loginCtrl.isNegativeBin && loginCtrl.unmanagedBanks.length != 0">-->
    <!--<span class="control-label ">-->
    <!--{{ 'login.select.label' | translate }}-->
    <!--</span>-->
    <!--<div class="card-form row">-->
    <!--<div class="col-sm-offset-1 col-md-10 col-sm-10 col-xs-12 gutter-sm bank-select">-->
    <!--<md-input-container>-->
    <!--<md-select md-no-ink-->
    <!--ng-model="loginCtrl.bankSelected"-->
    <!--placeholder="Banque"-->
    <!--ng-change="loginCtrl.alertBin()">-->
    <!--<md-option ng-repeat="bank in loginCtrl.unmanagedBanks | filter: {isActive: true} | orderBy: 'bankName'"-->
    <!--ng-value="bank">-->
    <!--{{bank.bankName}}-->
    <!--</md-option>-->
    <!--<md-option ng-value="loginCtrl.anotherBankOption">-->
    <!--{{loginCtrl.anotherBankOption.bankName}}-->
    <!--</md-option>-->
    <!--</md-select>-->
    <!--</md-input-container>-->
    <!--</div>-->
    <!--</div>-->
    <!--</div>-->
  </div>
  <div uib-alert="" ng-show="loginCtrl.alert.msg" ng-class="'alert-' + (loginCtrl.alert.type || 'warning')" close="loginCtrl.closeAlert()" class="ng-isolate-scope alert alert-dismissible ng-hide alert-warning" role="alert" aria-hidden="true"><button
      ng-show="closeable" type="button" class="close" ng-click="close({$event: $event})" aria-hidden="false">
      <span aria-hidden="true">×</span>
      <span class="sr-only">Close</span>
    </button>
    <div ng-transclude="">
      <div class="ti ti-alert ng-scope"></div>
      <div class="ng-binding ng-scope">
        <a href="" target="_blank" class="ng-binding">

							</a>
        <div ng-show="loginCtrl.alert.isBankIdentified" class="ng-binding ng-hide" aria-hidden="true"> For all other questions, please contact your bank adviser. </div>
      </div>
    </div>
  </div>
  <div class="form-submit">
    <button ng-disabled="loginForm.$invalid" class="btn btn-lg btn-primary btn-block" type="submit" disabled="disabled">
      <span class="title ng-binding">Confirm</span>
    </button>
  </div>
</form>

Text Content

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 * FR
 * EN

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YOUR MEDICAL ASSISTANCE SERVICES

Your card entitles you to assistance coverage for better peace of mind during
your travels.

To find out about the assistance services associated with your card or request
assistance certificate, enter the first 9 digits* of your card below:


To specify the contract associated with your card, please select the card type:

* By entering only the first 9 digits, your card's security is protected.

The first 9 digits of your card are required.

Invalid entry: only figures are authorized.

× Close
For all other questions, please contact your bank adviser.
Confirm

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