{"id":79,"date":"2025-09-17T09:53:35","date_gmt":"2025-09-17T09:53:35","guid":{"rendered":"http:\/\/localhost\/wptest\/wordpress\/?page_id=79"},"modified":"2025-09-17T12:29:58","modified_gmt":"2025-09-17T12:29:58","slug":"aanvraagformulier","status":"publish","type":"page","link":"https:\/\/urgentenodenuithoorn.nl\/index.php\/aanvraagformulier\/","title":{"rendered":"Aanvraagformulier"},"content":{"rendered":"<div class=\"jet-fb-form-block\" data-is-block=\"jet-forms\/form-block\"><link rel=\"preconnect\" href=\"https:\/\/fonts.gstatic.com\"><style id=\"jet-form-builder-111-inline-css\">.jet-sm-gb-8001fe6b-69d0-439e-a1cf-0e7ca83489c1 .jet-form-builder__desc{background-color: ;} .jet-sm-gb-065174d8-5997-4139-bacd-19e4a9b342d7 .jet-form-builder__desc{background-color: ;} .jet-sm-gb-5aa5ffe8-67d5-4826-90dd-762f8ef2cecb .jet-form-builder__desc{background-color: ;} .jet-sm-gb-9fd824a4-552c-4672-b54f-4e98fa3d341f .jet-form-builder__desc{background-color: ;} .jet-sm-gb-1bcae228-6519-4dcc-a4e8-47a819211607 .jet-form-builder__desc{background-color: ;} .jet-sm-gb-8e56fb63-18c8-4021-8059-066a3658dad9 .jet-form-builder__desc{background-color: ;} .jet-sm-gb-f85b8fc0-f00d-46ff-be53-6edfecff6347 .jet-form-builder__desc{background-color: ;} .jet-sm-gb-c554645d-b6b3-4296-a328-dcac60278895 .jet-form-builder__desc{background-color: ;} .jet-sm-gb-6084c351-e7b1-45b0-87fb-7ebf0700986f .jet-form-builder__desc{background-color: ;} .jet-sm-gb-70578ad2-1b0b-499e-ad68-d504a8702cf9 .jet-form-builder__desc{background-color: ;} .jet-sm-gb-a67bdea0-9c5b-43e6-b214-2e71af132ecb .jet-form-builder__desc{background-color: ;} .jet-sm-gb-b8280807-da49-459f-83b8-0b46a41095bd .jet-form-builder__desc{background-color: ;} .jet-sm-gb-e5188e55-fc18-470b-bcd8-92ac07fa3598 .jet-form-builder__desc{background-color: ;} <\/style><form  class=\"jet-form-builder layout-column submit-type-reload\" action=\"https:\/\/urgentenodenuithoorn.nl\/wp-json\/wp\/v2\/pages\/79\/?272RuL=Ql730DG59I1G&amp;method=reload\" method=\"POST\" data-form-id=\"111\" data-layout=\"column\" enctype=\"multipart\/form-data\" novalidate=\"null\" ssr_validation_method=\"rest\"><input type=\"hidden\" id=\"_wpnonce_111\" name=\"_wpnonce\" value=\"0e44265848\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/index.php\/wp-json\/wp\/v2\/pages\/79\" \/>\r\n<input type=\"hidden\" name=\"_jfb_current_render_states[]\" value=\"DEFAULT.STATE\" data-jfb-sync \/><input type=\"hidden\" class=\"jet-form-builder__field hidden-field\" name=\"_jet_engine_booking_form_id\" data-field-name=\"_jet_engine_booking_form_id\" value=\"111\">\n<input type=\"hidden\" class=\"jet-form-builder__field hidden-field\" name=\"_jet_engine_refer\" data-field-name=\"_jet_engine_refer\" value=\"https:\/\/urgentenodenuithoorn.nl\/wp-json\/wp\/v2\/pages\/79\/\">\n<input type=\"hidden\" class=\"jet-form-builder__field hidden-field\" name=\"__queried_post_id\" data-field-name=\"__queried_post_id\" value=\"79\">\n<div class=\"jet-form-builder-progress-pages jfb-progress-type--default jet-form-builder-progress-pages--global\" data-type=\"default\">\t<div class=\"jet-form-builder-progress-pages__item--wrapper active-page\" data-page=\"1\">\n\t\t<div class=\"jet-form-builder-progress-pages__item\">\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--circle\">1<\/div>\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--label\">Aanvrager<\/div>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"jet-form-builder-progress-pages__separator\"><\/div>\n\t\t\t<\/div>\n\t\t<div class=\"jet-form-builder-progress-pages__item--wrapper\" data-page=\"2\">\n\t\t<div class=\"jet-form-builder-progress-pages__item\">\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--circle\">2<\/div>\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--label\">Gegevens partner<\/div>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"jet-form-builder-progress-pages__separator\"><\/div>\n\t\t\t<\/div>\n\t\t<div class=\"jet-form-builder-progress-pages__item--wrapper\" data-page=\"3\">\n\t\t<div class=\"jet-form-builder-progress-pages__item\">\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--circle\">3<\/div>\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--label\">Partner<\/div>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"jet-form-builder-progress-pages__separator\"><\/div>\n\t\t\t<\/div>\n\t\t<div class=\"jet-form-builder-progress-pages__item--wrapper\" data-page=\"4\">\n\t\t<div class=\"jet-form-builder-progress-pages__item\">\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--circle\">4<\/div>\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--label\">Kinderen<\/div>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"jet-form-builder-progress-pages__separator\"><\/div>\n\t\t\t<\/div>\n\t\t<div class=\"jet-form-builder-progress-pages__item--wrapper\" data-page=\"5\">\n\t\t<div class=\"jet-form-builder-progress-pages__item\">\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--circle\">5<\/div>\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--label\">Inkomsten &amp; uitgaven<\/div>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"jet-form-builder-progress-pages__separator\"><\/div>\n\t\t\t<\/div>\n\t\t<div class=\"jet-form-builder-progress-pages__item--wrapper\" data-page=\"6\">\n\t\t<div class=\"jet-form-builder-progress-pages__item\">\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--circle\">6<\/div>\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--label\">Rapportage<\/div>\n\t\t<\/div>\n\t\t\t\t\t<div class=\"jet-form-builder-progress-pages__separator\"><\/div>\n\t\t\t<\/div>\n\t\t<div class=\"jet-form-builder-progress-pages__item--wrapper\" data-page=\"7\">\n\t\t<div class=\"jet-form-builder-progress-pages__item\">\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--circle\">7<\/div>\n\t\t\t<div class=\"jet-form-builder-progress-pages__item--label\">Indienen<\/div>\n\t\t<\/div>\n\t\t\t<\/div>\n\t<\/div><div class=\"jet-form-builder-page \" data-page=\"1\" data-page-offset=\"75\">\n<p class=\"wp-block-paragraph\">Via dit formulier kunt u een aanvraag indienen. Het is niet mogelijk om dit formulier tussentijds op te slaan.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Gegevens aanvrager<\/h3>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-e5188e55-fc18-470b-bcd8-92ac07fa3598 cb-drvwqebn\" data-block-id=\"jet-sm-gb-e5188e55-fc18-470b-bcd8-92ac07fa3598\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Naam hulpverlener <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"naam_aanvrager\" id=\"naam_aanvrager\" type=\"text\" data-field-name=\"naam_aanvrager\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_O5bHKv4m\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n\n<div  class=\"jet-form-builder-row field-type-text-field cb-gz058svh\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Organisatie<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"organisatie_aanvrager\" id=\"organisatie_aanvrager\" type=\"text\" data-field-name=\"organisatie_aanvrager\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_pDAGHSc3\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-7470b043-b957-4b80-994d-4e418d6ad741 cb-pn912k79\" data-block-id=\"jet-sm-gb-7470b043-b957-4b80-994d-4e418d6ad741\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Adres<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"adres_aanvrager\" id=\"adres_aanvrager\" type=\"text\" data-field-name=\"adres_aanvrager\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_VP1pBr8k\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-5944928a-d6e4-489e-b635-bcae11c7219b cb-ynma50ro\" data-block-id=\"jet-sm-gb-5944928a-d6e4-489e-b635-bcae11c7219b\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Telefoonnummer<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"telefoonnummer_aanvrager\" id=\"telefoonnummer_aanvrager\" type=\"text\" data-field-name=\"telefoonnummer_aanvrager\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_saSrkDTl\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-187d175c-3e7c-4c8e-95dc-c378d25c52a4 cb-j8r7cssg\" data-block-id=\"jet-sm-gb-187d175c-3e7c-4c8e-95dc-c378d25c52a4\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Email <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"email_aanvrager\" id=\"email_aanvrager\" type=\"email\" data-field-name=\"email_aanvrager\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_KcP7fW9L\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n\n\n<div class=\"wp-block-group is-layout-grid wp-container-core-group-is-layout-1e2e5166 wp-block-group-is-layout-grid\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-1be1b19d-b1dd-4ae9-bfc0-67819a21e3a5 cb-euwetabm\" data-block-id=\"jet-sm-gb-1be1b19d-b1dd-4ae9-bfc0-67819a21e3a5\" ><div  class=\"jet-form-builder-row field-type-submit-field wp-container-content-32a3e683\" >\n\t<div data-type=\"next\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button jet-form-builder__next-page\" type=\"button\">Gegevens cli\u00ebnt<\/button>\n\t<\/div>\n\t\n<\/div><\/div><\/div>\n\n\n<div class=\"jet-form-builder__next-page-wrap\">\n\t\t\t<\/div>\n<\/div>\n<div class=\"jet-form-builder-page jet-form-builder-page--hidden\" data-page=\"2\" data-page-offset=\"75\">\n\n\n<h2 class=\"wp-block-heading\">Gegevens cli\u00ebnt<\/h2>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-f85b8fc0-f00d-46ff-be53-6edfecff6347 cb-rzejo2l6\" data-block-id=\"jet-sm-gb-f85b8fc0-f00d-46ff-be53-6edfecff6347\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Naam cli\u00ebnt <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"naam_client\" id=\"naam_client\" type=\"text\" data-field-name=\"naam_client\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_eMDBwiaS\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field cb-tdebnrbx\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Geslacht<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" name=\"geslacht_client\" data-field-name=\"geslacht_client\" id=\"geslacht_client\" data-jfb-sync=\"null\">\n\t\t<option value=\"man\" >Man<\/option><option value=\"vrouw\" >Vrouw<\/option><option value=\"anders\" >Anders<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-c554645d-b6b3-4296-a328-dcac60278895\" data-block-id=\"jet-sm-gb-c554645d-b6b3-4296-a328-dcac60278895\" ><div  data-validation-type=\"advanced\" data-validation-messages=\"{&quot;date_max&quot;:&quot;De geboortedatum mag niet in de toekomst liggen.&quot;}\" class=\"jet-form-builder-row field-type-date-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Geboortedatum<\/div><\/div><input class=\"jet-form-builder__field date-field\" name=\"geboortedatum_client\" type=\"date\" data-field-name=\"geboortedatum_client\" id=\"geboortedatum_client\" data-jfb-sync=\"null\" data-max=\"&#039;%CT::CurrentDate%&#039;\">\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-6084c351-e7b1-45b0-87fb-7ebf0700986f cb-fzx1p1ej\" data-block-id=\"jet-sm-gb-6084c351-e7b1-45b0-87fb-7ebf0700986f\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Adres<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"adres_client\" id=\"adres_client\" type=\"text\" data-field-name=\"adres_client\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_dI6SytBQ\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-70578ad2-1b0b-499e-ad68-d504a8702cf9 cb-n9wf2hfk\" data-block-id=\"jet-sm-gb-70578ad2-1b0b-499e-ad68-d504a8702cf9\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Postcode<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"postcode_client\" id=\"postcode_client\" type=\"text\" data-field-name=\"postcode_client\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_xXdErGMc\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-a67bdea0-9c5b-43e6-b214-2e71af132ecb cb-h7qrijk3\" data-block-id=\"jet-sm-gb-a67bdea0-9c5b-43e6-b214-2e71af132ecb\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Woonplaats<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"woonplaats_client\" id=\"woonplaats_client\" type=\"text\" data-field-name=\"woonplaats_client\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_4iMOaQUx\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-b8280807-da49-459f-83b8-0b46a41095bd cb-mpuzs0py\" data-block-id=\"jet-sm-gb-b8280807-da49-459f-83b8-0b46a41095bd\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Telefoonnummer<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"telefoonnummer_client\" id=\"telefoonnummer_client\" type=\"text\" data-field-name=\"telefoonnummer_client\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_rA3l7wJq\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-7e761c80-49a3-427a-ba67-fe818b19c8d6 cb-mgug2mz5\" data-block-id=\"jet-sm-gb-7e761c80-49a3-427a-ba67-fe818b19c8d6\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Burgerlijke staat <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"burgerlijke_staat\" data-field-name=\"burgerlijke_staat\" id=\"burgerlijke_staat\" data-jfb-sync=\"null\">\n\t\t<option value=\"Alleenstaand\" >Alleenstaand<\/option><option value=\"samenwonend\" >Samenwonend<\/option><option value=\"Gehuwd\" >Gehuwd<\/option><option value=\"Gescheiden\" >Gescheiden<\/option><option value=\"Weduwe\/weduwnaar\" >Weduwe\/weduwnaar<\/option>\t<\/select>\n<\/div>\n<\/div><\/div>\n\n\n<div class=\"wp-block-group is-layout-grid wp-container-core-group-is-layout-28b052f3 wp-block-group-is-layout-grid\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-ab6c6901-4eab-460d-bfd4-650081b21444 cb-b0fmgtzu\" data-block-id=\"jet-sm-gb-ab6c6901-4eab-460d-bfd4-650081b21444\" ><div  class=\"jet-form-builder-row field-type-submit-field wp-container-content-a37929a5\" >\n\t<div data-type=\"prev\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button def_form_button jet-form-builder__prev-page\" type=\"button\">Vorige pagina<\/button>\n\t<\/div>\n\t\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-c49787ea-599f-420f-a234-42984fd528d8 cb-l56oqzw2\" data-block-id=\"jet-sm-gb-c49787ea-599f-420f-a234-42984fd528d8\" ><div  class=\"jet-form-builder-row field-type-submit-field wp-container-content-a37929a5\" >\n\t<div data-type=\"next\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button def_form_button jet-form-builder__next-page\" type=\"button\">Gegevens partner<\/button>\n\t<\/div>\n\t\n<\/div><\/div><\/div>\n\n\n<div class=\"jet-form-builder__next-page-wrap\">\n\t\t\t<\/div>\n<\/div>\n<div class=\"jet-form-builder-page jet-form-builder-page--hidden\" data-page=\"3\" data-page-offset=\"75\">\n\n\n<h3 class=\"wp-block-heading\">Gegevens partner<\/h3>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-b8319620-8c77-4333-a69b-69a621b7db7a cb-ppq25imr\" data-block-id=\"jet-sm-gb-b8319620-8c77-4333-a69b-69a621b7db7a\" ><div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Heeft cli\u00ebnt een partner? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" required=\"required\" name=\"heeft_client_een_partner\" data-field-name=\"heeft_client_een_partner\" id=\"heeft_client_een_partner\" data-jfb-sync=\"null\">\n\t\t<option value=\"Ja\" >Ja<\/option><option value=\"Nee\" >Nee<\/option>\t<\/select>\n<\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-1722fe70-6147-48ee-a2fa-f988b17b5237\" data-block-id=\"jet-sm-gb-1722fe70-6147-48ee-a2fa-f988b17b5237\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;Ja&quot;,&quot;field&quot;:&quot;heeft_client_een_partner&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div  class=\"jet-form-builder-row field-type-text-field cb-uxt73mb0\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Naam partner <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input required=\"required\" name=\"naam_partner\" id=\"naam_partner\" type=\"text\" data-field-name=\"naam_partner\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_gcoNjTkv\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-select-field wp-block-jet-forms-select-field cb-rt2z4sij\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Geslacht<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t<select class=\"jet-form-builder__field select-field\" name=\"geslacht_partner\" data-field-name=\"geslacht_partner\" id=\"geslacht_partner\" data-jfb-sync=\"null\">\n\t\t<option value=\"Man\" >Man<\/option><option value=\"Vrouw\" >Vrouw<\/option><option value=\"Anders\" >Anders<\/option>\t<\/select>\n<\/div>\n<\/div>\n\n<div  data-validation-type=\"advanced\" data-validation-messages=\"{&quot;date_max&quot;:&quot;De geboortedatum mag niet in de toekomst liggen.&quot;}\" class=\"jet-form-builder-row field-type-date-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Geboortedatum partner<\/div><\/div><input class=\"jet-form-builder__field date-field\" name=\"geboortedatum_partner\" type=\"date\" data-field-name=\"geboortedatum_partner\" id=\"geboortedatum_partner\" data-jfb-sync=\"null\" data-max=\"&#039;%CT::CurrentDate%&#039;\">\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-text-field cb-rh31cc18\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Adres partner<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"adres_partner\" id=\"adres_partner\" type=\"text\" data-field-name=\"adres_partner\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_kc2zLBv1\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-text-field cb-upwo6x9e\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Postcode partner<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"postcode_partner\" id=\"postcode_partner\" type=\"text\" data-field-name=\"postcode_partner\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_Px5kenA4\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-8e56fb63-18c8-4021-8059-066a3658dad9 cb-dcdc799p\" data-block-id=\"jet-sm-gb-8e56fb63-18c8-4021-8059-066a3658dad9\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Woonplaats partner<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"woonplaats_partner\" id=\"woonplaats_partner\" type=\"text\" data-field-name=\"woonplaats_partner\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_Pws9hu4O\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n<div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;Nee&quot;,&quot;field&quot;:&quot;heeft_client_een_partner&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n\n<p class=\"wp-block-paragraph\">U heeft aangegeven dat uw cli\u00ebnt geen partner heeft; u kunt door naar de volgende pagina.<\/p>\n\n<\/div>\n\n\n<div class=\"wp-block-group is-layout-grid wp-container-core-group-is-layout-28b052f3 wp-block-group-is-layout-grid\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-6d877b02-bff8-4a45-a0e3-05749b23df95 cb-o16e8zo0\" data-block-id=\"jet-sm-gb-6d877b02-bff8-4a45-a0e3-05749b23df95\" ><div  class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"prev\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button jet-form-builder__prev-page\" type=\"button\">Vorige pagina<\/button>\n\t<\/div>\n\t\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-af98a566-5712-4ea9-84f0-7729cec9920f cb-ees1hk9h\" data-block-id=\"jet-sm-gb-af98a566-5712-4ea9-84f0-7729cec9920f\" ><div  class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"next\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button jet-form-builder__next-page\" type=\"button\">Gegevens kinderen<\/button>\n\t<\/div>\n\t\n<\/div><\/div><\/div>\n\n\n<div class=\"jet-form-builder__next-page-wrap\">\n\t\t\t<\/div>\n<\/div>\n<div class=\"jet-form-builder-page jet-form-builder-page--hidden\" data-page=\"4\" data-page-offset=\"75\">\n\n\n<h3 class=\"wp-block-heading\">Inwonende kinderen<\/h3>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-04262373-c6b2-4d0e-ab7e-74bae10cdcaa\" data-block-id=\"jet-sm-gb-04262373-c6b2-4d0e-ab7e-74bae10cdcaa\" ><div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Heeft cli\u00ebnt inwonende kinderen? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" value=\"0\" class=\"jet-form-builder__field text-field\" required=\"required\" min=\"0\" max=\"12\" step=\"1\" name=\"client_aantal_inwonende_kinderen\" data-field-name=\"client_aantal_inwonende_kinderen\" id=\"client_aantal_inwonende_kinderen\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div><\/div>\n\n<div  class=\"jet-form-builder-row field-type-repeater-field cb-h9019jzz\" >\n<div class=\"jet-form-builder__field-wrap\"><div data-repeater=\"1\" data-field-name=\"inwonend_kind\" name=\"inwonend_kind\" data-manage-items=\"dynamically\" data-items-field=\"client_aantal_inwonende_kinderen\"  class=\"jet-form-builder-repeater jet-form-builder__field\" data-jfb-sync=\"null\">\n<template class=\"jet-form-builder-repeater__initial\"><div class=\"jet-form-builder-repeater__row\" data-repeater-row=\"1\"><div class=\"jet-form-builder-repeater__row-fields\">\n<div  class=\"jet-form-builder-row field-type-text-field cb-mqj65bdi\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Naam<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"inwonend_kind[__i__][naam]\" id=\"inwonend_kind___i___naam\" type=\"text\" data-field-name=\"naam\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_3FjQR6yC\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"advanced\" data-validation-messages=\"{&quot;date_max&quot;:&quot;De geboortedatum mag niet in de toekomst liggen.&quot;}\" class=\"jet-form-builder-row field-type-date-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Geboortedatum<\/div><\/div><input class=\"jet-form-builder__field date-field\" name=\"inwonend_kind[__i__][geboortedatum]\" type=\"date\" data-field-name=\"geboortedatum\" id=\"inwonend_kind___i___geboortedatum\" data-jfb-sync=\"null\" data-max=\"&#039;%CT::CurrentDate%&#039;\">\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-text-field cb-ch42fyd5\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Onderwijs\/beroep<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"inwonend_kind[__i__][onderwijs_beroep]\" id=\"inwonend_kind___i___onderwijs_beroep\" type=\"text\" data-field-name=\"onderwijs_beroep\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_CAhBUZaD\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"advanced\" data-validation-messages=\"{&quot;number_min&quot;:&quot;Voer een bedrag hoger dan 0 in of laat dit veld leeg.&quot;}\" class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Studiefinanciering<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" min=\"0\" name=\"inwonend_kind[__i__][studiefinanciering]\" data-field-name=\"studiefinanciering\" id=\"inwonend_kind___i___studiefinanciering\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div  data-validation-type=\"advanced\" data-validation-messages=\"{&quot;number_min&quot;:&quot;Voer een bedrag hoger dan 0 in of laat dit veld leeg.&quot;}\" class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Inkomen<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" min=\"0\" name=\"inwonend_kind[__i__][inkomen]\" data-field-name=\"inkomen\" id=\"inwonend_kind___i___inkomen\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n<\/div><\/div><\/template>\n<div class=\"jet-form-builder-repeater__items\"><\/div><\/div><\/div>\n<\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-2d9267b6-f7ff-4e17-a9d2-23050b025c43\" data-block-id=\"jet-sm-gb-2d9267b6-f7ff-4e17-a9d2-23050b025c43\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;0&quot;,&quot;field&quot;:&quot;client_aantal_inwonende_kinderen&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n\n<p class=\"wp-block-paragraph\">U heeft aangegeven dat uw cli\u00ebnt geen inwonende kinderen heeft; u kunt door naar de volgende pagina.<\/p>\n\n<\/div><\/div>\n\n\n<div class=\"wp-block-group is-layout-grid wp-container-core-group-is-layout-28b052f3 wp-block-group-is-layout-grid\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-014f8e8d-b10c-4a19-8d5f-1b54a4db7947 cb-sq0cdvpp\" data-block-id=\"jet-sm-gb-014f8e8d-b10c-4a19-8d5f-1b54a4db7947\" ><div  class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"prev\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button def_form_button jet-form-builder__prev-page\" type=\"button\">Vorige pagina<\/button>\n\t<\/div>\n\t\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-39a069b6-f9e0-40f3-9da2-038a705ffe57 cb-bv53y1e9\" data-block-id=\"jet-sm-gb-39a069b6-f9e0-40f3-9da2-038a705ffe57\" ><div  class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"next\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button def_form_button jet-form-builder__next-page\" type=\"button\">Inkomsten &amp; uitgaven<\/button>\n\t<\/div>\n\t\n<\/div><\/div><\/div>\n\n\n<div class=\"jet-form-builder__next-page-wrap\">\n\t\t\t<\/div>\n<\/div>\n<div class=\"jet-form-builder-page jet-form-builder-page--hidden\" data-page=\"5\" data-page-offset=\"75\">\n\n\n<h3 class=\"wp-block-heading\">Inkomsten en uitgaven<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">S.v.p. netto bedragen per maand invullen.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Inkomsten<\/h4>\n\n\n<div  data-validation-type=\"advanced\" class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Salaris cli\u00ebnt<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"salaris_client\" data-field-name=\"salaris_client\" id=\"salaris_client\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Salaris partner<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"salaris_partner\" data-field-name=\"salaris_partner\" id=\"salaris_partner\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Uitkering client<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"uitkering_client\" data-field-name=\"uitkering_client\" id=\"uitkering_client\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-9fd824a4-552c-4672-b54f-4e98fa3d341f\" data-block-id=\"jet-sm-gb-9fd824a4-552c-4672-b54f-4e98fa3d341f\" ><div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Uitkering partner<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"uitkering_partner\" data-field-name=\"uitkering_partner\" id=\"uitkering_partner\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div><\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Uitkering kinderen<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"uitkering_kinderen\" data-field-name=\"uitkering_kinderen\" id=\"uitkering_kinderen\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-5aa5ffe8-67d5-4826-90dd-762f8ef2cecb\" data-block-id=\"jet-sm-gb-5aa5ffe8-67d5-4826-90dd-762f8ef2cecb\" ><div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Kinderbijslag per maand<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"kinderbijslag\" data-field-name=\"kinderbijslag\" id=\"kinderbijslag\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div><\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">AOW<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"aow\" data-field-name=\"aow\" id=\"aow\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Pensioen<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"pensioen\" data-field-name=\"pensioen\" id=\"pensioen\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Alimentatie<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"alimentatie\" data-field-name=\"alimentatie\" id=\"alimentatie\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Ontvangen kostgeld voor kinderen<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"ontvangen_kostgeld_kinderen\" data-field-name=\"ontvangen_kostgeld_kinderen\" id=\"ontvangen_kostgeld_kinderen\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Studiefinanciering<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"studiefinanciering\" data-field-name=\"studiefinanciering\" id=\"studiefinanciering\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Andere inkomsten (bv. PGB)<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"andere_inkomsten\" data-field-name=\"andere_inkomsten\" id=\"andere_inkomsten\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-ad3f2e07-60de-46b3-acc7-1123e8883a24\" data-block-id=\"jet-sm-gb-ad3f2e07-60de-46b3-acc7-1123e8883a24\" >\n<div  class=\"jet-form-builder-row field-type-calculated-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Totaal inkomsten<\/div><\/div><div data-formula=\"%salaris_client% + %salaris_partner% + %uitkering_client% + %uitkering_partner% + %uitkering_kinderen% + %kinderbijslag% + %aow% + %pensioen%+ %alimentatie% + %ontvangen_kostgeld_kinderen% + %studiefinanciering% + %andere_inkomsten%\" data-name=\"totaal_inkomsten\" data-precision=\"2\" data-sep-decimal=\".\" data-value-type=\"number\" data-date-format=\"YYYY-MM-DD\" class=\"jet-form-builder__calculated-field\">\n\t\t\t<input type=\"hidden\"\n\t\t\tname=\"totaal_inkomsten\"\n\t\t\tid=\"totaal_inkomsten\"\n\t\t\tvalue=\"\"\n\t\t\tclass=\"jet-form-builder__calculated-field-input jet-form-builder__field\"\n\t\t\tdata-field-name=\"totaal_inkomsten\"\n\t\t\tdata-jfb-sync\n\t\/>\n\t<div class=\"jet-form-builder__calculated-field-val\">0.00<\/div>\n\t\t<\/div>\n<\/div>\n<\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-2df596df-c1f1-450f-9bef-a53a2737db1f cb-kn70edlq\" data-block-id=\"jet-sm-gb-2df596df-c1f1-450f-9bef-a53a2737db1f\" ><div  class=\"jet-form-builder-row field-type-group-break-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t<div class=\"jet-form-builder__group-break\"><\/div>\n<\/div>\n<\/div><\/div>\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h4 class=\"wp-block-heading\">Uitgaven<\/h4>\n\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-f49b1ac6-ac14-42e6-92f1-ada00a45a2ac\" data-block-id=\"jet-sm-gb-f49b1ac6-ac14-42e6-92f1-ada00a45a2ac\" ><div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Huur<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"huur\" data-field-name=\"huur\" id=\"huur\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div><\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Hypotheeklasten<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"hypotheeklasten\" data-field-name=\"hypotheeklasten\" id=\"hypotheeklasten\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Energie, water, gas<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"kosten_nuts\" data-field-name=\"kosten_nuts\" id=\"kosten_nuts\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Ziektekostenverzekering<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"ziektekostenverzekering\" data-field-name=\"ziektekostenverzekering\" id=\"ziektekostenverzekering\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Overige verzekeringen<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"overige_verzekeringen\" data-field-name=\"overige_verzekeringen\" id=\"overige_verzekeringen\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Huishoudgeld<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"huishoudgeld\" data-field-name=\"huishoudgeld\" id=\"huishoudgeld\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Kleding\/schoeisel<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"kleding_schoeisel\" data-field-name=\"kleding_schoeisel\" id=\"kleding_schoeisel\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-1bcae228-6519-4dcc-a4e8-47a819211607\" data-block-id=\"jet-sm-gb-1bcae228-6519-4dcc-a4e8-47a819211607\" ><div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Telefoon\/TV\/internet en vervoer<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"telefoon_vervoer\" data-field-name=\"telefoon_vervoer\" id=\"telefoon_vervoer\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-065174d8-5997-4139-bacd-19e4a9b342d7\" data-block-id=\"jet-sm-gb-065174d8-5997-4139-bacd-19e4a9b342d7\" ><div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Eigen bijdrage kinderopvang \/ thuiszorg<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"eigen_bijdrage_kinderopvang_thuiszorg\" data-field-name=\"eigen_bijdrage_kinderopvang_thuiszorg\" id=\"eigen_bijdrage_kinderopvang_thuiszorg\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div><\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Extra kosten ziekte \/ handicap<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"extra_kosten_ziekte_handicap\" data-field-name=\"extra_kosten_ziekte_handicap\" id=\"extra_kosten_ziekte_handicap\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Belastingen<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"belastingen\" data-field-name=\"belastingen\" id=\"belastingen\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Afbetalen schulden<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"afbetalen_schulden\" data-field-name=\"afbetalen_schulden\" id=\"afbetalen_schulden\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-15908391-ccb4-4eae-9397-16b6ad63472c\" data-block-id=\"jet-sm-gb-15908391-ccb4-4eae-9397-16b6ad63472c\" >\n<div  class=\"jet-form-builder-row field-type-calculated-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Totaal uitgaven<\/div><\/div><div data-formula=\"%huur% + %hypotheeklasten% + %kosten_nuts% + %ziektekostenverzekering% + %overige_verzekeringen% + %huishoudgeld% + %kleding_schoeisel% + %telefoon_vervoer% + %eigen_bijdrage_kinderopvang_thuiszorg% + %extra_kosten_ziekte_handicap% + %belastingen% + %afbetalen_schulden%\" data-name=\"totaal_uitgaven\" data-precision=\"2\" data-sep-decimal=\".\" data-value-type=\"number\" data-date-format=\"YYYY-MM-DD\" class=\"jet-form-builder__calculated-field\">\n\t\t\t<input type=\"hidden\"\n\t\t\tname=\"totaal_uitgaven\"\n\t\t\tid=\"totaal_uitgaven\"\n\t\t\tvalue=\"\"\n\t\t\tclass=\"jet-form-builder__calculated-field-input jet-form-builder__field\"\n\t\t\tdata-field-name=\"totaal_uitgaven\"\n\t\t\tdata-jfb-sync\n\t\/>\n\t<div class=\"jet-form-builder__calculated-field-val\">0.00<\/div>\n\t\t<\/div>\n<\/div>\n<\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-45560a71-b831-42e8-ba48-18041a20e222 cb-hprxz2ek\" data-block-id=\"jet-sm-gb-45560a71-b831-42e8-ba48-18041a20e222\" ><div  class=\"jet-form-builder-row field-type-group-break-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t<div class=\"jet-form-builder__group-break\"><\/div>\n<\/div>\n<\/div><\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Spaargeld \/ vermogen<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"spaargeld_vermogen\" data-field-name=\"spaargeld_vermogen\" id=\"spaargeld_vermogen\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Hoogte hypotheek<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"hoogte_hypotheek\" data-field-name=\"hoogte_hypotheek\" id=\"hoogte_hypotheek\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-dcb631aa-6255-4b61-aec8-90cc540843a5\" data-block-id=\"jet-sm-gb-dcb631aa-6255-4b61-aec8-90cc540843a5\" ><div  class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Hoogte schulden<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" name=\"hoogte_schulden\" data-field-name=\"hoogte_schulden\" id=\"hoogte_schulden\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-fabc7389-53e6-43c2-b908-36018ad2d1b5 cb-zpcv0e6v\" data-block-id=\"jet-sm-gb-fabc7389-53e6-43c2-b908-36018ad2d1b5\" ><div  class=\"jet-form-builder-row field-type-group-break-field\" >\n<div class=\"jet-form-builder__field-wrap\">\n\t<div class=\"jet-form-builder__group-break\"><\/div>\n<\/div>\n<\/div><\/div>\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity is-style-wide\"\/>\n\n\n\n<h4 class=\"wp-block-heading\">Overige vragen t.b.v. inkomsten en uitgaven<\/h4>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-1c9d32df-c37c-4669-be06-f9f5ad00aee4 cb-gbjiqvjw\" data-block-id=\"jet-sm-gb-1c9d32df-c37c-4669-be06-f9f5ad00aee4\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Is er sprake van schuldhulpverlening of WSNP? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"overig_schuldhulpverlening_of_wsnp\" value=\"Ja\" data-field-name=\"overig_schuldhulpverlening_of_wsnp\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>Ja<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"overig_schuldhulpverlening_of_wsnp\" value=\"Nee\" data-field-name=\"overig_schuldhulpverlening_of_wsnp\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>Nee<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-a39d543c-f6ae-4906-a9f6-a7a82f07ab2e\" data-block-id=\"jet-sm-gb-a39d543c-f6ae-4906-a9f6-a7a82f07ab2e\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;Ja&quot;,&quot;field&quot;:&quot;overig_schuldhulpverlening_of_wsnp&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-774e3222-5e67-4f0d-a821-c3d355a93171 cb-e7g9ptb2\" data-block-id=\"jet-sm-gb-774e3222-5e67-4f0d-a821-c3d355a93171\" ><div  class=\"jet-form-builder-row field-type-textarea-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Geef hier een toelichting<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<textarea class=\"jet-form-builder__field textarea-field\" name=\"toelichting_schuldhulpverlening_wnsp\" data-field-name=\"toelichting_schuldhulpverlening_wnsp\" id=\"toelichting_schuldhulpverlening_wnsp\" data-jfb-sync=\"null\"><\/textarea>\n\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-ec9d4fee-1415-4772-9025-7aa482a0fecc cb-zjmptdln\" data-block-id=\"jet-sm-gb-ec9d4fee-1415-4772-9025-7aa482a0fecc\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Is er bijzondere bijstand voor de gevraagde kosten aangevraagd? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"overig_bijzondere_bijstand\" value=\"Ja\" data-field-name=\"overig_bijzondere_bijstand\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>Ja<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"overig_bijzondere_bijstand\" value=\"Nee\" data-field-name=\"overig_bijzondere_bijstand\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>Nee<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-6b1f2b64-6b46-42a1-b428-78702a433d59\" data-block-id=\"jet-sm-gb-6b1f2b64-6b46-42a1-b428-78702a433d59\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;Ja&quot;,&quot;field&quot;:&quot;overig_bijzondere_bijstand&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-f208ad81-f4b5-45a3-97b9-4a9e9a4eac98 cb-ahsi20ye\" data-block-id=\"jet-sm-gb-f208ad81-f4b5-45a3-97b9-4a9e9a4eac98\" ><div  class=\"jet-form-builder-row field-type-textarea-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Geef hier een toelichting<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<textarea class=\"jet-form-builder__field textarea-field\" name=\"toelichting_bijzondere_bijstand\" data-field-name=\"toelichting_bijzondere_bijstand\" id=\"toelichting_bijzondere_bijstand\" data-jfb-sync=\"null\"><\/textarea>\n\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-bf83d78a-97fc-4544-b1a3-3707e95031bc cb-f9wi3yd9\" data-block-id=\"jet-sm-gb-bf83d78a-97fc-4544-b1a3-3707e95031bc\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Is er een huisbezoek gebracht? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"overig_huisbezoek\" value=\"Ja\" data-field-name=\"overig_huisbezoek\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>Ja<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"overig_huisbezoek\" value=\"Nee\" data-field-name=\"overig_huisbezoek\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>Nee<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-6b1f2b64-6b46-42a1-b428-78702a433d59\" data-block-id=\"jet-sm-gb-6b1f2b64-6b46-42a1-b428-78702a433d59\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;Ja&quot;,&quot;field&quot;:&quot;overig_huisbezoek&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-f208ad81-f4b5-45a3-97b9-4a9e9a4eac98 cb-keyanjn0\" data-block-id=\"jet-sm-gb-f208ad81-f4b5-45a3-97b9-4a9e9a4eac98\" ><div  class=\"jet-form-builder-row field-type-textarea-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Geef hier een toelichting<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<textarea class=\"jet-form-builder__field textarea-field\" name=\"toelichting_huisbezoek\" data-field-name=\"toelichting_huisbezoek\" id=\"toelichting_huisbezoek\" data-jfb-sync=\"null\"><\/textarea>\n\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-bf83d78a-97fc-4544-b1a3-3707e95031bc cb-naxpb2ti\" data-block-id=\"jet-sm-gb-bf83d78a-97fc-4544-b1a3-3707e95031bc\" ><div  class=\"jet-form-builder-row field-type-radio-field wp-block-jet-forms-radio-field\">\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Zijn er andere fondsen aangeschreven? <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"overig_fondsen\" value=\"Ja\" data-field-name=\"overig_fondsen\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>Ja<\/span><\/label><\/div><div class=\"jet-form-builder__field-wrap radio-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-radio\">\n<input type=\"radio\" name=\"overig_fondsen\" value=\"Nee\" data-field-name=\"overig_fondsen\"  class=\"jet-form-builder__field radio-field checkradio-field\" required=\"required\"><span>Nee<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-6b1f2b64-6b46-42a1-b428-78702a433d59\" data-block-id=\"jet-sm-gb-6b1f2b64-6b46-42a1-b428-78702a433d59\" ><div class=\"jet-form-builder__conditional \" data-jfb-conditional=\"[{&quot;operator&quot;:&quot;equal&quot;,&quot;value&quot;:&quot;Ja&quot;,&quot;field&quot;:&quot;overig_fondsen&quot;,&quot;use_preset&quot;:false}]\" data-jfb-func=\"show\">\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-f208ad81-f4b5-45a3-97b9-4a9e9a4eac98 cb-ws7s556t\" data-block-id=\"jet-sm-gb-f208ad81-f4b5-45a3-97b9-4a9e9a4eac98\" ><div  class=\"jet-form-builder-row field-type-textarea-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Welke fondsen zijn met welke hulpvraag aangeschreven?<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<textarea class=\"jet-form-builder__field textarea-field\" name=\"toelichting_overige_fondsen\" data-field-name=\"toelichting_overige_fondsen\" id=\"toelichting_overige_fondsen\" data-jfb-sync=\"null\"><\/textarea>\n\t<\/div>\n<\/div><\/div>\n<\/div><\/div>\n\n\n<div class=\"wp-block-group is-layout-grid wp-container-core-group-is-layout-28b052f3 wp-block-group-is-layout-grid\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-df87dea3-a154-42bf-90b7-026608c37ab0 cb-m3soeev0\" data-block-id=\"jet-sm-gb-df87dea3-a154-42bf-90b7-026608c37ab0\" ><div  class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"prev\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button def_form_button jet-form-builder__prev-page\" type=\"button\">Vorige pagina<\/button>\n\t<\/div>\n\t\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-81475ec9-4c77-4bdd-aa5b-c2a1205d4c3b cb-xo6rl7wt\" data-block-id=\"jet-sm-gb-81475ec9-4c77-4bdd-aa5b-c2a1205d4c3b\" ><div  class=\"jet-form-builder-row field-type-submit-field wp-container-content-a37929a5\" >\n\t<div data-type=\"next\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button def_form_button jet-form-builder__next-page\" type=\"button\">Rapportage<\/button>\n\t<\/div>\n\t\n<\/div><\/div><\/div>\n\n\n<div class=\"jet-form-builder__next-page-wrap\">\n\t\t\t<\/div>\n<\/div>\n<div class=\"jet-form-builder-page jet-form-builder-page--hidden\" data-page=\"6\" data-page-offset=\"75\">\n\n\n<h3 class=\"wp-block-heading\">Rapportage<\/h3>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-7eadfc86-9084-4f70-b1fc-f067af881a0a cb-xv7s71y8\" data-block-id=\"jet-sm-gb-7eadfc86-9084-4f70-b1fc-f067af881a0a\" ><div  class=\"jet-form-builder-row field-type-textarea-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Omschrijving van de probleemsituatie en hoe deze is ontstaan <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<textarea class=\"jet-form-builder__field textarea-field\" required=\"required\" name=\"omschrijven_van_de_probleemsituatie_en_hoe_deze_is_ontstaan\" data-field-name=\"omschrijven_van_de_probleemsituatie_en_hoe_deze_is_ontstaan\" id=\"omschrijven_van_de_probleemsituatie_en_hoe_deze_is_ontstaan\" data-jfb-sync=\"null\"><\/textarea>\n\t<\/div>\n<\/div><\/div>\n\n<div class=\" jet-sm-gb-wrapper jet-sm-gb-0f3e5e96-69e6-47b4-b271-e9fdbf0212d6\" data-block-id=\"jet-sm-gb-0f3e5e96-69e6-47b4-b271-e9fdbf0212d6\" ><div  data-validation-type=\"advanced\" data-validation-messages=\"{&quot;number_min&quot;:&quot;Voer een bedrag hoger dan 1 in.&quot;,&quot;empty&quot;:&quot;Voer hier een waarde in.&quot;}\" class=\"jet-form-builder-row field-type-number-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Gewenst bedrag <span class=\"jet-form-builder__required\">*<\/span><\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t<input type=\"number\" class=\"jet-form-builder__field text-field\" required=\"required\" min=\"1\" name=\"gewenst_bedrag\" data-field-name=\"gewenst_bedrag\" id=\"gewenst_bedrag\" data-jfb-sync=\"null\">\n\t<\/div>\n<\/div><\/div>\n\n<div  class=\"jet-form-builder-row field-type-text-field cb-senx9qq7\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Begunstigde<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"begunstigde\" id=\"begunstigde\" type=\"text\" data-field-name=\"begunstigde\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_wgPsSyEv\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div  class=\"jet-form-builder-row field-type-text-field cb-htiiotpz\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Referentie<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"referentie\" id=\"referentie\" type=\"text\" data-field-name=\"referentie\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_I4cQuNSC\">\n\t\t\t\t\t<\/div>\n<\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-8001fe6b-69d0-439e-a1cf-0e7ca83489c1 cb-g8y0jczo\" data-block-id=\"jet-sm-gb-8001fe6b-69d0-439e-a1cf-0e7ca83489c1\" ><div  class=\"jet-form-builder-row field-type-text-field\" >\n<div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Bankrekeningnummer<\/div><\/div><div class=\"jet-form-builder__field-wrap\">\n\t\t\t\t<input name=\"bankrekeningnummer\" id=\"bankrekeningnummer\" type=\"text\" data-field-name=\"bankrekeningnummer\" class=\"jet-form-builder__field text-field\" data-jfb-sync=\"null\" autocomplete=\"off_h76xTbH0\">\n\t\t\t\t\t<\/div>\n<\/div><\/div>\n\n<div  class=\"jet-form-builder-row field-type-advanced-media-field\" >\n<template class=\"jet-form-builder-advanced-media__preview-template\"><div class=\"jet-form-builder-advanced-media-file-upload__file\">\n    <!-- preview -->\n\n    <button type=\"button\"\n            class=\"jet-form-builder-advanced-media-file-upload__file-remove\"\n            aria-label=\"Remove file\"\n            data-file-name=\"%file_name%\">\n        <svg viewBox=\"0 0 24 24\" width=\"16\" height=\"16\" fill=\"none\" stroke=\"currentColor\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\" aria-hidden=\"true\">\n            <line x1=\"18\" y1=\"6\" x2=\"6\" y2=\"18\"><\/line>\n            <line x1=\"6\" y1=\"6\" x2=\"18\" y2=\"18\"><\/line>\n        <\/svg>\n    <\/button>\n\n\n    <!-- field -->\n<\/div><\/template><div class=\"jet-form-builder__label\">\r\n<div class=\"jet-form-builder__label-text\">Bijlagen<\/div><\/div><div class=\"jet-form-builder__field-wrap jet-form-builder-advanced-media\">\n\t\t<div class=\"jet-form-builder-advanced-media__content\">\n\t\t\t\t\t<div class=\"jet-form-builder-advanced-media__dropzone\" data-jfb-dropzone>\n\t\t\t\t<span class=\"jet-form-builder-advanced-media__placeholder\">Drag and drop media files to upload<\/span>\n\t\t\t\t<span>or<\/span>\n\t\t\t\t<button type=\"button\" class=\"jet-form-builder-advanced-media__browse\">Select files<\/button>\n\t\t\t\t<div class=\"jet-form-builder-advanced-media__message\">\n\t\t\t\t\t<small>Maximale bestandsgrootte: 2 MB<\/small>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<span class=\"jet-form-builder-advanced-media__limit\"><span class=\"jet-form-builder-advanced-media__current\">0<\/span>\/2<\/span>\n\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"jet-form-builder-advanced-media__files\" data-args=\"{&quot;max_files&quot;:2,&quot;max_size&quot;:2097152,&quot;max_image_width&quot;:&quot;&quot;,&quot;max_image_height&quot;:&quot;&quot;,&quot;image_quality&quot;:100}\"  style=\"display: none;\">\n\t\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t<div class=\"jet-form-builder-advanced-media__fields\">\n\t\t<input class=\"jet-form-builder__field advanced-media-field jet-form-builder-advanced-media__input\" name=\"aanvraag_bijlagen[]\" data-field-name=\"aanvraag_bijlagen\" type=\"file\" data-form_id=\"111\" id=\"aanvraag_bijlagen_1\" data-jfb-sync=\"null\" data-upload_mode=\"instant\" data-allowed_user_cap=\"any_user\" data-insert_attachment=\"0\" data-save_uploaded_file=\"1\" data-max_files=\"2\" multiple=\"1\" data-image_quality=\"100\" data-required_message=\"This field is required. Please upload or select at least one file.\" data-max_files_message=\"Maximaal %s bijlagen toegestaan\" data-max_size=\"2097152\">\n\t\t\t<\/div>\n\t<\/div><div class=\"jet-form-builder__desc\"><small>Voeg hier optioneel bijlagen toe<\/small><\/div>\n<\/div>\n\n\n<div class=\"wp-block-group is-layout-grid wp-container-core-group-is-layout-28b052f3 wp-block-group-is-layout-grid\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-0c587e25-d1ad-4a49-a8dc-8c19c1eb6b6a cb-dydigs0j\" data-block-id=\"jet-sm-gb-0c587e25-d1ad-4a49-a8dc-8c19c1eb6b6a\" ><div  class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"prev\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button def_form_button jet-form-builder__prev-page\" type=\"button\">Vorige pagina<\/button>\n\t<\/div>\n\t\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-ef08cda6-eb9d-49a9-96ae-22bf1229220c cb-vykwxvjc\" data-block-id=\"jet-sm-gb-ef08cda6-eb9d-49a9-96ae-22bf1229220c\" ><div  class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"next\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button def_form_button jet-form-builder__next-page\" type=\"button\">Indienen aanvraag<\/button>\n\t<\/div>\n\t\n<\/div><\/div><\/div>\n\n\n<div class=\"jet-form-builder__next-page-wrap\">\n\t\t\t<\/div>\n<\/div>\n<div class=\"jet-form-builder-page jet-form-builder-page--hidden\" data-page=\"7\" data-page-offset=\"75\">\n\n\n<div class=\"wp-block-columns is-layout-flex wp-container-core-columns-is-layout-8f761849 wp-block-columns-is-layout-flex\">\n<div class=\"wp-block-column is-layout-flow wp-block-column-is-layout-flow\" style=\"flex-basis:100%\"><\/div>\n<\/div>\n\n\n\n<h3 class=\"wp-block-heading\">Indienen aanvraag<\/h3>\n\n\n\n<p class=\"wp-block-paragraph\">Door het indienen van dit formulier verklaart de rapporteur in het kader van de Algemene Verordening Gegevensbescherming (AVG), dat zij de Stichting Urgente Noden Uithoorn, indien en voor zover relevant voor de behandeling van de aanvraag, aan derden gegevens te vragen en\/of verstrekken en de aanvraag in zijn geheel aan een of meerdere fondsen ter honorering voor te leggen en dat zij ervan op de hoogte zijn dat de verstrekte gegevens worden opgenomen in een persoonsregistratie.<\/p>\n\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-4084e06d-dd57-4080-baff-5fbab2bd164e cb-uk3i4d6w\" data-block-id=\"jet-sm-gb-4084e06d-dd57-4080-baff-5fbab2bd164e\" ><div  class=\"jet-form-builder-row field-type-checkbox-field\" >\n<div class=\"jet-form-builder__fields-group checkradio-wrap\" data-jfb-sync><div class=\"jet-form-builder__field-wrap checkboxes-wrap checkradio-wrap\"><label class=\"jet-form-builder__field-label for-checkbox\">\n\t\t\t<input type=\"checkbox\" name=\"check_id\" data-field-name=\"check_id\"  class=\"jet-form-builder__field checkboxes-field checkradio-field\" required=\"required\" data-default-val=\"[&quot;-&quot;]\"><span>Ik bevestig dat ik het ID-bewijs van cli\u00ebnt heb gecontroleerd.<\/span><\/label><\/div><\/div>\n<\/div><\/div>\n\n\n<div class=\"wp-block-group is-layout-grid wp-container-core-group-is-layout-28b052f3 wp-block-group-is-layout-grid\"><div class=\"jet-sm-gb-wrapper jet-sm-gb-9a85a981-3069-4f69-a8fb-2a4ac41b4ab5 cb-k72283rz\" data-block-id=\"jet-sm-gb-9a85a981-3069-4f69-a8fb-2a4ac41b4ab5\" ><div  class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"prev\" class=\"jet-form-builder__action-button-wrapper\">\n\t<button class=\"jet-form-builder__action-button def_form_button jet-form-builder__prev-page\" type=\"button\">Vorige pagina<\/button>\n\t<\/div>\n\t\n<\/div><\/div>\n\n<div class=\"jet-sm-gb-wrapper jet-sm-gb-1e16d602-c476-49ac-b28d-f93aee19ef5f cb-lgkyc7ec\" data-block-id=\"jet-sm-gb-1e16d602-c476-49ac-b28d-f93aee19ef5f\" ><input type=\"hidden\" class=\"captcha-token wp-container-content-a37929a5\" name=\"_captcha_token\" value=\"\"\/><div  class=\"jet-form-builder-row field-type-submit-field\" >\n\t<div data-type=\"submit\" class=\"jet-form-builder__action-button-wrapper jet-form-builder__submit-wrap\">\n\t<button class=\"jet-form-builder__action-button def_form_button jet-form-builder__submit submit-type-reload\" type=\"submit\">Aanvraagformulier indienen<\/button>\n\t<\/div>\n\t\n<\/div><\/div><\/div>\n\n\n<\/div>\t<div class=\"jet-form-builder-messages-wrap\" data-form-id=\"111\"><\/div>\n<\/form>\n<\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_jet_sm_ready_style":"","_jet_sm_style":"","_jet_sm_controls_values":"","_jet_sm_fonts_collection":"","_jet_sm_fonts_links":"","footnotes":"","_members_access_role":[],"_members_access_error":""},"class_list":["post-79","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/urgentenodenuithoorn.nl\/index.php\/wp-json\/wp\/v2\/pages\/79","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/urgentenodenuithoorn.nl\/index.php\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/urgentenodenuithoorn.nl\/index.php\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/urgentenodenuithoorn.nl\/index.php\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/urgentenodenuithoorn.nl\/index.php\/wp-json\/wp\/v2\/comments?post=79"}],"version-history":[{"count":2,"href":"https:\/\/urgentenodenuithoorn.nl\/index.php\/wp-json\/wp\/v2\/pages\/79\/revisions"}],"predecessor-version":[{"id":114,"href":"https:\/\/urgentenodenuithoorn.nl\/index.php\/wp-json\/wp\/v2\/pages\/79\/revisions\/114"}],"wp:attachment":[{"href":"https:\/\/urgentenodenuithoorn.nl\/index.php\/wp-json\/wp\/v2\/media?parent=79"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}