www.dbs.com.sg Open in urlscan Pro
104.18.28.18  Public Scan

URL: https://www.dbs.com.sg/sme/dbs-forms/commercial-insurance-solutions?pk_source=google&pk_medium=organic&pk_campaign=seo
Submission: On April 10 via api from SG — Scanned from SG

Form analysis 3 forms found in the DOM

<form>
  <div class="mobile-search-field">
    <div class="search-group" id="mobile-search-group"> <input class="mobile-search" autocomplete="off" type="text" placeholder="Search" id="mobile-input-text" maxlength="1000" oncut="searchEvent()">
      <a class="btn-close-history" id="mobile-btn-close-history">
                        <i class="icon" style="padding-right: 12px"></i>
                        </a>
      <button class="btn-search" data-url="#" data-target="_self" href="javascript:void(0);" type="button">
        <i class="icon ico-search"></i>
      </button>
      <div id="search-suggestions-mobile" class="search-suggestions mobile-search">
      </div>
    </div>
  </div>
</form>

Name: _com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_fmPOST https://www.dbs.com.sg/sme/dbs-forms/commercial-insurance-solutions?p_p_id=com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt&p_p_lifecycle=1&p_p_state=normal&p_p_mode=view&_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_javax.portlet.action=addFormInstanceRecord&p_auth=5CDSrSQO

<form
  action="https://www.dbs.com.sg/sme/dbs-forms/commercial-insurance-solutions?p_p_id=com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt&amp;p_p_lifecycle=1&amp;p_p_state=normal&amp;p_p_mode=view&amp;_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_javax.portlet.action=addFormInstanceRecord&amp;p_auth=5CDSrSQO"
  class="form " data-fm-namespace="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_" id="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_fm" method="post"
  name="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_fm" data-ddmforminstanceid="183874394"> <input class="field form-control"
    id="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_formDate" name="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_formDate" type="hidden" value="1681116834508">
  <input class="field form-control" id="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_groupId" name="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_groupId"
    type="hidden" value="276102"> <input class="field form-control" id="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_formInstanceId"
    name="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_formInstanceId" type="hidden" value="183874394"> <input class="field form-control"
    id="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_languageId" name="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_languageId" type="hidden" value="en_US"> <input
    class="field form-control" id="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_workflowAction" name="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_workflowAction"
    type="hidden" value="1">
  <div id="otpPopup" style="display: none;">
    <div class="otp-desc-wrapper"></div>
    <div class="row row-custom otp-pop-body"> <span class="icon-custom col-md-1 col-1"> <!-- <i class="icon-lock icon-2x custom-lock-icon" aria-hidden="true"></i> --> <img src="/o/gsmc-theme/images/ico_mobile.png" alt="Icon-Mobile"> </span> <span
        class="col-md-10 col-sm-10 col-10">
        <div> <span class="otp-span">
            <div class="form-group input-text-wrapper"> <input class="field form-control" id="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_otpnumber"
                name="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_otpnumber" placeholder="One Time Password" title="otpnumber" type="number" value=""> </div>
          </span> </div>
      </span> <span id="timer_div" class="timer-custom col-md-1 col-1"> </span> </div>
    <div class="row otp-error error-msg hide">Invalid OTP</div>
    <div class="row otp-button-wrapper">
      <div class="col-6 otp-submit-wrapper"> <button class="btn btn-submit-otp custom-form-button" id="submit-otp-id" onclick="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_verifyOTP()">SUBMIT</button> </div>
      <div class=" col-6"> <button id="resend-otp-id" class="btn btn-resend-otp custom-form-button" onclick="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_resendotp()">RESEND</button> </div>
    </div>
  </div>
  <div id="pop-up-Sign" class="custom-form-pop-up" style="display: none;">
    <div class="pop-up-description"> </div>
    <div class="modal-body-form"></div>
    <div class="email-error error-msg hide">Email/Mobile number is not registered</div>
  </div>
  <div class="hide dbs-form-type">generic</div>
  <div class="ddm-form-basic-info">
    <div class="container-fluid-1280">
      <h2 class="ddm-form-name">Insurance Enquiry eDM</h2>
    </div>
  </div>
  <div class="container-fluid-1280 ddm-form-builder-app">
    <div class="lfr-ddm-form-container" id="IeMmc1X4">
      <div class="lfr-ddm-form-container" id="IeMmc1X4">
        <div class="ddm-user-view-content lfr-ddm-form-content">
          <div class="lfr-ddm-form-pages">
            <div class="active lfr-ddm-form-page">
              <h3 class="lfr-ddm-form-page-title">Contact Us - DBS Commercial Insurance</h3>
              <h4 class="lfr-ddm-form-page-description">Simply leave your contact details here and we will contact you within 2 working days.</h4><label class="required-warning">All fields marked with <svg aria-hidden="true"
                  class="lexicon-icon lexicon-icon-asterisk reference-mark" viewBox="0 0 512 512">
                  <path class="lexicon-icon-outline" d="M323.6,190l146.7-48.8L512,263.9l-149.2,47.6l93.6,125.2l-104.9,76.3l-96.1-126.4l-93.6,126.4L56.9,435.3l92.3-123.9
	L0,263.8l40.4-122.6L188.4,190v-159h135.3L323.6,190L323.6,190z"></path>
                </svg> are required.</label>
              <div class="row">
                <div class="col-md-12 col-12">
                  <div class="clearfix  lfr-ddm-form-field-container" ref="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$NatureOfEnquiry$Zj8fOGmN$0$$en_US" id="yui_patched_v3_18_1_1_1681116835225_5012">
                    <div class="form-group" data-fieldname="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$NatureOfEnquiry$Zj8fOGmN$0$$en_US">
                      <div class="input-select-wrapper"><label for="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$NatureOfEnquiry$Zj8fOGmN$0$$en_US">Nature of Enquiry <svg aria-hidden="true"
                            class="lexicon-icon lexicon-icon-asterisk reference-mark" viewBox="0 0 512 512">
                            <path class="lexicon-icon-outline" d="M323.6,190l146.7-48.8L512,263.9l-149.2,47.6l93.6,125.2l-104.9,76.3l-96.1-126.4l-93.6,126.4L56.9,435.3l92.3-123.9
	L0,263.8l40.4-122.6L188.4,190v-159h135.3L323.6,190L323.6,190z"></path>
                          </svg></label>
                        <div class="form-builder-select-field input-group-container">
                          <div class="form-control select-field-trigger" dir="ltr" id="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$NatureOfEnquiry$Zj8fOGmN$0$$en_US"
                            name="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$NatureOfEnquiry$Zj8fOGmN$0$$en_US" tabindex="0">
                            <div class="option-selected option-selected-placeholder">Choose Options</div><a class="select-arrow-down-container" href="javascript:;" tabindex="-1"><span><i class="icon ico-arrowdown1 icon-animate"></i></span></a>
                          </div>
                        </div>
                      </div>
                    </div>
                  </div>
                </div>
              </div>
              <div class="row">
                <div class="col-md-12 col-12">
                  <div class="clearfix  lfr-ddm-form-field-container" ref="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$PageURLDJGWjX$7UlGm71q$0$$en_US">
                    <div class="form-group  liferay-ddm-form-field-text" data-fieldname="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$PageURLDJGWjX$7UlGm71q$0$$en_US"><label
                        for="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$PageURLDJGWjX$7UlGm71q$0$$en_US">PageURL </label>
                      <div class="input-group">
                        <div class="input-group-item"><input class="field form-control" dir="ltr" id="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$PageURLDJGWjX$7UlGm71q$0$$en_US"
                            name="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$PageURLDJGWjX$7UlGm71q$0$$en_US" placeholder="" type="text" value=""></div>
                      </div>
                    </div>
                  </div>
                </div>
              </div>
              <div class="row">
                <div class="col-md-12 col-12">
                  <div class="clearfix  lfr-ddm-form-field-container" ref="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$LastNamebEcANc$FwNPO667$0$$en_US">
                    <div class="form-group  liferay-ddm-form-field-text" data-fieldname="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$LastNamebEcANc$FwNPO667$0$$en_US"><label
                        for="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$LastNamebEcANc$FwNPO667$0$$en_US">Full Name <svg aria-hidden="true" class="lexicon-icon lexicon-icon-asterisk reference-mark"
                          viewBox="0 0 512 512">
                          <path class="lexicon-icon-outline" d="M323.6,190l146.7-48.8L512,263.9l-149.2,47.6l93.6,125.2l-104.9,76.3l-96.1-126.4l-93.6,126.4L56.9,435.3l92.3-123.9
	L0,263.8l40.4-122.6L188.4,190v-159h135.3L323.6,190L323.6,190z"></path>
                        </svg></label>
                      <div class="input-group">
                        <div class="input-group-item"><input class="field form-control" dir="ltr" id="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$LastNamebEcANc$FwNPO667$0$$en_US"
                            name="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$LastNamebEcANc$FwNPO667$0$$en_US" placeholder="Full Name" type="text" value=""></div>
                      </div>
                    </div>
                  </div>
                </div>
              </div>
              <div class="row">
                <div class="col-md-12 col-12">
                  <div class="clearfix  lfr-ddm-form-field-container" ref="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$CompanyName9D87ff$USR9KgRm$0$$en_US">
                    <div class="form-group  liferay-ddm-form-field-text" data-fieldname="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$CompanyName9D87ff$USR9KgRm$0$$en_US"><label
                        for="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$CompanyName9D87ff$USR9KgRm$0$$en_US">Company Name <svg aria-hidden="true"
                          class="lexicon-icon lexicon-icon-asterisk reference-mark" viewBox="0 0 512 512">
                          <path class="lexicon-icon-outline" d="M323.6,190l146.7-48.8L512,263.9l-149.2,47.6l93.6,125.2l-104.9,76.3l-96.1-126.4l-93.6,126.4L56.9,435.3l92.3-123.9
	L0,263.8l40.4-122.6L188.4,190v-159h135.3L323.6,190L323.6,190z"></path>
                        </svg></label>
                      <div class="input-group">
                        <div class="input-group-item"><input class="field form-control" dir="ltr" id="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$CompanyName9D87ff$USR9KgRm$0$$en_US"
                            name="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$CompanyName9D87ff$USR9KgRm$0$$en_US" placeholder="Company Name" type="text" value=""></div>
                      </div>
                    </div>
                  </div>
                </div>
              </div>
              <div class="row">
                <div class="col-md-12 col-12">
                  <div class="clearfix  lfr-ddm-form-field-container" ref="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$EmailAddressiPM3AZ$nHsUFo6z$0$$en_US">
                    <div class="form-group  liferay-ddm-form-field-text" data-fieldname="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$EmailAddressiPM3AZ$nHsUFo6z$0$$en_US"><label
                        for="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$EmailAddressiPM3AZ$nHsUFo6z$0$$en_US">Business Email Address <svg aria-hidden="true"
                          class="lexicon-icon lexicon-icon-asterisk reference-mark" viewBox="0 0 512 512">
                          <path class="lexicon-icon-outline" d="M323.6,190l146.7-48.8L512,263.9l-149.2,47.6l93.6,125.2l-104.9,76.3l-96.1-126.4l-93.6,126.4L56.9,435.3l92.3-123.9
	L0,263.8l40.4-122.6L188.4,190v-159h135.3L323.6,190L323.6,190z"></path>
                        </svg></label>
                      <div class="input-group">
                        <div class="input-group-item"><input class="field form-control" dir="ltr" id="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$EmailAddressiPM3AZ$nHsUFo6z$0$$en_US"
                            name="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$EmailAddressiPM3AZ$nHsUFo6z$0$$en_US" placeholder="Business Email Address" type="text" value=""></div>
                      </div>
                    </div>
                  </div>
                </div>
              </div>
              <div class="row">
                <div class="col-md-2 col-sm-2 col-4">
                  <div class="clearfix  lfr-ddm-form-field-container" ref="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$PhoneNumber9C9D1l$Xl86W3MQ$0$$en_US">
                    <div class="form-group  liferay-ddm-form-field-text" data-fieldname="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$PhoneNumber9C9D1l$Xl86W3MQ$0$$en_US"><label
                        for="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$PhoneNumber9C9D1l$Xl86W3MQ$0$$en_US">Country Code <svg aria-hidden="true"
                          class="lexicon-icon lexicon-icon-asterisk reference-mark" viewBox="0 0 512 512">
                          <path class="lexicon-icon-outline" d="M323.6,190l146.7-48.8L512,263.9l-149.2,47.6l93.6,125.2l-104.9,76.3l-96.1-126.4l-93.6,126.4L56.9,435.3l92.3-123.9
	L0,263.8l40.4-122.6L188.4,190v-159h135.3L323.6,190L323.6,190z"></path>
                        </svg></label>
                      <div class="input-group">
                        <div class="input-group-item"><input class="field form-control" dir="ltr" id="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$PhoneNumber9C9D1l$Xl86W3MQ$0$$en_US"
                            name="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$PhoneNumber9C9D1l$Xl86W3MQ$0$$en_US" placeholder="+65" type="text" value="+65"></div>
                      </div>
                    </div>
                  </div>
                </div>
                <div class="col-md-10 col-sm-10 col-8">
                  <div class="clearfix  lfr-ddm-form-field-container" ref="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$NumberJEpb4V$0Bq0ci9Q$0$$en_US">
                    <div class="form-group  liferay-ddm-form-field-text" data-fieldname="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$NumberJEpb4V$0Bq0ci9Q$0$$en_US"><label
                        for="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$NumberJEpb4V$0Bq0ci9Q$0$$en_US">Phone Number <svg aria-hidden="true" class="lexicon-icon lexicon-icon-asterisk reference-mark"
                          viewBox="0 0 512 512">
                          <path class="lexicon-icon-outline" d="M323.6,190l146.7-48.8L512,263.9l-149.2,47.6l93.6,125.2l-104.9,76.3l-96.1-126.4l-93.6,126.4L56.9,435.3l92.3-123.9
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                        </svg></label>
                      <div class="input-group">
                        <div class="input-group-item"><input class="field form-control" dir="ltr" id="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$NumberJEpb4V$0Bq0ci9Q$0$$en_US"
                            name="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$NumberJEpb4V$0Bq0ci9Q$0$$en_US" placeholder="" type="text" value=""></div>
                      </div>
                    </div>
                  </div>
                </div>
              </div>
              <div class="row">
                <div class="col-md-12 col-12">
                  <div class="clearfix hide lfr-ddm-form-field-container" ref="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$Product$wP1DMKyQ$0$$en_US">
                    <div class="form-group liferay-ddm-form-field-checkbox-multiple" data-fieldname="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$Product$wP1DMKyQ$0$$en_US" style="display: none;">
                      <div><label for="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$Product$wP1DMKyQ$0$$en_US">We'd like to learn more about your Business General Insurance. Which of the following
                          insurance policies does your company hold? Select the product(s) you’re currently insured for your business: </label></div>
                      <div class="form-check custom-checkbox custom-control"><label class="form-check-label-option-FireAllRiskInsurance"
                          for="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$Product$wP1DMKyQ$0$$en_US_FireAllRiskInsurance"><input dir="ltr" class="custom-control-input"
                            id="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$Product$wP1DMKyQ$0$$en_US_FireAllRiskInsurance"
                            name="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$Product$wP1DMKyQ$0$$en_US" type="checkbox" value="FireAllRiskInsurance"><span
                            class="form-check-description custom-control-label"><span class="custom-control-label-text">Fire/All Risk Insurance </span></span></label></div>
                      <div class="form-check custom-checkbox custom-control"><label class="form-check-label-option-PublicLiabilityInsurance"
                          for="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$Product$wP1DMKyQ$0$$en_US_PublicLiabilityInsurance"><input dir="ltr" class="custom-control-input"
                            id="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$Product$wP1DMKyQ$0$$en_US_PublicLiabilityInsurance"
                            name="_com_liferay_dynamic_data_mapping_form_web_portlet_DDMFormPortlet_INSTANCE_Gf1jYRuKJFbt_ddm$$Product$wP1DMKyQ$0$$en_US" type="checkbox" value="PublicLiabilityInsurance"><span
                            class="form-check-description custom-control-label"><span class="custom-control-label-text">Public Liability Insurance </span></span></label></div>
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