www.aia.com.my
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23.37.226.97
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Submitted URL: http://www.aia.com.my/
Effective URL: https://www.aia.com.my/en/index.html
Submission: On July 29 via manual from US — Scanned from DE
Effective URL: https://www.aia.com.my/en/index.html
Submission: On July 29 via manual from US — Scanned from DE
Form analysis 3 forms found in the DOM
<form class="search-form" id="search-form1">
<input type="hidden" name="searchExecutor" value="/en/search" id="searchExecutor">
<input type="hidden" name="type" value="123" id="search_type">
<!--*/ end, by Ocean Lan */-->
<div class="search-col-left">
<input name="keyword" data-id="search-input" class="search-input" type="search" placeholder="Type your question" tabindex="9801"
data-search-options="{"hideAllFilter":false,"hideProductsFilter":false,"hideArticlesFilter":false,"hideFormsFilter":false}" autocomplete="off">
</div>
<div class="search-col-right">
<button class="btn btn-primary go-btn" tabindex="9802">Go</button>
<button class="btn dismiss-search-btn" tabindex="9803">
<svg title="Dismiss" class="icon icon-xs hide-on-fallback " role="img">
<g>
<title>Dismiss</title>
<use xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href="/content/dam/aia/icons/icons.svg#closewhite-glyph"></use>
<image class="icon icon-xs " src="/content/dam/aia/icons/glyph/closewhite-glyph.png" alt="undefined" xmlns:xlink="http://www.w3.org/1999/xlink" xlink:href=""></image>
</g>
</svg>
</button>
</div>
</form><form class="curator margin-bottom-4xl" data-toggle="curator" id="product-curator-form">
<select class="curator-select curator-field curator-measurer" data-curator="measurer" style="display: none;">
<option></option>
</select>
<div class="text-center" data-curator="goal-sentence">
<span class="bt6 shrinkbt6 p4 margin-bottom-xxs"><label for="goallooking_forid">I want to</label></span>
<select class="curator-select curator-goal curator-field margin-bottom-xxs" data-curator="goal" name="looking_for" id="goallooking_forid" style="width: 12px; min-width: 14px; background-position: -4px 50%;">
<option value="default" disabled="" selected="" data-option-placeholder="">please select...</option>
<option value="i_want_a_medical_cover_or_card">obtain a medical card</option>
<option value="i_want_to_prepare_for_critical_illness_challenges">prepare for unexpected health issues</option>
<option value="i_want_to_prepare_for_unexpected_accidents">protect myself against accidents</option>
<option value="i_want_to_protect_myself">protect me and my loved ones</option>
<option value="i_want_to_grow_my_money">grow my savings</option>
<option value="i_want_to_plan_for_my_retirement">plan for my retirement</option>
<option value="i_want_the_best_for_my_kids">plan for my children's future</option>
<option value="i_want_to_protect_my_home">protect my home</option>
</select>
</div>
<div class="text-center curator-age-sentence" data-curator="1-sentence"><span class="bt6 shrinkbt6 p4 margin-bottom-xxs"></span></div>
<div class="text-center curator-age-sentence" data-curator="2-sentence"><span class="bt6 shrinkbt6 p4 margin-bottom-xxs"></span></div>
<div class="text-center curator-age-sentence" data-curator="3-sentence"><span class="bt6 shrinkbt6 p4 margin-bottom-xxs"></span></div>
<div class="text-center curator-age-sentence" data-curator="4-sentence"><span class="bt6 shrinkbt6 p4 margin-bottom-xxs"></span></div>
<div class="text-center curator-age-sentence" data-curator="5-sentence"><span class="bt6 shrinkbt6 p4 margin-bottom-xxs"></span></div>
<div class="text-center curator-age-sentence" data-curator="6-sentence"><span class="bt6 shrinkbt6 p4 margin-bottom-xxs"></span></div>
<div class="text-center curator-age-sentence" data-curator="7-sentence"><span class="bt6 shrinkbt6 p4 margin-bottom-xxs"></span></div>
<div class="text-center curator-age-sentence" data-curator="8-sentence"><span class="bt6 shrinkbt6 p4 margin-bottom-xxs"></span></div>
<p class="bt4 u2 text-center curator-age-validation" data-curator="tss-return-error-message"></p>
<p class="bt4 u2 text-center curator-age-validation" data-curator="prompt-value-error-message"></p>
<div class="margin-top-4xl">
<div class="submit button aiabase parbase">
<div class="margin-bottom-l">
<div>
<button id="btn1543850512" class="btn btn-default btn-primary center-block " type="button" onclick="buttonClick(this)" data-target="_blank">Find my products</button>
</div>
</div>
</div>
</div>
</form><form id="aia521464904">
<div class="container-fluid">
<div>
<div class="html-script section">
<div id="leads-form-target"></div>
<script>
$(function() {
$('button[data-link="#leads-form"]').addClass("leads-form-scroll");
$('button[data-link="#leads-form"]').removeAttr("data-link");
$('.list-action').find('[title*=brochure], [title*=Brochure]').closest('a').click(function() {
event.stopImmediatePropagation();
$('html, body').animate({
scrollTop: $("#leads-form").offset().top
}, 1000);
});
$('button.leads-form-scroll').click(function(event) {
event.stopImmediatePropagation();
event.preventDefault();
$('html, body').animate({
scrollTop: $("#leads-form").offset().top
}, 1000);
});
});
</script>
</div>
<div class="html-script section">
<span id="leads-form"></span>
</div>
<div class="html-script section">
<div id="form-life-planner"></div>
</div>
<div class="sub-title section">
<h4 class="h4 text-center p4 margin-top-md-5xl margin-bottom-md-3xl margin-top-sm-5xl margin-bottom-sm-l margin-top-5xl margin-bottom-l">CONNECT ME WITH AN AIA LIFE PLANNER</h4>
</div>
<div class="grid-control-2-col section">
<div class="row edit-contact-crs">
<div class="col col-md-6 col-sm-6 col-xs-12 col-md-offset-0 col-sm-offset-0 col-xs-offset-0 ">
<div>
<div class="sub-title section">
<h6 class="h6 text-left p4 margin-bottom-md-l margin-bottom-sm-l margin-bottom-l">FULL NAME</h6>
</div>
<div class="form-input form-base section">
<input type="text" class="primary-select parent-width" id="aia499789896" name="name" placeholder="e.g. John Doe" required="true" validationtype="text">
<div class="fieldError label-error" id="aia499789896_msg" requiredmessage="*Name is required"></div>
</div>
<div class="sub-title section">
<h6 class="h6 text-left p4 margin-top-md-l margin-bottom-md-l margin-top-sm-l margin-bottom-sm-l margin-top-l margin-bottom-l">Mobile Number</h6>
</div>
<div class="grid-control-2-col section">
<div class="row lead-select">
<div class="col col-md-6 col-sm-6 col-xs-6 col-md-offset-0 col-sm-offset-0 col-xs-offset-0 ">
<div>
<div class="form-dropdown form-base section">
<select class="primary-select parent-width" name="countryList" id="aia1271979061" required="true" style="color: #;">
<option value="" disabled="" selected="" data-option-placeholder="">Please Select</option>
<option value="AFG" data-code="93">Afghanistan (93)<!-- option--></option>
<option value="ALD" data-code="358">Aland Islands (358)<!-- option--></option>
<option value="ALB" data-code="355">Albania (355)<!-- option--></option>
<option value="ALG" data-code="213">Algeria (213)<!-- option--></option>
<option value="AMS" data-code="1684">American Samoa (1684)<!-- option--></option>
<option value="AND" data-code="376">Andorra (376)<!-- option--></option>
<option value="ANG" data-code="244">Angola (244)<!-- option--></option>
<option value="AGL" data-code="1264">Anguilla (1264)<!-- option--></option>
<option value="ANT" data-code="672">Antarctica (672)<!-- option--></option>
<option value="ANB" data-code="1268">Antigua and Barbuda (1268)<!-- option--></option>
<option value="ARG" data-code="54">Argentina (54)<!-- option--></option>
<option value="ARM" data-code="374">Armenia (374)<!-- option--></option>
<option value="ARU" data-code="297">Aruba (297)<!-- option--></option>
<option value="AUS" data-code="61">Australia (61)<!-- option--></option>
<option value="AUT" data-code="43">Austria (43)<!-- option--></option>
<option value="AZE" data-code="994">Azerbaijan (994)<!-- option--></option>
<option value="BHM" data-code="1242">Bahamas (1242)<!-- option--></option>
<option value="BRN" data-code="973">Bahrain (973)<!-- option--></option>
<option value="BGD" data-code="880">Bangladesh (880)<!-- option--></option>
<option value="BDS" data-code="1246">Barbados (1246)<!-- option--></option>
<option value="BLR" data-code="375">Belarus (375)<!-- option--></option>
<option value="BEL" data-code="32">Belgium (32)<!-- option--></option>
<option value="BLZ" data-code="501">Belize (501)<!-- option--></option>
<option value="BEN" data-code="229">Benin (229)<!-- option--></option>
<option value="BER" data-code="1441">Bermuda (1441)<!-- option--></option>
<option value="BHU" data-code="975">Bhutan (975)<!-- option--></option>
<option value="BOL" data-code="591">Bolivia (591)<!-- option--></option>
<option value="BOS" data-code="387">Bosnia and Herzegovina (387)<!-- option--></option>
<option value="BOT" data-code="267">Botswana (267)<!-- option--></option>
<option value="BOU" data-code="47">Bouvet Island (47)<!-- option--></option>
<option value="BRZ" data-code="55">Brazil (55)<!-- option--></option>
<option value="BIO" data-code="246">British Indian Ocean Territory (246)<!-- option--></option>
<option value="BVI" data-code="1284">British Virgin Islands (1284)<!-- option--></option>
<option value="BRU" data-code="673">Brunei Darussalam (673)<!-- option--></option>
<option value="BUL" data-code="359">Bulgaria (359)<!-- option--></option>
<option value="BUF" data-code="226">Burkina Faso (226)<!-- option--></option>
<option value="BRD" data-code="257">Burundi (257)<!-- option--></option>
<option value="CAM" data-code="855">Cambodia (855)<!-- option--></option>
<option value="CMR" data-code="237">Cameroon (237)<!-- option--></option>
<option value="CDN" data-code="1">Canada (1)<!-- option--></option>
<option value="CPV" data-code="238">Cape Verde (238)<!-- option--></option>
<option value="CAY" data-code="1345">Cayman Islands (1345)<!-- option--></option>
<option value="RCA" data-code="236">Central African Republic (236)<!-- option--></option>
<option value="CHD" data-code="235">Chad (235)<!-- option--></option>
<option value="CHI" data-code="56">Chile (56)<!-- option--></option>
<option value="CHN" data-code="86">China (86)<!-- option--></option>
<option value="CXM" data-code="61">Christmas Island (61)<!-- option--></option>
<option value="COC" data-code="61">Cocos (Keeling) Islands (61)<!-- option--></option>
<option value="COL" data-code="57">Colombia (57)<!-- option--></option>
<option value="COM" data-code="269">Comoros (269)<!-- option--></option>
<option value="CON" data-code="242">Congo (242)<!-- option--></option>
<option value="COO" data-code="682">Cook Islands (682)<!-- option--></option>
<option value="CTR" data-code="506">Costa Rica (506)<!-- option--></option>
<option value="CRO" data-code="385">Croatia (385)<!-- option--></option>
<option value="CUB" data-code="53">Cuba (53)<!-- option--></option>
<option value="CUW" data-code="599">Curacao (599)<!-- option--></option>
<option value="CYP" data-code="357">Cyprus (357)<!-- option--></option>
<option value="CZH" data-code="420">Czech Republic (420)<!-- option--></option>
<option value="DRC" data-code="243">Dem. Republic of The Congo (243)<!-- option--></option>
<option value="DNM" data-code="45">Denmark (45)<!-- option--></option>
<option value="DJI" data-code="253">Djibouti (253)<!-- option--></option>
<option value="DMC" data-code="1767">Dominica (1767)<!-- option--></option>
<option value="DOM" data-code="1">Dominican Republic (1)<!-- option--></option>
<option value="ECD" data-code="593">Ecuador (593)<!-- option--></option>
<option value="EGT" data-code="20">Egypt (20)<!-- option--></option>
<option value="ELS" data-code="503">El Salvador (503)<!-- option--></option>
<option value="ENG" data-code="44">England (44)<!-- option--></option>
<option value="EQG" data-code="240">Equatorial Guinea (240)<!-- option--></option>
<option value="ERI" data-code="291">Eritrea (291)<!-- option--></option>
<option value="EST" data-code="372">Estonia (372)<!-- option--></option>
<option value="ETH" data-code="251">Ethiopia (251)<!-- option--></option>
<option value="FAL" data-code="500">Falkland Islands (Malvinas) (500)<!-- option--></option>
<option value="FAR" data-code="298">Faroe Islands (298)<!-- option--></option>
<option value="FSM" data-code="691">Federated States of Micronesia (691)<!-- option--></option>
<option value="FJI" data-code="679">Fiji (679)<!-- option--></option>
<option value="FIN" data-code="358">Finland (358)<!-- option--></option>
<option value="FRN" data-code="33">France (33)<!-- option--></option>
<option value="FRG" data-code="594">French Guiana (594)<!-- option--></option>
<option value="FRP" data-code="689">French Polynesia (689)<!-- option--></option>
<option value="FST" data-code="262">French Southern Territories (262)<!-- option--></option>
<option value="GAB" data-code="241">Gabon (241)<!-- option--></option>
<option value="GAM" data-code="220">Gambia (220)<!-- option--></option>
<option value="GEO" data-code="32">Georgia (32)<!-- option--></option>
<option value="GMN" data-code="49">Germany (49)<!-- option--></option>
<option value="GHN" data-code="233">Ghana (233)<!-- option--></option>
<option value="GIB" data-code="350">Gibraltar (350)<!-- option--></option>
<option value="GBR" data-code="44">Great Britain (44)<!-- option--></option>
<option value="GRE" data-code="30">Greece (30)<!-- option--></option>
<option value="GLD" data-code="299">Greenland (299)<!-- option--></option>
<option value="GRN" data-code="1473">Grenada (1473)<!-- option--></option>
<option value="GUA" data-code="590">Guadeloupe (590)<!-- option--></option>
<option value="GUM" data-code="671">Guam (671)<!-- option--></option>
<option value="GCA" data-code="502">Guatemala (502)<!-- option--></option>
<option value="GUE" data-code="441481">Guernsey (441481)<!-- option--></option>
<option value="GUI" data-code="224">Guinea (224)<!-- option--></option>
<option value="GUB" data-code="245">Guinea-Bissau (245)<!-- option--></option>
<option value="GUY" data-code="592">Guyana (592)<!-- option--></option>
<option value="HAI" data-code="509">Haiti (509)<!-- option--></option>
<option value="HMI" data-code="#N/A">Heard Is. And Mcdonald Is. (#N/A)<!-- option--></option>
<option value="HON" data-code="504">Honduras (504)<!-- option--></option>
<option value="HKG" data-code="852">Hong Kong (852)<!-- option--></option>
<option value="HUN" data-code="36">Hungary (36)<!-- option--></option>
<option value="ICE" data-code="354">Iceland (354)<!-- option--></option>
<option value="IND" data-code="91">India (91)<!-- option--></option>
<option value="INA" data-code="62">Indonesia (62)<!-- option--></option>
<option value="IRN" data-code="98">Iran (98)<!-- option--></option>
<option value="IRQ" data-code="964">Iraq (964)<!-- option--></option>
<option value="IRL" data-code="353">Ireland (353)<!-- option--></option>
<option value="ISL" data-code="441624">Isle of Man (441624)<!-- option--></option>
<option value="ISR" data-code="972">Israel (972)<!-- option--></option>
<option value="ITL" data-code="39">Italy (39)<!-- option--></option>
<option value="IVC" data-code="225">Ivory Coast (225)<!-- option--></option>
<option value="JAM" data-code="1876">Jamaica (1876)<!-- option--></option>
<option value="JPN" data-code="81">Japan (81)<!-- option--></option>
<option value="JER" data-code="441534">Jersey (441534)<!-- option--></option>
<option value="JOR" data-code="962">Jordan (962)<!-- option--></option>
<option value="KAZ" data-code="7">Kazakhstan (7)<!-- option--></option>
<option value="KEN" data-code="254">Kenya (254)<!-- option--></option>
<option value="KIR" data-code="686">Kiribati (686)<!-- option--></option>
<option value="KWT" data-code="965">Kuwait (965)<!-- option--></option>
<option value="KYR" data-code="996">Kyrgyzstan (996)<!-- option--></option>
<option value="LAO" data-code="856">Laos (856)<!-- option--></option>
<option value="LAT" data-code="371">Latvia (371)<!-- option--></option>
<option value="LEB" data-code="961">Lebanon (961)<!-- option--></option>
<option value="LES" data-code="266">Lesotho (266)<!-- option--></option>
<option value="LBR" data-code="231">Liberia (231)<!-- option--></option>
<option value="LAR" data-code="218">Libya (218)<!-- option--></option>
<option value="LIE" data-code="423">Liechtenstein (423)<!-- option--></option>
<option value="LIT" data-code="370">Lithuania (370)<!-- option--></option>
<option value="LUX" data-code="352">Luxembourg (352)<!-- option--></option>
<option value="MAC" data-code="853">Macau (853)<!-- option--></option>
<option value="MCD" data-code="389">Macedonia (389)<!-- option--></option>
<option value="MAD" data-code="261">Madagascar (261)<!-- option--></option>
<option value="MLW" data-code="265">Malawi (265)<!-- option--></option>
<option value="MAL" data-code="60">Malaysia (60)<!-- option--></option>
<option value="MDV" data-code="960">Maldives (960)<!-- option--></option>
<option value="MLI" data-code="223">Mali (223)<!-- option--></option>
<option value="MTA" data-code="356">Malta (356)<!-- option--></option>
<option value="MAR" data-code="692">Marshall Islands (692)<!-- option--></option>
<option value="MTQ" data-code="596">Martinique (596)<!-- option--></option>
<option value="MRT" data-code="222">Mauritania (222)<!-- option--></option>
<option value="MAU" data-code="230">Mauritius (230)<!-- option--></option>
<option value="MAY" data-code="262">Mayotte (262)<!-- option--></option>
<option value="MEX" data-code="52">Mexico (52)<!-- option--></option>
<option value="MNC" data-code="377">Monaco (377)<!-- option--></option>
<option value="MON" data-code="976">Mongolia (976)<!-- option--></option>
<option value="MTG" data-code="382">Montenegro (382)<!-- option--></option>
<option value="MSR" data-code="1664">Montserrat (1664)<!-- option--></option>
<option value="MOR" data-code="212">Morocco (212)<!-- option--></option>
<option value="MOZ" data-code="258">Mozambique (258)<!-- option--></option>
<option value="MYN" data-code="95">Myanmar (95)<!-- option--></option>
<option value="NAM" data-code="264">Namibia (264)<!-- option--></option>
<option value="NAU" data-code="674">Nauru (674)<!-- option--></option>
<option value="NEP" data-code="977">Nepal (977)<!-- option--></option>
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<option value="NTA" data-code="599">Netherlands Antilles (599)<!-- option--></option>
<option value="NCA" data-code="687">New Caledonia (687)<!-- option--></option>
<option value="NZL" data-code="64">New Zealand (64)<!-- option--></option>
<option value="NIC" data-code="505">Nicaragua (505)<!-- option--></option>
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<option value="NIG" data-code="234">Nigeria (234)<!-- option--></option>
<option value="NIU" data-code="683">Niue (683)<!-- option--></option>
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<option value="SPN" data-code="34">Spain (34)<!-- option--></option>
<option value="SLK" data-code="94">Sri Lanka (94)<!-- option--></option>
<option value="SUD" data-code="249">Sudan (249)<!-- option--></option>
<option value="SUR" data-code="597">Suriname (597)<!-- option--></option>
<option value="SJM" data-code="47">Svalbard and Jan Mayen (47)<!-- option--></option>
<option value="SWA" data-code="268">Swaziland (268)<!-- option--></option>
<option value="SWD" data-code="46">Sweden (46)<!-- option--></option>
<option value="SWI" data-code="41">Switzerland (41)<!-- option--></option>
<option value="SYR" data-code="963">Syria (963)<!-- option--></option>
<option value="TAI" data-code="886">Taiwan (886)<!-- option--></option>
<option value="TAJ" data-code="992">Tajikistan (992)<!-- option--></option>
<option value="TAN" data-code="255">Tanzania (255)<!-- option--></option>
<option value="THN" data-code="66">Thailand (66)<!-- option--></option>
<option value="TIM" data-code="670">Timor-Leste (670)<!-- option--></option>
<option value="TOG" data-code="228">Togo (228)<!-- option--></option>
<option value="TOK" data-code="690">Tokelau (690)<!-- option--></option>
<option value="TON" data-code="676">Tonga (676)<!-- option--></option>
<option value="TRI" data-code="1-868">Trinidad and Tobago (1-868)<!-- option--></option>
<option value="TUN" data-code="216">Tunisia (216)<!-- option--></option>
<option value="TUR" data-code="90">Turkey (90)<!-- option--></option>
<option value="TMN" data-code="993">Turkmenistan (993)<!-- option--></option>
<option value="TCI" data-code="1-649">Turks and Caicos Islands (1-649)<!-- option--></option>
<option value="TUV" data-code="688">Tuvalu (688)<!-- option--></option>
<option value="MOI" data-code="1">U.S Minor Outlying Islands (1)<!-- option--></option>
<option value="UGA" data-code="256">Uganda (256)<!-- option--></option>
<option value="UKR" data-code="380">Ukraine (380)<!-- option--></option>
<option value="UAE" data-code="971">United Arab Emirates (971)<!-- option--></option>
<option value="UKG" data-code="44">United Kingdom (44)<!-- option--></option>
<option value="USA" data-code="1">United States of America (1)<!-- option--></option>
<option value="URU" data-code="598">Uruguay (598)<!-- option--></option>
<option value="USV" data-code="340">US Virgin Islands (340)<!-- option--></option>
<option value="UZB" data-code="998">Uzbekistan (998)<!-- option--></option>
<option value="VAN" data-code="678">Vanuatu (678)<!-- option--></option>
<option value="VAT" data-code="379">Vatican City State (379)<!-- option--></option>
<option value="VEN" data-code="58">Venezuela (58)<!-- option--></option>
<option value="VIE" data-code="84">Vietnam (84)<!-- option--></option>
<option value="WAF" data-code="681">Wallis and Futuna (681)<!-- option--></option>
<option value="WSA" data-code="212">Western Sahara (212)<!-- option--></option>
<option value="YMN" data-code="967">Yemen (967)<!-- option--></option>
<option value="ZAM" data-code="260">Zambia (260)<!-- option--></option>
<option value="ZIM" data-code="263">Zimbabwe (263)<!-- option--></option>
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<div class="col col-md-6 col-sm-6 col-xs-6 ">
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<div class="form-input form-base section">
<input type="text" class="primary-select parent-width" id="aia1262479867" name="phone_number" placeholder="e.g. 123456677" required="true" re="^.{9,12}$" validationtype="text">
<div class="fieldError label-error" id="aia1262479867_msg" requiredmessage="*Mobile number is required" remessage="*Mobile number length is invalid"></div>
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<div class="sub-title section">
<h6 class="h6 text-left p4 margin-top-md-l margin-bottom-md-l margin-top-sm-l margin-bottom-sm-l margin-top-l margin-bottom-l">Home/Work Phone Number</h6>
</div>
<div class="grid-control-2-col section">
<div class="row lead-select">
<div class="col col-md-6 col-sm-6 col-xs-6 col-md-offset-0 col-sm-offset-0 col-xs-offset-0 ">
<div>
<div class="form-dropdown form-base section">
<select class="primary-select parent-width" name="countryListHome" id="aia355775065" style="color: #;">
<option value="" disabled="" selected="" data-option-placeholder="">Please Select</option>
<option selected="">Please Select</option>
<option value="AFG" data-code="93">Afghanistan (93)<!-- option--></option>
<option value="ALD" data-code="358">Aland Islands (358)<!-- option--></option>
<option value="ALB" data-code="355">Albania (355)<!-- option--></option>
<option value="ALG" data-code="213">Algeria (213)<!-- option--></option>
<option value="AMS" data-code="1684">American Samoa (1684)<!-- option--></option>
<option value="AND" data-code="376">Andorra (376)<!-- option--></option>
<option value="ANG" data-code="244">Angola (244)<!-- option--></option>
<option value="AGL" data-code="1264">Anguilla (1264)<!-- option--></option>
<option value="ANT" data-code="672">Antarctica (672)<!-- option--></option>
<option value="ANB" data-code="1268">Antigua and Barbuda (1268)<!-- option--></option>
<option value="ARG" data-code="54">Argentina (54)<!-- option--></option>
<option value="ARM" data-code="374">Armenia (374)<!-- option--></option>
<option value="ARU" data-code="297">Aruba (297)<!-- option--></option>
<option value="AUS" data-code="61">Australia (61)<!-- option--></option>
<option value="AUT" data-code="43">Austria (43)<!-- option--></option>
<option value="AZE" data-code="994">Azerbaijan (994)<!-- option--></option>
<option value="BHM" data-code="1242">Bahamas (1242)<!-- option--></option>
<option value="BRN" data-code="973">Bahrain (973)<!-- option--></option>
<option value="BGD" data-code="880">Bangladesh (880)<!-- option--></option>
<option value="BDS" data-code="1246">Barbados (1246)<!-- option--></option>
<option value="BLR" data-code="375">Belarus (375)<!-- option--></option>
<option value="BEL" data-code="32">Belgium (32)<!-- option--></option>
<option value="BLZ" data-code="501">Belize (501)<!-- option--></option>
<option value="BEN" data-code="229">Benin (229)<!-- option--></option>
<option value="BER" data-code="1441">Bermuda (1441)<!-- option--></option>
<option value="BHU" data-code="975">Bhutan (975)<!-- option--></option>
<option value="BOL" data-code="591">Bolivia (591)<!-- option--></option>
<option value="BOS" data-code="387">Bosnia and Herzegovina (387)<!-- option--></option>
<option value="BOT" data-code="267">Botswana (267)<!-- option--></option>
<option value="BOU" data-code="47">Bouvet Island (47)<!-- option--></option>
<option value="BRZ" data-code="55">Brazil (55)<!-- option--></option>
<option value="BIO" data-code="246">British Indian Ocean Territory (246)<!-- option--></option>
<option value="BVI" data-code="1284">British Virgin Islands (1284)<!-- option--></option>
<option value="BRU" data-code="673">Brunei Darussalam (673)<!-- option--></option>
<option value="BUL" data-code="359">Bulgaria (359)<!-- option--></option>
<option value="BUF" data-code="226">Burkina Faso (226)<!-- option--></option>
<option value="BRD" data-code="257">Burundi (257)<!-- option--></option>
<option value="CAM" data-code="855">Cambodia (855)<!-- option--></option>
<option value="CMR" data-code="237">Cameroon (237)<!-- option--></option>
<option value="CDN" data-code="1">Canada (1)<!-- option--></option>
<option value="CPV" data-code="238">Cape Verde (238)<!-- option--></option>
<option value="CAY" data-code="1345">Cayman Islands (1345)<!-- option--></option>
<option value="RCA" data-code="236">Central African Republic (236)<!-- option--></option>
<option value="CHD" data-code="235">Chad (235)<!-- option--></option>
<option value="CHI" data-code="56">Chile (56)<!-- option--></option>
<option value="CHN" data-code="86">China (86)<!-- option--></option>
<option value="CXM" data-code="61">Christmas Island (61)<!-- option--></option>
<option value="COC" data-code="61">Cocos (Keeling) Islands (61)<!-- option--></option>
<option value="COL" data-code="57">Colombia (57)<!-- option--></option>
<option value="COM" data-code="269">Comoros (269)<!-- option--></option>
<option value="CON" data-code="242">Congo (242)<!-- option--></option>
<option value="COO" data-code="682">Cook Islands (682)<!-- option--></option>
<option value="CTR" data-code="506">Costa Rica (506)<!-- option--></option>
<option value="CRO" data-code="385">Croatia (385)<!-- option--></option>
<option value="CUB" data-code="53">Cuba (53)<!-- option--></option>
<option value="CUW" data-code="599">Curacao (599)<!-- option--></option>
<option value="CYP" data-code="357">Cyprus (357)<!-- option--></option>
<option value="CZH" data-code="420">Czech Republic (420)<!-- option--></option>
<option value="DRC" data-code="243">Dem. Republic of The Congo (243)<!-- option--></option>
<option value="DNM" data-code="45">Denmark (45)<!-- option--></option>
<option value="DJI" data-code="253">Djibouti (253)<!-- option--></option>
<option value="DMC" data-code="1767">Dominica (1767)<!-- option--></option>
<option value="DOM" data-code="1">Dominican Republic (1)<!-- option--></option>
<option value="ECD" data-code="593">Ecuador (593)<!-- option--></option>
<option value="EGT" data-code="20">Egypt (20)<!-- option--></option>
<option value="ELS" data-code="503">El Salvador (503)<!-- option--></option>
<option value="ENG" data-code="44">England (44)<!-- option--></option>
<option value="EQG" data-code="240">Equatorial Guinea (240)<!-- option--></option>
<option value="ERI" data-code="291">Eritrea (291)<!-- option--></option>
<option value="EST" data-code="372">Estonia (372)<!-- option--></option>
<option value="ETH" data-code="251">Ethiopia (251)<!-- option--></option>
<option value="FAL" data-code="500">Falkland Islands (Malvinas) (500)<!-- option--></option>
<option value="FAR" data-code="298">Faroe Islands (298)<!-- option--></option>
<option value="FSM" data-code="691">Federated States of Micronesia (691)<!-- option--></option>
<option value="FJI" data-code="679">Fiji (679)<!-- option--></option>
<option value="FIN" data-code="358">Finland (358)<!-- option--></option>
<option value="FRN" data-code="33">France (33)<!-- option--></option>
<option value="FRG" data-code="594">French Guiana (594)<!-- option--></option>
<option value="FRP" data-code="689">French Polynesia (689)<!-- option--></option>
<option value="FST" data-code="262">French Southern Territories (262)<!-- option--></option>
<option value="GAB" data-code="241">Gabon (241)<!-- option--></option>
<option value="GAM" data-code="220">Gambia (220)<!-- option--></option>
<option value="GEO" data-code="32">Georgia (32)<!-- option--></option>
<option value="GMN" data-code="49">Germany (49)<!-- option--></option>
<option value="GHN" data-code="233">Ghana (233)<!-- option--></option>
<option value="GIB" data-code="350">Gibraltar (350)<!-- option--></option>
<option value="GBR" data-code="44">Great Britain (44)<!-- option--></option>
<option value="GRE" data-code="30">Greece (30)<!-- option--></option>
<option value="GLD" data-code="299">Greenland (299)<!-- option--></option>
<option value="GRN" data-code="1473">Grenada (1473)<!-- option--></option>
<option value="GUA" data-code="590">Guadeloupe (590)<!-- option--></option>
<option value="GUM" data-code="671">Guam (671)<!-- option--></option>
<option value="GCA" data-code="502">Guatemala (502)<!-- option--></option>
<option value="GUE" data-code="441481">Guernsey (441481)<!-- option--></option>
<option value="GUI" data-code="224">Guinea (224)<!-- option--></option>
<option value="GUB" data-code="245">Guinea-Bissau (245)<!-- option--></option>
<option value="GUY" data-code="592">Guyana (592)<!-- option--></option>
<option value="HAI" data-code="509">Haiti (509)<!-- option--></option>
<option value="HMI" data-code="#N/A">Heard Is. And Mcdonald Is. (#N/A)<!-- option--></option>
<option value="HON" data-code="504">Honduras (504)<!-- option--></option>
<option value="HKG" data-code="852">Hong Kong (852)<!-- option--></option>
<option value="HUN" data-code="36">Hungary (36)<!-- option--></option>
<option value="ICE" data-code="354">Iceland (354)<!-- option--></option>
<option value="IND" data-code="91">India (91)<!-- option--></option>
<option value="INA" data-code="62">Indonesia (62)<!-- option--></option>
<option value="IRN" data-code="98">Iran (98)<!-- option--></option>
<option value="IRQ" data-code="964">Iraq (964)<!-- option--></option>
<option value="IRL" data-code="353">Ireland (353)<!-- option--></option>
<option value="ISL" data-code="441624">Isle of Man (441624)<!-- option--></option>
<option value="ISR" data-code="972">Israel (972)<!-- option--></option>
<option value="ITL" data-code="39">Italy (39)<!-- option--></option>
<option value="IVC" data-code="225">Ivory Coast (225)<!-- option--></option>
<option value="JAM" data-code="1876">Jamaica (1876)<!-- option--></option>
<option value="JPN" data-code="81">Japan (81)<!-- option--></option>
<option value="JER" data-code="441534">Jersey (441534)<!-- option--></option>
<option value="JOR" data-code="962">Jordan (962)<!-- option--></option>
<option value="KAZ" data-code="7">Kazakhstan (7)<!-- option--></option>
<option value="KEN" data-code="254">Kenya (254)<!-- option--></option>
<option value="KIR" data-code="686">Kiribati (686)<!-- option--></option>
<option value="KWT" data-code="965">Kuwait (965)<!-- option--></option>
<option value="KYR" data-code="996">Kyrgyzstan (996)<!-- option--></option>
<option value="LAO" data-code="856">Laos (856)<!-- option--></option>
<option value="LAT" data-code="371">Latvia (371)<!-- option--></option>
<option value="LEB" data-code="961">Lebanon (961)<!-- option--></option>
<option value="LES" data-code="266">Lesotho (266)<!-- option--></option>
<option value="LBR" data-code="231">Liberia (231)<!-- option--></option>
<option value="LAR" data-code="218">Libya (218)<!-- option--></option>
<option value="LIE" data-code="423">Liechtenstein (423)<!-- option--></option>
<option value="LIT" data-code="370">Lithuania (370)<!-- option--></option>
<option value="LUX" data-code="352">Luxembourg (352)<!-- option--></option>
<option value="MAC" data-code="853">Macau (853)<!-- option--></option>
<option value="MCD" data-code="389">Macedonia (389)<!-- option--></option>
<option value="MAD" data-code="261">Madagascar (261)<!-- option--></option>
<option value="MLW" data-code="265">Malawi (265)<!-- option--></option>
<option value="MAL" data-code="60">Malaysia (60)<!-- option--></option>
<option value="MDV" data-code="960">Maldives (960)<!-- option--></option>
<option value="MLI" data-code="223">Mali (223)<!-- option--></option>
<option value="MTA" data-code="356">Malta (356)<!-- option--></option>
<option value="MAR" data-code="692">Marshall Islands (692)<!-- option--></option>
<option value="MTQ" data-code="596">Martinique (596)<!-- option--></option>
<option value="MRT" data-code="222">Mauritania (222)<!-- option--></option>
<option value="MAU" data-code="230">Mauritius (230)<!-- option--></option>
<option value="MAY" data-code="262">Mayotte (262)<!-- option--></option>
<option value="MEX" data-code="52">Mexico (52)<!-- option--></option>
<option value="MNC" data-code="377">Monaco (377)<!-- option--></option>
<option value="MON" data-code="976">Mongolia (976)<!-- option--></option>
<option value="MTG" data-code="382">Montenegro (382)<!-- option--></option>
<option value="MSR" data-code="1664">Montserrat (1664)<!-- option--></option>
<option value="MOR" data-code="212">Morocco (212)<!-- option--></option>
<option value="MOZ" data-code="258">Mozambique (258)<!-- option--></option>
<option value="MYN" data-code="95">Myanmar (95)<!-- option--></option>
<option value="NAM" data-code="264">Namibia (264)<!-- option--></option>
<option value="NAU" data-code="674">Nauru (674)<!-- option--></option>
<option value="NEP" data-code="977">Nepal (977)<!-- option--></option>
<option value="NTL" data-code="31">Netherlands (31)<!-- option--></option>
<option value="NTA" data-code="599">Netherlands Antilles (599)<!-- option--></option>
<option value="NCA" data-code="687">New Caledonia (687)<!-- option--></option>
<option value="NZL" data-code="64">New Zealand (64)<!-- option--></option>
<option value="NIC" data-code="505">Nicaragua (505)<!-- option--></option>
<option value="NGR" data-code="227">Niger (227)<!-- option--></option>
<option value="NIG" data-code="234">Nigeria (234)<!-- option--></option>
<option value="NIU" data-code="683">Niue (683)<!-- option--></option>
<option value="NFI" data-code="672">Norfolk Island (672)<!-- option--></option>
<option value="NKO" data-code="850">North Korea (850)<!-- option--></option>
<option value="NMI" data-code="1670">Northern Mariana Islands (1670)<!-- option--></option>
<option value="NOR" data-code="47">Norway (47)<!-- option--></option>
<option value="OPT" data-code="970">Occupied Palestinian Territory (970)<!-- option--></option>
<option value="OMN" data-code="968">Oman (968)<!-- option--></option>
<option value="PAK" data-code="92">Pakistan (92)<!-- option--></option>
<option value="PAL" data-code="680">Palau (680)<!-- option--></option>
<option value="PAN" data-code="507">Panama (507)<!-- option--></option>
<option value="PNG" data-code="675">Papua New Guinea (675)<!-- option--></option>
<option value="PAR" data-code="595">Paraguay (595)<!-- option--></option>
<option value="PER" data-code="51">Peru (51)<!-- option--></option>
<option value="PHI" data-code="63">Philippines (63)<!-- option--></option>
<option value="PIT" data-code="64">Pitcairn (64)<!-- option--></option>
<option value="POL" data-code="48">Poland (48)<!-- option--></option>
<option value="POR" data-code="351">Portugal (351)<!-- option--></option>
<option value="PUE" data-code="1787">Puerto Rico (1787)<!-- option--></option>
<option value="QTR" data-code="974">Qatar (974)<!-- option--></option>
<option value="MOL" data-code="373">Republic of Moldova (373)<!-- option--></option>
<option value="REU" data-code="262">Reunion (262)<!-- option--></option>
<option value="ROM" data-code="40">Romania (40)<!-- option--></option>
<option value="RUS" data-code="7">Russia (7)<!-- option--></option>
<option value="RWA" data-code="250">Rwanda (250)<!-- option--></option>
<option value="BAR" data-code="590">Saint Barthelemy (590)<!-- option--></option>
<option value="HEL" data-code="290">Saint Helena (290)<!-- option--></option>
<option value="SKN" data-code="1-869">Saint Kitts and Nevis (1-869)<!-- option--></option>
<option value="LUC" data-code="1758">Saint Lucia (1758)<!-- option--></option>
<option value="STM" data-code="590">Saint Martin (590)<!-- option--></option>
<option value="SPM" data-code="508">Saint Pierre and Miquelon (508)<!-- option--></option>
<option value="SVG" data-code="1-784">Saint Vincent and the Grenadines (1-784)<!-- option--></option>
<option value="SAM" data-code="685">Samoa (685)<!-- option--></option>
<option value="SMR" data-code="378">San Marino (378)<!-- option--></option>
<option value="STP" data-code="239">Sao Tome and Principe (239)<!-- option--></option>
<option value="SAU" data-code="966">Saudi Arabia (966)<!-- option--></option>
<option value="SEN" data-code="221">Senegal (221)<!-- option--></option>
<option value="SER" data-code="381">Serbia (381)<!-- option--></option>
<option value="SEY" data-code="248">Seychelles (248)<!-- option--></option>
<option value="SIE" data-code="232">Sierra Leone (232)<!-- option--></option>
<option value="SGP" data-code="65">Singapore (65)<!-- option--></option>
<option value="SXM" data-code="1-721">Sint Maarten (1-721)<!-- option--></option>
<option value="SLV" data-code="421">Slovakia (421)<!-- option--></option>
<option value="SLO" data-code="386">Slovenia (386)<!-- option--></option>
<option value="SOL" data-code="677">Solomon Islands (677)<!-- option--></option>
<option value="SOM" data-code="252">Somalia (252)<!-- option--></option>
<option value="RSA" data-code="27">South Africa (27)<!-- option--></option>
<option value="SGS" data-code="500">South Georgia & S.Sandwich Is. (500)<!-- option--></option>
<option value="KOR" data-code="82">South Korea (82)<!-- option--></option>
<option value="SPN" data-code="34">Spain (34)<!-- option--></option>
<option value="SLK" data-code="94">Sri Lanka (94)<!-- option--></option>
<option value="SUD" data-code="249">Sudan (249)<!-- option--></option>
<option value="SUR" data-code="597">Suriname (597)<!-- option--></option>
<option value="SJM" data-code="47">Svalbard and Jan Mayen (47)<!-- option--></option>
<option value="SWA" data-code="268">Swaziland (268)<!-- option--></option>
<option value="SWD" data-code="46">Sweden (46)<!-- option--></option>
<option value="SWI" data-code="41">Switzerland (41)<!-- option--></option>
<option value="SYR" data-code="963">Syria (963)<!-- option--></option>
<option value="TAI" data-code="886">Taiwan (886)<!-- option--></option>
<option value="TAJ" data-code="992">Tajikistan (992)<!-- option--></option>
<option value="TAN" data-code="255">Tanzania (255)<!-- option--></option>
<option value="THN" data-code="66">Thailand (66)<!-- option--></option>
<option value="TIM" data-code="670">Timor-Leste (670)<!-- option--></option>
<option value="TOG" data-code="228">Togo (228)<!-- option--></option>
<option value="TOK" data-code="690">Tokelau (690)<!-- option--></option>
<option value="TON" data-code="676">Tonga (676)<!-- option--></option>
<option value="TRI" data-code="1-868">Trinidad and Tobago (1-868)<!-- option--></option>
<option value="TUN" data-code="216">Tunisia (216)<!-- option--></option>
<option value="TUR" data-code="90">Turkey (90)<!-- option--></option>
<option value="TMN" data-code="993">Turkmenistan (993)<!-- option--></option>
<option value="TCI" data-code="1-649">Turks and Caicos Islands (1-649)<!-- option--></option>
<option value="TUV" data-code="688">Tuvalu (688)<!-- option--></option>
<option value="MOI" data-code="1">U.S Minor Outlying Islands (1)<!-- option--></option>
<option value="UGA" data-code="256">Uganda (256)<!-- option--></option>
<option value="UKR" data-code="380">Ukraine (380)<!-- option--></option>
<option value="UAE" data-code="971">United Arab Emirates (971)<!-- option--></option>
<option value="UKG" data-code="44">United Kingdom (44)<!-- option--></option>
<option value="USA" data-code="1">United States of America (1)<!-- option--></option>
<option value="URU" data-code="598">Uruguay (598)<!-- option--></option>
<option value="USV" data-code="340">US Virgin Islands (340)<!-- option--></option>
<option value="UZB" data-code="998">Uzbekistan (998)<!-- option--></option>
<option value="VAN" data-code="678">Vanuatu (678)<!-- option--></option>
<option value="VAT" data-code="379">Vatican City State (379)<!-- option--></option>
<option value="VEN" data-code="58">Venezuela (58)<!-- option--></option>
<option value="VIE" data-code="84">Vietnam (84)<!-- option--></option>
<option value="WAF" data-code="681">Wallis and Futuna (681)<!-- option--></option>
<option value="WSA" data-code="212">Western Sahara (212)<!-- option--></option>
<option value="YMN" data-code="967">Yemen (967)<!-- option--></option>
<option value="ZAM" data-code="260">Zambia (260)<!-- option--></option>
<option value="ZIM" data-code="263">Zimbabwe (263)<!-- option--></option>
</select>
<div class="fieldError label-error" id="aia355775065_msg" requiredmessage="Please select your country calling code."></div>
<script type="text/javascript">
+ function($) {
"use strict";
$("#aia355775065").click(function() {
var current = $(this).val();
if (current != null) {
$("#aia355775065").css('color', '#554344');
}
});
$("#aia355775065").change(function() {
$(this).css({
'color': '#554344'
});
});
}(jQuery);
</script>
</div>
</div>
</div>
<div class="col col-md-6 col-sm-6 col-xs-6 ">
<div>
<div class="form-input form-base section">
<input type="text" class="primary-select parent-width" id="aia1822059501" name="home_number" placeholder="e.g. 328889342" re="^.{8,12}$" validationtype="text">
<div class="fieldError label-error" id="aia1822059501_msg" requiredmessage="*Home or work number is required" remessage="*Home or work number length is invalid"></div>
</div>
</div>
</div>
</div>
</div>
<div class="sub-title section">
<h6 class="h6 text-left p4 margin-top-md-xxl margin-bottom-md-l margin-top-sm-xxl margin-bottom-sm-l margin-top-l margin-bottom-l">Email Address</h6>
</div>
<div class="form-input form-base section">
<input type="text" class="primary-select parent-width" id="aia1407677752" name="email" placeholder="e.g. john.doe@email.com" required="true" re="^(?=^.{1,50}$)[a-zA-Z0-9.!#$%&’*+/=?^_`{|}~-]+@[a-zA-Z0-9-]+(?:\.[a-zA-Z0-9-]+)*$"
validationtype="text">
<div class="fieldError label-error" id="aia1407677752_msg" requiredmessage="*Email address is required" remessage="Please enter a valid email address."></div>
</div>
<div class="grid-control-1-col section">
<div class="row margin-bottom-sm-l margin-bottom-l">
<div class="col col-md-12 col-sm-12 col-xs-12 col-md-offset-0 col-sm-offset-0 col-xs-offset-0 ">
<div>
</div>
</div>
</div>
</div>
<div class="form-hidden-field form-base section">
<div class="margin-bottom-l" style="display: none;">
<label class="form-label margin-bottom-xxs p3 bt4">hiddenfield</label>
<input type="text" id="aia829712130" name="query_string">
<div class="fieldError label-error" id="aia829712130_msg"></div>
</div>
</div>
<div class="form-hidden-field form-base section">
<div class="margin-bottom-l" style="display: none;">
<label class="form-label margin-bottom-xxs p3 bt4">hiddenfield</label>
<input type="text" id="aia724924391" name="product_detail_name">
<div class="fieldError label-error" id="aia724924391_msg"></div>
</div>
</div>
</div>
</div>
<div class="col col-md-6 col-sm-6 col-xs-12 ">
<div>
<div class="sub-title section">
<h6 class="h6 text-left p4 margin-bottom-md-l margin-bottom-sm-l margin-bottom-l">AIA Customer?</h6>
</div>
<div class="grid-control-1-col section">
<div class="row ">
<div class="col col-md-8 col-sm-10 col-xs-12 col-md-offset-0 col-sm-offset-0 col-xs-offset-0 ">
<div>
<div class="form-toggle-box form-base section">
<input type="hidden" id="toggle-group-448159699" name="is_existing_customer" value="yes" required="true">
<div data-target="toggle-group" class="btn-toggle-group parent-width" id="448159699" name="is_existing_customer">
<button type="button" class="btn btn-toggle btn-selected" value="yes">yes</button>
<button type="button" class="btn btn-toggle " value="no">no</button>
</div>
<div id="toggle-group-448159699" class="fieldError label-error"></div>
<script type="text/javascript">
// Toggle buttons init
$("body").ready(function() {
$("#448159699 .btn-toggle").off("click");
$("#448159699").each(function(i, e) {
var groupID = $(e).attr("id");
$(this).find(".btn-toggle").on('click', function(e) {
$("#toggle-group-" + groupID).attr("value", $(this).attr("value"));
var toggleButtons = $("#" + groupID + " .btn-toggle");
var selectedToggleButtons = $("#" + groupID + " .btn-toggle.btn-selected");
var currentToggleIndex = toggleButtons.index(this);
selectToggleButton448159699(toggleButtons, currentToggleIndex);
});
});
});
</script>
<script type="text/javascript">
function selectToggleButton448159699(toggleButtons, currentToggleIndex) {
toggleButtons.removeClass("btn-selected");
toggleButtons.eq(currentToggleIndex).addClass("btn-selected");
}
</script>
</div>
<div class="html-script section">
<script type="text/javascript">
var toggleName = "is_existing_customer";
var icNumber = "ic_number";
$(function() {
function requireICNo() {
if ($('[name=' + toggleName + ']').val() == "yes") {
$('[name=' + icNumber + ']').prop('required', true);
$('[name=' + icNumber + ']').prop('disabled', false);
} else {
$('[name=' + icNumber + ']').prop('required', false);
$('[name=' + icNumber + ']').prop('disabled', true);
$('[name=' + icNumber + ']').removeClass("field-error");
var toggleId = $('[name=' + icNumber + ']').attr('id') + "_msg";
$('#' + toggleId).html("");
$('input[name="ic_number"]').val(null);
}
}
$('[name="is_existing_customer"]').click(function() {
requireICNo();
});
});
</script>
<style>
input[disabled] {
background-color: #CDD3D9;
}
</style>
</div>
</div>
</div>
</div>
</div>
<div class="sub-title section">
<h6 class="h6 text-left p4 margin-top-md-l margin-bottom-md-l margin-top-sm-l margin-bottom-sm-l margin-top-l margin-bottom-l">ID Number</h6>
</div>
<div class="form-input form-base section">
<input type="text" class="primary-select parent-width" id="aia849233255" name="ic_number" placeholder="e.g. 881202142345" required="true" re="^.{12,14}$" validationtype="text">
<div class="fieldError label-error" id="aia849233255_msg" requiredmessage="*IC Number is required for AIA customers" remessage="*IC Number must be 12 to 14 characters"></div>
</div>
<div class="text parbase section">
<div class="aia-text text-left p4 bt5 margin-bottom-md-l margin-bottom-sm-l margin-bottom-l" data-emptytext="Text">
<p>*Only applicable to AIA customers</p>
</div>
</div>
<div class="sub-title section">
<h6 class="h6 text-left p4 margin-bottom-md-l margin-bottom-sm-l margin-bottom-l">Preferred Location To Meet</h6>
</div>
<div class="form-dropdown form-base section">
<select class="primary-select parent-width" name="Location" id="aia805954284" required="true" style="color: #;">
<option selected="">Select location</option>
<option value="Alor Setar" style="color: rgb(85, 67, 68);">Alor Setar</option>
<option value="Batu Pahat" style="color: rgb(85, 67, 68);">Batu Pahat</option>
<option value="Bukit Mertajam" style="color: rgb(85, 67, 68);">Bukit Mertajam</option>
<option value="Ipoh" style="color: rgb(85, 67, 68);">Ipoh</option>
<option value="Johor Bahru" style="color: rgb(85, 67, 68);">Johor Bahru</option>
<option value="Klang" style="color: rgb(85, 67, 68);">Klang</option>
<option value="Kluang" style="color: rgb(85, 67, 68);">Kluang</option>
<option value="Kota Bharu" style="color: rgb(85, 67, 68);">Kota Bharu</option>
<option value="Kota Kinabalu" style="color: rgb(85, 67, 68);">Kota Kinabalu</option>
<option value="Kuala Lumpur" style="color: rgb(85, 67, 68);">Kuala Lumpur</option>
<option value="Kuantan" style="color: rgb(85, 67, 68);">Kuantan</option>
<option value="Kuching" style="color: rgb(85, 67, 68);">Kuching</option>
<option value="Kulim" style="color: rgb(85, 67, 68);">Kulim</option>
<option value="Melaka" style="color: rgb(85, 67, 68);">Melaka</option>
<option value="Miri" style="color: rgb(85, 67, 68);">Miri</option>
<option value="Muar" style="color: rgb(85, 67, 68);">Muar</option>
<option value="Petaling Jaya" style="color: rgb(85, 67, 68);">Petaling Jaya</option>
<option value="Penang" style="color: rgb(85, 67, 68);">Penang</option>
<option value="Sandakan" style="color: rgb(85, 67, 68);">Sandakan</option>
<option value="Segamat" style="color: rgb(85, 67, 68);">Segamat</option>
<option value="Seremban" style="color: rgb(85, 67, 68);">Seremban</option>
<option value="Sibu" style="color: rgb(85, 67, 68);">Sibu</option>
<option value="Sungai Petani" style="color: rgb(85, 67, 68);">Sungai Petani</option>
<option value="Taiping" style="color: rgb(85, 67, 68);">Taiping</option>
<option value="Tawau" style="color: rgb(85, 67, 68);">Tawau</option>
<option value="Teluk Intan" style="color: rgb(85, 67, 68);">Teluk Intan</option>
<option value="Temerloh" style="color: rgb(85, 67, 68);">Temerloh</option>
<option value="Terengganu" style="color: rgb(85, 67, 68);">Terengganu</option>
</select>
<div class="fieldError label-error" id="aia805954284_msg" requiredmessage="*Location is required"></div>
<script type="text/javascript">
+ function($) {
"use strict";
$("#aia805954284").click(function() {
var current = $(this).val();
if (current != null) {
$("#aia805954284").css('color', '#554344');
}
});
$("#aia805954284").change(function() {
$(this).css({
'color': '#554344'
});
});
}(jQuery);
</script>
</div>
<div class="sub-title section">
<h6 class="h6 text-left p4 margin-bottom-md-l margin-bottom-sm-l margin-top-l margin-bottom-l">Preferred Day and Time</h6>
</div>
<div class="grid-control-2-col section">
<div class="row lead-select">
<div class="col col-md-6 col-sm-6 col-xs-6 col-md-offset-0 col-sm-offset-0 col-xs-offset-0 ">
<div>
<div class="form-dropdown form-base section">
<select class="primary-select parent-width" name="day" id="aia1561794732" required="true" style="color: #;">
<option style="color: rgb(85, 67, 68);">Select day</option>
<option value="Weekend" style="color: rgb(85, 67, 68);">Weekend</option>
<option value="Weekday" style="color: rgb(85, 67, 68);">Weekday</option>
</select>
<div class="fieldError label-error" id="aia1561794732_msg" requiredmessage="*Location is required"></div>
<script type="text/javascript">
+ function($) {
"use strict";
$("#aia1561794732").click(function() {
var current = $(this).val();
if (current != null) {
$("#aia1561794732").css('color', '#554344');
}
});
$("#aia1561794732").change(function() {
$(this).css({
'color': '#554344'
});
});
}(jQuery);
</script>
</div>
</div>
</div>
<div class="col col-md-6 col-sm-6 col-xs-6 ">
<div>
<div class="form-dropdown form-base section">
<select class="primary-select parent-width" name="time" id="aia96902097" required="true" style="color: #;">
<option style="color: rgb(85, 67, 68);">Select time</option>
<option value="Office hours" style="color: rgb(85, 67, 68);">Office hours</option>
<option value="Non-office hours" style="color: rgb(85, 67, 68);">Non-office hours</option>
</select>
<div class="fieldError label-error" id="aia96902097_msg" requiredmessage="*Location is required"></div>
<script type="text/javascript">
+ function($) {
"use strict";
$("#aia96902097").click(function() {
var current = $(this).val();
if (current != null) {
$("#aia96902097").css('color', '#554344');
}
});
$("#aia96902097").change(function() {
$(this).css({
'color': '#554344'
});
});
}(jQuery);
</script>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="text parbase section">
<div class="aia-text p4 bt4 margin-bottom-md-l margin-bottom-sm-l margin-top-xxl margin-bottom-l" data-emptytext="Text">
<p>To receive the information regarding promotions and offers from AIA Bhd., AIA General Berhad, AIA PUBLIC Takaful Bhd., AIA Pension and Asset Management Sdn. Bhd. and AIA Health Services Sdn. Bhd. (“AIA Malaysia”), please tick below:</p>
</div>
</div>
<div class="form-checkbox form-base section">
<label class="checkbox margin-bottom-s" for="5861480361">
<input type="checkbox" id="5861480361" name="agreement" value="0" groupid="1128825285" index="0">
<span class="indicator"><span class="tick"></span></span> I agree that any personal information collected or held by AIA Malaysia may be disclosed by AIA Malaysia to any selected third party for the purposes of cross marketing, direct
marketing and to communicate with me for such purpose. I understand that I have a right to obtain access to and to request correction of any personal information held by AIA Malaysia concerning me and such request can be made at
<a href="mailto:my.contact@aia.com">my.contact@aia.com.</a>
</label>
<div id="1128825285_msg" class="fieldError label-error" requiredmessage="This field is required."></div>
</div>
<div class="grid-control-1-col section">
<div class="row onlyFhr">
<div class="col col-md-12 col-sm-12 col-xs-12 col-md-offset-0 col-sm-offset-0 col-xs-offset-0 ">
<div>
<div class="form-checkbox form-base section">
<label class="checkbox margin-bottom-s" for="5518308221">
<input type="checkbox" id="5518308221" name="consentIndicator" value="0" groupid="1788748049" index="0" checked="true">
<span class="indicator"><span class="tick"></span></span> I agree to share my Financial Health Check results with my pre-assigned AIA life planner. </label>
<div id="1788748049_msg" class="fieldError label-error" requiredmessage="This field is required."></div>
</div>
</div>
</div>
</div>
</div>
<div class="html-script section">
<br>
<!-- PROD <div class="g-recaptcha" data-sitekey="6LcDjjoUAAAAACXtvjtk8aNPyQtbR5pcfwuPjQMc"></div>-->
<!-- localhost -->
<!--<div class="g-recaptcha" data-sitekey="6Ldn3lUUAAAAANZHXLoYA5Mp0jSiBeC8Zj8EGjT7"></div> -->
<!-- SIT -->
<!--<div class="g-recaptcha" data-sitekey="6LeMzWAUAAAAAEsQeWq9W0x2LyiX4vuBt4mS1BD5"></div>-->
<!-- SIT PUBLISHER -->
<!-- <div class="g-recaptcha" data-sitekey="6LfIG3QUAAAAAMu9N6gJRGNnjA70R2DERya629Pj"></div> -->
<!-- UAT -->
<!-- <div class="g-recaptcha" data-sitekey="6LcdazYUAAAAAIMErY_H3eI59ehDyTrmY_8moK88"></div> -->
<div class="g-recaptcha" data-sitekey="6LcDjjoUAAAAACXtvjtk8aNPyQtbR5pcfwuPjQMc">
<div style="width: 304px; height: 78px;">
<div><iframe title="reCAPTCHA"
src="https://www.google.com/recaptcha/api2/anchor?ar=1&k=6LcDjjoUAAAAACXtvjtk8aNPyQtbR5pcfwuPjQMc&co=aHR0cHM6Ly93d3cuYWlhLmNvbS5teTo0NDM.&hl=de&v=pCoGBhjs9s8EhFOHJFe8cqis&size=normal&cb=ykrp49rk8bxs"
width="304" height="78" role="presentation" name="a-7j3qtylq6xib" frameborder="0" scrolling="no"
sandbox="allow-forms allow-popups allow-same-origin allow-scripts allow-top-navigation allow-modals allow-popups-to-escape-sandbox"></iframe></div><textarea id="g-recaptcha-response-1" name="g-recaptcha-response"
class="g-recaptcha-response" style="width: 250px; height: 40px; border: 1px solid rgb(193, 193, 193); margin: 10px 25px; padding: 0px; resize: none; display: none;"></textarea>
</div><iframe style="display: none;"></iframe>
</div>
<script>
$(function() {
var captchaKey = [{
'domain': 'localhost',
'key': '6Ldn3lUUAAAAANZHXLoYA5Mp0jSiBeC8Zj8EGjT7'
}, {
'domain': 'aia-my.growthops-fs.com',
'key': '6Lf_gMcZAAAAABDXPO2Mp9REIYXDnq-4oEJmoB-J'
}, {
'domain': 'hkgdctlapp020.aia.biz',
'key': '6LfIG3QUAAAAAMu9N6gJRGNnjA70R2DERya629Pj'
}, {
'domain': 'wwwuat2.aia.com.my',
'key': '6LcdazYUAAAAAIMErY_H3eI59ehDyTrmY_8moK88'
}, {
'domain': 'www.aia.com.my',
'key': '6LcDjjoUAAAAACXtvjtk8aNPyQtbR5pcfwuPjQMc'
}]
var getHost = window.location.hostname;
var result = captchaKey.filter(a => a.domain.indexOf(getHost) !== -1);
// console.log('xxx', getHost, result)
$('.g-recaptcha').attr('data-sitekey', result[0].key);
})
</script>
</div>
<div class="html-script section">
<script>
$(function() {
$('input[name="g-recaptcha-check"]').parent().children(':not(div)').hide();
$('input[name="g-recaptcha-check"]').parent().show();
setTimeout(function() {
$('.submit button').bind("click mouseenter mouseleave", function() {
$('input[name="g-recaptcha-check"]').val($('[name="g-recaptcha-response"]').val());
});
}, 3000)
});
</script>
<script src="https://www.google.com/recaptcha/api.js" defer=""></script>
</div>
<div class="form-input form-base section">
<input type="text" class="primary-select parent-width" id="aia1350785472" name="g-recaptcha-check" required="true" validationtype="text" style="display: none;">
<div class="fieldError label-error" id="aia1350785472_msg" requiredmessage="*Please verify the reCAPTCHA and tick the check box before submission"></div>
</div>
<div class="html-script section">
<br>
<style>
.onlyFhr,
.thank-you-cont {
display: none;
}
.thank-you-page img {
margin: auto;
}
.lead-select .col:nth-child(1) {
padding-right: 8px;
}
.lead-select .col:nth-child(2) {
padding-left: 8px;
}
.submit.disable-btn>div {
position: relative;
}
.submit.disable-btn>div:before {
content: '';
display: block;
width: 100%;
height: 100%;
position: absolute;
top: 0;
left: 0;
z-index: 1;
background: white;
opacity: 0.5;
}
</style>
</div>
<div class="html-script section">
<p data-validation="return-error-message" class="bt4 u2 text-center generic-form-validation margin-top-l label-error "></p>
</div>
<div class="html-script section">
<script type="text/javascript">
let fhrConsent = false;
let isFhr = getQueryVariable("isfhr");
let isContestFlag = false;
let contentObj = {}
let isCampaign = false;
let campaignInfo = {};
var hasChannel = sessionStorage.getItem('oaop_fhrRcData');
if (sessionStorage.getItem('luckDrawData')) {
isFhr = true;
contentObj = JSON.parse(sessionStorage.getItem('luckDrawData'));
$('input[name="name"]').val(contentObj.CustomerName);
$('input[name="email"]').val(contentObj.Email);
$('input[name="phone_number"]').val(contentObj.MobTel);
$('select[name="countryList"]').val(contentObj.CountryCode);
}
//Added for campaign
const url = new URL(window.location.href);
const encodedUrlParam = url.searchParams.get('infoParam');
const source = url.searchParams.get('source');
if (source?.toLowerCase() == 'campaign') {
//$('.navbar-three').addClass('hidden');
//$('.navbar-sub-spacer').addClass('hidden');
isCampaign = true;
console.log(isCampaign);
}
if (encodedUrlParam) {
const decodedObjInString = JSON.parse(atob(decodeURIComponent(encodedUrlParam)));
const decodedObj = common_stringParamsToObject(decodedObjInString);
campaignInfo = decodedObj;
}
/* if(hasChannel){
$('.onlyFhr').show();
}
*/
/*if (isFhr) {
$('.onlyFhr').show();
}*/
//===============GET MOBILE & HOME NO============================
// Retrieve the country code list from common.js
setTimeout(function() {
countryCode();
}, 1000);
var mobileCountryCode;
var HWCountryCode;
//Dropdown list field, retrive the country
$('select[name="countryList"]').on('change', function() {
mobileCountryCode = $('option:selected', this).attr('data-code');
});
$('select[name="countryListHome"]').on('change', function() {
HWCountryCode = $('option:selected', this).attr('data-code');
});
//console.log(crsSrcType)
//=================QUERY STRING=====================
function countryCode() {
var obj = {};
var formUrl = $.myAiaCommonUrl.retrieveCountry();
var dataPackage = {};
$.ajax({
type: formUrl.action,
url: formUrl.endpoint,
headers: portal_getHeader('post-login', false),
data: JSON.stringify(dataPackage),
contentType: $.sspCommonUrl.getContentTypeServlet()
}).done(function(data, textStatus, jqXHR) {
if (!data.errorCode) {
$(data.country).each(function() {
$('select[name="countryList"]').append('<option value="' + this.countryCode + '" data-code="' + this.countryPhoneCode + '">' + this.countryName + ' (' + this.countryPhoneCode + ')' + '</ option>');
$('select[name="countryListHome"]').append('<option value="' + this.countryCode + '" data-code="' + this.countryPhoneCode + '">' + this.countryName + ' (' + this.countryPhoneCode + ')' + '</ option>');
});
if (sessionStorage.getItem('luckDrawData')) {
//contentObj = JSON.parse(sessionStorage.getItem('luckDrawData'));
$('select[name="countryList"]').val(contentObj.countryCode);
console.log('xxxxxxxxxxxxx', contentObj.countryCode, $('select[name="countryList"]').val())
}
}
}).fail(function(jqXHR, textStatus, errorThrown) {});
// var url = $.sspCommonUrl.getRetrieveCountryURL();
// $.sspManager.BasicPost(url, obj, 'application/json', getHeader()).done(function (data) {
// if (!data.ErrorCode) {
// $(data.Country).each(function () {
// $('select[name="countryList"]').append('<option value="' + this.CountryCode +
// '" data-code="' + this.CountryPhoneCode + '">' + this.Country + ' (' + this
// .CountryPhoneCode + ')' + '</ option>');
// $('select[name="countryListHome"]').append('<option value="' + this.CountryCode +
// '" data-code="' + this.CountryPhoneCode + '">' + this.Country + ' (' + this
// .CountryPhoneCode + ')' + '</ option>');
// });
// if (sessionStorage.getItem('luckDrawData')) {
// //contentObj = JSON.parse(sessionStorage.getItem('luckDrawData'));
// $('select[name="countryList"]').val(contentObj.CountryCode);
// console.log('xxxxxxxxxxxxx', contentObj.CountryCode, $('select[name="countryList"]').val())
// }
// }
// });
}
function getQueryVariable(variable) {
var query = window.location.search.substring(1);
var vars = query.split("&");
for (var i = 0; i < vars.length; i++) {
var pair = vars[i].split("=");
if (pair[0] == variable) {
if (pair[1].indexOf('%20') != -1) {
var fullName = pair[1].split('%20')
return fullName[0] + ' ' + fullName[1]
} else {
return pair[1];
}
}
}
return (false);
}
//var result = getQueryVariable("cmpid");
//$('input[name="query_string"]').val(result);
//get product title
$('input[name="product_detail_name"]').val($('.product-detail-type-banner').parent().find('.h2').text().trim());
$('input[name="product_detail_name"]').val();
//===============SUBMIT BUTTON================================
$(".form-container-leadcapture > form").submit(function() {
//var epUrl = "https://www.aia-uat.com.my/MyAIASIT/services/submitCRMProdLead";
var epUrl = $.sspCommonUrl.getSubmitCRMProdLeadURL();
var name = $('input[name="name"]').val();
var cont = $('input[name="phone_number"]').val();
var HWcont = $('input[name="home_number"]').val();
var dateTime = getDate();
var McountryCode = $('select[name="countryList"]').find(':selected').attr('data-code');
var HWcountryCode = $('select[name="countryListHome"]').find(':selected').attr('data-code');
var Mcountry = McountryCode + cont;
var HWcountry = HWcountryCode + HWcont;
var Email = $('input[name="email"]').val();
var Customer = $('input[name="is_existing_customer"]').val();
var NRIC = $('input[name="ic_number"]').val();
var Location = $('select[name="Location"]').val();
var GIT = $('input:checkbox[name=agreement]').is(':checked');
var Product = $('input[name="product_detail_name"]').val();
//var result = getQueryVariable("cmpid");
//$('input[name="query_string"]').val(result);
var qstring = $('input[name="query_string"]').val();
// 08082020 - 1a1p amend lead form for fhr
//Anisah - 20201203 - default consentIndicator to false cause the checkbox is hidden for R2 relase. uncomment this for next release
//fhrConsent = $('input:checkbox[name=consentIndicator]').is(':checked');
var _preferredDay = $('select[name="day"]').val();
var _preferredTime = $('select[name="time"]').val();
//grab URL until .html omit after '?'
var URL = window.location.href.split('?')[0];
//capture the path language /EN/ from /content/my/en/our-products/life-protection/a-life-link.html
var lang = getCurrentLanguage();
var $form = $('.form-container-leadcapture')
if (false) {
scrollToElement($($form).find('.field-error').first(), 10, 500);
$(".contact-err").text('').hide();
return false;
}
//if all the input field are correctly filled
else {
if (!isFhr && !isCampaign) {
var lead_data = {};
var preference = {
location: Location,
preferredDate: _preferredDay,
preferredTimeSlot: _preferredTime
};
lead_data.contactNo = Mcountry;
lead_data.preferredLanguague = lang;
lead_data.name = name;
lead_data.email = Email;
//lead_data.PreferredLocation = Location;
lead_data.preference = {
location: Location,
preferredDate: _preferredDay,
preferredTimeSlot: _preferredTime
};
lead_data.consentIndicator = GIT;
lead_data.preferredProduct = Product;
lead_data.leadSubmissionDate = dateTime;
lead_data.leadSource = "product_page";
lead_data.leadSubSource = "product_leads_form";
lead_data.leadType = "Sales";
if (qstring !== "false") {
lead_data.productPage = URL;
lead_data.urlParam = qstring;
} else {
lead_data.productPage = URL;
}
if (Customer == "yes" && NRIC !== "") {
lead_data.IC = NRIC;
lead_data.coverageFlag = true;
} else {
lead_data.coverageFlag = false;
}
if (HWcountry !== "undefined") {
lead_data.alternateContactNo = HWcountry;
}
// 08082020 - 1a1p amend lead form for fhr
lead_data.marketingConsent = fhrConsent;
//lead_data.PreferredDay = _preferredDay;
//lead_data.PreferredTimeSlot = _preferredTime;
//overlay, prevent multiple submission
$('.submit button').parent().parent().addClass('disable-btn');
$.getScript('/etc/designs/aia-my-app-portal/clientlib-footer/js/portalCommon.js').done(function(data) {
var formUrl = $.myAiaCommonUrl.submitLeadPreLogin();
$.ajax({
type: formUrl.action,
url: formUrl.endpoint,
cache: false,
headers: portal_getHeader('pre-login', false),
contentType: $.sspCommonUrl.getContentTypeServlet(),
data: JSON.stringify(lead_data),
}).done(function(data, textStatus, jqXHR) {
if (typeof data.errorCode !== "undefined") {
$(".generic-form-validation[data-validation='return-error-message']").text(data.Errordescription);
$(".generic-form-validation[data-validation='return-error-message']").show();
//enable button again
$('.submit.disable-btn').removeClass('disable-btn');
} else {
sendDirectCall("lead-gen-form-completion");
window.location.href = '/content/my/en/our-products/thank-you.html?strProduct=' + Product;
}
}).fail(function(jqXHR, textStatus, errorThrown) {
console.log('Server Error', jqXHR, textStatus, errorThrown);
//ajaxFailPreLoginHandler(jqXHR, textStatus, errorThrown);
//enable button again
$('.submit.disable-btn').removeClass('disable-btn');
});
});
} else {
$('.submit button').parent().parent().addClass('disable-btn');
$.getScript('/etc/designs/aia-my-app-portal/clientlib-footer/js/portalCommon.js').done(function(data) {
var formUrl = $.myAiaCommonUrl.submitLeadPreLogin();
var fromStorage = sessionStorage.getItem('oaop_fhrCompletedResultData');
fromStorage = JSON.parse(fromStorage);
/*if (hasChannel) {
fhrConsent = $('input:checkbox[name=consentIndicator]').is(':checked');
}*/
var dataPackage = {
name: name,
//IC: '',
type: "OTHERS",
email: Email,
contactNo: Mcountry,
preference: {
location: Location,
preferredDate: _preferredDay,
preferredTimeSlot: _preferredTime
},
consentIndicator: fhrConsent,
marketingConsent: GIT,
fhrResultId: fromStorage?.result?.fhrResultId
};
if (hasChannel) {
dataPackage.type = "RC";
dataPackage.agentInfo = {
code: JSON.parse(hasChannel).agentCode
};
}
if (HWcountry !== "undefined") {
dataPackage.alternateContactNo = HWcountry;
}
if (Customer == "yes" && NRIC !== "") {
dataPackage.IC = NRIC;
dataPackage.coverageFlag = true;
} else {
dataPackage.coverageFlag = false;
}
if (isCampaign) {
//dataPackage.channel = campaignInfo.templateKey; //o2o 2.0
dataPackage.leadSource = campaignInfo.leadSource;
dataPackage.leadSubSource = campaignInfo.leadSubSource;
dataPackage.templateKey = campaignInfo.templateKey;
dataPackage.specialForYou = campaignInfo.specialForYou == 'true' ? true : false;
}
$.ajax({
type: formUrl.action,
url: formUrl.endpoint,
cache: false,
headers: portal_getHeader('pre-login', false),
contentType: $.sspCommonUrl.getContentTypeServlet(),
data: JSON.stringify(dataPackage),
}).done(function(data, textStatus, jqXHR) {
// show fhr thank you interface.
$('#postLoginForm').hide();
$('.form-cont').hide();
$('.thank-you-cont').show();
$('.submit.disable-btn').removeClass('disable-btn');
}).fail(function(jqXHR, textStatus, errorThrown) {
$('.submit.disable-btn').removeClass('disable-btn');
});
});
}
}
});
function validateEmail(email) {
var filter = /^([a-zA-Z0-9_.-])+@(([a-zA-Z0-9-])+.)+([a-zA-Z0-9]{2,4})+$/;
if (!filter.test(email)) {
//alert('Please provide a valid email address');
return false;
}
}
function ContactNoMatch(ContactNo) {
var pattern = "^.{9,12}$";
var re = new RegExp(pattern);
var m = re.exec(ContactNo);
if (m == null) {
return false;
} else {
return true;
}
}
function getDate() {
var today = new Date();
var dd = today.getDate();
var mm = today.getMonth() + 1; //January is 0!
var time = today.toTimeString().substr(0, 8); //output: 18:19:14
var yyyy = today.getFullYear();
if (dd < 10) {
dd = '0' + dd;
}
if (mm < 10) {
mm = '0' + mm;
}
var submitDate = yyyy + '-' + mm + '-' + dd + " " + time;
return submitDate;
}
function getQueryVariable(variable) {
var query = window.location.search.substring(1);
var vars = query.split("&");
for (var i = 0; i < vars.length; i++) {
var pair = vars[i].split("=");
if (pair[0] == variable) {
if (pair[1].indexOf('%20') != -1) {
console.log(pair[1].indexOf('%20'))
var fullName = pair[1].split('%20')
console.log(fullName)
return fullName[0] + ' ' + fullName[1]
} else {
return pair[1];
}
}
}
return (false);
}
</script>
</div>
<div class="html-script section">
<!-- <h5 id="maintenanceMessage" class="label-error maintenance-err-msg">Dear customers, please be informed that we will be performing a major system upgrade from Friday, 7 July 11:00 PM (MYT) till Saturday, 8 July 3:00PM (MYT) Sorry for the inconvenient
</h5> -->
</div>
</div>
<p class="bt4 u2 text-center lead-form-validation" data-validation="tss-return-error-message"></p>
<div class="submit btn parent-width margin-bottom-xl">
<div class="margin-top-md-l margin-top-sm-l margin-top-l submit">
<div>
<button id="btn801156161" class="btn btn-default btn-primary center-block " type="button" onclick="" data-link="/content/my/en/our-products/thank-you.html" data-target="_blank">Contact Me</button>
</div>
</div>
</div>
</div>
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(45)Djibouti (253)Dominica (1767)Dominican Republic (1)Ecuador (593)Egypt (20)El
Salvador (503)England (44)Equatorial Guinea (240)Eritrea (291)Estonia
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