{"id":1667,"date":"2025-10-09T13:57:19","date_gmt":"2025-10-09T11:57:19","guid":{"rendered":"https:\/\/kvg-bus.de\/heidekreis\/?page_id=1667"},"modified":"2025-10-30T09:32:11","modified_gmt":"2025-10-30T08:32:11","slug":"liquidacion-de-siniestros","status":"publish","type":"page","link":"https:\/\/kvg-bus.de\/heidekreis\/es\/servicio\/liquidacion-de-siniestros\/","title":{"rendered":"Liquidaci\u00f3n de siniestros"},"content":{"rendered":"<div data-elementor-type=\"wp-page\" data-elementor-id=\"1667\" class=\"elementor elementor-1667\" data-elementor-post-type=\"page\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-b76a81b elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"b76a81b\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-6ab41e3\" data-id=\"6ab41e3\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-7fceb95 elementor-widget elementor-widget-heading\" data-id=\"7fceb95\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">LIQUIDACI\u00d3N DE SINIESTROS POR ACCIDENTES<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fdd2561 elementor-widget elementor-widget-text-editor\" data-id=\"fdd2561\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>\u00bfHa tenido un accidente con uno de nuestros veh\u00edculos? No hay problema, estaremos encantados de ayudarle.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-top-column elementor-element elementor-element-c9f32b1 elementor-hidden-mobile\" data-id=\"c9f32b1\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap\">\n\t\t\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t<div class=\"elementor-element elementor-element-8e6990e e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"8e6990e\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a0d0dab elementor-widget elementor-widget-text-editor\" data-id=\"a0d0dab\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Si ha sufrido un accidente con KVG, p\u00f3ngase en contacto con nosotros antes de dar ning\u00fan otro paso. Puede descargar el cuestionario para reclamantes\u00a0<a href=\"#OnlineformularSchadenabwicklung\">en l\u00ednea<\/a><a href=\"#PDFSchadenabwicklung\"> rellenar<\/a> o como <a href=\"#PDFSchadenabwicklung\">Descargar PDF.<\/a> Le rogamos que adjunte a su carta toda la informaci\u00f3n y documentos pertinentes relacionados con el accidente (por ejemplo, fotos, declaraciones de testigos, informe policial) para que podamos tramitar su solicitud lo antes posible.<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-658d50c elementor-widget elementor-widget-spacer\" data-id=\"658d50c\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-926c545 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"926c545\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d5d61c2 elementor-widget elementor-widget-menu-anchor\" data-id=\"d5d61c2\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-menu-anchor\" id=\"OnlineformularSchadenabwicklung\"><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3be477e elementor-widget elementor-widget-heading\" data-id=\"3be477e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Cuestionario para solicitantes <\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7da2b59 elementor-widget elementor-widget-elementor-extension-gravity-forms\" data-id=\"7da2b59\" data-element_type=\"widget\" data-widget_type=\"elementor-extension-gravity-forms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<script type=\"text\/javascript\">\n\/* <![CDATA[ *\/\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of 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gfield_required_asterisk\">*<\/span>\" se\u00f1ala los campos obligatorios<\/p>\n                        <\/div><form method='post' enctype='multipart\/form-data'  id='gform_22'  action='\/heidekreis\/es\/wp-json\/wp\/v2\/pages\/1667' data-formid='22' novalidate data-trp-original-action=\"\/heidekreis\/es\/wp-json\/wp\/v2\/pages\/1667\">\n                        <div class='gform-body gform_body'><div id='gform_fields_22' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_22_8\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Datos personales<\/h3><\/div><div id=\"field_22_3\" class=\"gfield gfield--type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_3'>Saludo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_3' id='input_22_3' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Herr' >Sr.<\/option><option value='Frau' >Sra.<\/option><option value='Keine Angabe' >No especificado<\/option><\/select><\/div><\/div><fieldset id=\"field_22_5\" class=\"gfield gfield--type-name gfield--width-three-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nombre<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_22_5'>\n                            \n                            <span id='input_22_5_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.3' id='input_22_5_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_5_3' class='gform-field-label gform-field-label--type-sub'>Nombre<\/label>\n                                                <\/span>\n                            \n                            <span id='input_22_5_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_5.6' id='input_22_5_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_5_6' class='gform-field-label gform-field-label--type-sub'>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><div id=\"field_22_12\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_12'>Tel\u00e9fono<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_12' id='input_22_12' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_13\" class=\"gfield gfield--type-email gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_13'>correo electr\u00f3nico<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_13' id='input_22_13' type='email' value='' class='large'    aria-required=\"true\" aria-invalid=\"false\"  \/>\n                        <\/div><\/div><fieldset id=\"field_22_6\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >direcci\u00f3n<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_22_6' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_22_6_1_container' >\n                                        <input type='text' name='input_6.1' id='input_22_6_1' value=''    aria-required='true'    \/>\n                                        <label for='input_22_6_1' id='input_22_6_1_label' class='gform-field-label gform-field-label--type-sub'>Direcci\u00f3n<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_22_6_3_container' >\n                                    <input type='text' name='input_6.3' id='input_22_6_3' value=''    aria-required='true'    \/>\n                                    <label for='input_22_6_3' id='input_22_6_3_label' class='gform-field-label gform-field-label--type-sub'>Ciudad<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_6.4' id='input_22_6_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_22_6_5_container' >\n                                    <input type='text' name='input_6.5' id='input_22_6_5' value=''    aria-required='true'    \/>\n                                    <label for='input_22_6_5' id='input_22_6_5_label' class='gform-field-label gform-field-label--type-sub'>ZIP \/ C\u00f3digo Postal<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_22_6_6_container' >\n                                        <select name='input_6.6' id='input_22_6_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanist\u00e1n' >Afghanist\u00e1n<\/option><option value='Albania' >Albania<\/option><option value='Alemania' >Alemania<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguila<\/option><option value='Antigua y Barbuda' >Antigua y Barbuda<\/option><option value='Ant\u00e1rtida' >Ant\u00e1rtida<\/option><option value='Arabia Saudita' >Arabia Saudita<\/option><option value='Argelia' >Argelia<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaiy\u00e1n' >Azerbaiy\u00e1n<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Bar\u00e9in' >Bar\u00e9in<\/option><option value='Belice' >Belice<\/option><option value='Benin' >Ben\u00edn<\/option><option value='Bermuda' >Bermudas<\/option><option value='Bhut\u00e1n' >But\u00e1n<\/option><option value='Bielorusia' >Bielorrusia<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, San Eustaquio y Saba' >Bonaire, San Eustaquio y Saba<\/option><option value='Bosnia y Herzegovina' >Bosnia y Herzegovina<\/option><option value='Botswana' >Botsuana<\/option><option value='Brasil' >Brasil<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='B\u00e9lgica' >B\u00e9lgica<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Camboya' >Camboya<\/option><option value='Camer\u00fan' >Camer\u00fan<\/option><option value='Canada' >Canad\u00e1<\/option><option value='Chad' >Chad<\/option><option value='Chequia' >Chequia<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Chipre' >Chipre<\/option><option value='Colombia' >Colombia<\/option><option value='Comoras' >Comoras<\/option><option value='Congo' >Congo<\/option><option value='Congo, Rep\u00fablica Democr\u00e1tica del' >Congo, Rep\u00fablica Democr\u00e1tica del<\/option><option value='Corea, Rep\u00fablica Popular Democr\u00e1tica de' >Corea, Rep\u00fablica Popular Democr\u00e1tica de<\/option><option value='Corea, Rep\u00fablica de' >Corea, Rep\u00fablica de<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Costa de Marfil' >Costa de Marfil<\/option><option value='Croacia' >Croacia<\/option><option value='Cuba' >Cuba<\/option><option value='Curazao' >Curazao<\/option><option value='Dinamarca' >Dinamarca<\/option><option value='Djibouti' >Yibuti<\/option><option value='Dominica' >Dominica<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egipto' >Egipto<\/option><option value='El Salvador' >El Salvador<\/option><option value='Emiratos \u00c1rabes Unidos' >Emiratos \u00c1rabes Unidos<\/option><option value='Eritrea' >Eritrea<\/option><option value='Eslovaquia' >Eslovaquia<\/option><option value='Eslovenia' >Eslovenia<\/option><option value='Espa\u00f1a' >Espa\u00f1a<\/option><option value='Estados Unidos' >Estados Unidos<\/option><option value='Estonia' >Estonia<\/option><option value='Esuatini' >Esuatini<\/option><option value='Etiop\u00eda' >Etiop\u00eda<\/option><option value='Federaci\u00f3n Rusa' >Federaci\u00f3n Rusa<\/option><option value='Fiji' >Fiyi<\/option><option value='Filipinas' >Filipinas<\/option><option value='Finlandia' >Finlandia<\/option><option value='Francia' >Francia<\/option><option value='Gab\u00f3n' >Gab\u00f3n<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Granada' >Granada<\/option><option value='Grecia' >Grecia<\/option><option value='Groenlandia' >Groenlandia<\/option><option value='Guadalupe' >Guadalupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guayana' >Guayana Francesa<\/option><option value='Guayana Francesa' >Guayana Francesa<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea Bissau' >Guinea Bissau<\/option><option value='Guinea Ecuatorial' >Guinea Ecuatorial<\/option><option value='Hait\u00ed' >Hait\u00ed<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungr\u00eda' >Hungr\u00eda<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iraq' >Iraq<\/option><option value='Irlanda' >Irlanda<\/option><option value='Ir\u00e1n' >Ir\u00e1n<\/option><option value='Isla Bouvet' >Isla Bouvet<\/option><option value='Isla Norfolk' >Isla Norfolk<\/option><option value='Isla de Man' >Isla de Man<\/option><option value='Isla de Navidad' >Isla de Navidad<\/option><option value='Islandia' >Islandia<\/option><option value='Islas Caim\u00e1n' >Islas Caim\u00e1n<\/option><option value='Islas Cocos' >Islas Cocos<\/option><option value='Islas Cook' >Islas Cook<\/option><option value='Islas Faroe' >Islas Feroe<\/option><option value='Islas Heard y McDonald' >Islas Heard y McDonald<\/option><option value='Islas Malvinas' >Islas Malvinas<\/option><option value='Islas Marianas del Norte' >Islas Marianas del Norte<\/option><option value='Islas Marshall' >Islas Marshall<\/option><option value='Islas Salom\u00f3n' >Islas Salom\u00f3n<\/option><option value='Islas Turcas y Caicos' >Islas Turcas y Caicos<\/option><option value='Islas Ultramarinas Menores de Estados Unidos' >Islas Ultramarinas Menores de Estados Unidos<\/option><option value='Islas V\u00edrgenes Brit\u00e1nicas' >Islas V\u00edrgenes Brit\u00e1nicas<\/option><option value='Islas V\u00edrgenes de los Estados Unidos' >Islas V\u00edrgenes de los Estados Unidos<\/option><option value='Islas \u00c5land' >Islas \u00c5land<\/option><option value='Israel' >Israel<\/option><option value='Italia' >Italia<\/option><option value='Jamaica' >Jamaica<\/option><option value='Jap\u00f3n' >Jap\u00f3n<\/option><option value='Jersey' >Jersey<\/option><option value='Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy' >Ji\u017en\u00ed Georgie y Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='Jord\u00e1n' >Jord\u00e1n<\/option><option value='Kazajist\u00e1n' >Kazajist\u00e1n<\/option><option value='Kenia' >Kenia<\/option><option value='Kirguist\u00e1n' >Kirguist\u00e1n<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kuwait' >Kuwait<\/option><option value='LIbia' >LIbia<\/option><option value='Lesoto' >Lesoto<\/option><option value='Liberia' >Liberia<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituania' >Lituania<\/option><option value='Lituania' >Lituania<\/option><option value='Luxemburgo' >Luxemburgo<\/option><option value='L\u00edbano' >L\u00edbano<\/option><option value='Macau' >Macao<\/option><option value='Macedonia del Norte' >Macedonia del Norte<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malasia' >Malasia<\/option><option value='Malawi' >Malawi<\/option><option value='Maldivas' >Maldivas<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marruecos' >Marruecos<\/option><option value='Martinica' >Martinica<\/option><option value='Mauricio' >Mauricio<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mayotte' >Mayotte<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldavia' >Moldavia<\/option><option value='Monaco' >M\u00f3naco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='M\u00e9xico' >M\u00e9xico<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Noruega' >Noruega<\/option><option value='Nueva Caledonia' >Nueva Caledonia<\/option><option value='Nueva Zelanda' >Nueva Zelanda<\/option><option value='N\u00edger' >N\u00edger<\/option><option value='Om\u00e1n' >Om\u00e1n<\/option><option value='Paises Bajos' >Pa\u00edses Bajos<\/option><option value='Pakist\u00e1n' >Pakist\u00e1n<\/option><option value='Palau' >Palau<\/option><option value='Palestina, Estado de' >Palestina, Estado de<\/option><option value='Panam\u00e1' >Panam\u00e1<\/option><option value='Pap\u00faa Nueva Guinea' >Pap\u00faa Nueva Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Per\u00fa' >Per\u00fa<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Polinesia Francesa' >Polinesia Francesa<\/option><option value='Polonia' >Polonia<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Reino Unido' >Reino Unido<\/option><option value='Rep\u00fablica Centroafricana' >Rep\u00fablica Centroafricana<\/option><option value='Rep\u00fablica Democr\u00e1tica Popular de Laos' >Rep\u00fablica Democr\u00e1tica Popular de Laos<\/option><option value='Rep\u00fablica Dominicana' >Rep\u00fablica Dominicana<\/option><option value='Rep\u00fablica \u00c1rabe de Siria' >Rep\u00fablica \u00c1rabe de Siria<\/option><option value='Reuni\u00f3n' >Reuni\u00f3n<\/option><option value='Ruanda' >Ruanda<\/option><option value='Ruman\u00eda' >Ruman\u00eda<\/option><option value='Sahara Occidental' >Sahara Occidental<\/option><option value='Samoa' >Samoa<\/option><option value='Samoa Americana' >Samoa Americana<\/option><option value='San Bartolom\u00e9' >San Bartolom\u00e9<\/option><option value='San Crist\u00f3bal y Nieves' >San Crist\u00f3bal y Nieves<\/option><option value='San Marino' >San Marino<\/option><option value='San Mart\u00edn' >San Mart\u00edn<\/option><option value='San Pedro y Miquel\u00f3n' >San Pedro y Miquel\u00f3n<\/option><option value='San Vicente y las Granadinas' >San Vicente y las Granadinas<\/option><option value='Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a' >Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option value='Santa Luc\u00eda' >Santa Luc\u00eda<\/option><option value='Santa Sede' >Santa Sede<\/option><option value='Santo Tom\u00e9 y Principe' >Santo Tom\u00e9 y Pr\u00edncipe<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leona' >Sierra Leona<\/option><option value='Singapur' >Singapur<\/option><option value='Sint Maarten' >San Mart\u00edn<\/option><option value='Somalia' >Somalia<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sud\u00e1frica' >Sud\u00e1frica<\/option><option value='Sud\u00e1n' >Sud\u00e1n<\/option><option value='Sud\u00e1n del Sur' >Sud\u00e1n del Sur<\/option><option value='Suecia' >Suecia<\/option><option value='Suiza' >Suiza<\/option><option value='Surinam' >Surinam<\/option><option value='Svalbard y Jan Mayen' >Svalbard y Jan Mayen<\/option><option value='Tailandia' >Tailandia<\/option><option value='Taiwan' >Taiw\u00e1n<\/option><option value='Tanzania (Rep\u00fablica Unida de)' >Tanzania (Rep\u00fablica Unida de)<\/option><option value='Tayikist\u00e1n' >Tayikist\u00e1n<\/option><option value='Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico' >Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option value='Tierras Australes y Ant\u00e1rticas Francesas' >Tierras Australes y Ant\u00e1rticas Francesas<\/option><option value='Timor Oriental' >Timor Oriental<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad y Tobago' >Trinidad y Tobago<\/option><option value='Turkmenist\u00e1n' >Turkmenist\u00e1n<\/option><option value='Turqu\u00eda' >Turqu\u00eda<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fanez' >T\u00fanez<\/option><option value='Ucrania' >Ucrania<\/option><option value='Uganda' >Uganda<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekist\u00e1n' >Uzbekist\u00e1n<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Wallis y Futuna' >Wallis y Futuna<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbaue' >Cimbaue<\/option><\/select>\n                                        <label for='input_22_6_6' id='input_22_6_6_label' class='gform-field-label gform-field-label--type-sub'>Pa\u00eds<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_22_7\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Detalles del accidente<\/h3><\/div><div id=\"field_22_14\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_14'>Lugar<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_22_14' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_22_11\" class=\"gfield gfield--type-date gfield--input-type-datedropdown gfield--width-seven-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >fecha<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div id='input_22_11' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_22_11_2_container'><label for='input_22_11_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>D\u00eda<\/label><select name='input_11[]' id='input_22_11_2'   aria-required='true'  ><option value=''>D\u00eda<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_22_11_1_container'><label for='input_22_11_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>mes<\/label><select name='input_11[]' id='input_22_11_1'   aria-required='true'  ><option value=''>mes<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_22_11_3_container'><label for='input_22_11_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>A\u00f1o<\/label><select name='input_11[]' id='input_22_11_3'   aria-required='true'  ><option value=''>A\u00f1o<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><fieldset id=\"field_22_10\" class=\"gfield gfield--type-time gfield--width-five-twelfths gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Tiempo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class=\"ginput_container ginput_complex gform-grid-row\">\n                        <div class='gfield_time_hour ginput_container ginput_container_time gform-grid-col' id='input_22_10'>\n                            <input type='number' name='input_10[]' id='input_22_10_1' value=''  min='0' max='24' step='1'  placeholder='HH' aria-required='true'   \/> \n                            <label class='gform-field-label gform-field-label--type-sub hour_label screen-reader-text' for='input_22_10_1'>Horas<\/label>\n                        <\/div>\n                        <div class=\"below hour_minute_colon gform-grid-col\">:<\/div>\n                        <div class='gfield_time_minute ginput_container ginput_container_time gform-grid-col'>\n                            <input type='number' name='input_10[]' id='input_22_10_2' value=''  min='0' max='59' step='1'  placeholder='MM' aria-required='true'  \/>\n                            <label class='gform-field-label gform-field-label--type-sub minute_label screen-reader-text' for='input_22_10_2'>Minutos<\/label>\n                        <\/div>\n                        \n                    <\/div><\/fieldset><div id=\"field_22_67\" class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_67'>Carretera\/cruce<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_67' id='input_22_67' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_68\" class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_68'>L\u00ednea\/n\u00famero de viaje<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_68' id='input_22_68' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_71\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_71'>Parada de autob\u00fas<\/label><div class='ginput_container ginput_container_text'><input name='input_71' id='input_22_71' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_69\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_69'>Matr\u00edcula de autob\u00fas<\/label><div class='ginput_container ginput_container_text'><input name='input_69' id='input_22_69' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_70\" class=\"gfield gfield--type-text gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_70'>Nombre del conductor<\/label><div class='ginput_container ginput_container_text'><input name='input_70' id='input_22_70' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_48\" class=\"gfield gfield--type-textarea gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_48'>Descripci\u00f3n del accidente<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_48' id='input_22_48' class='textarea large'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_22_76\" class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_22_76'>Archivo<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_22_76' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_22_76&quot;,&quot;container&quot;:&quot;gform_multifile_upload_22_76&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_22_76&quot;,&quot;filelist&quot;:&quot;gform_preview_22_76&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/kvg-bus.de\\\/heidekreis\\\/?gf_page=e39fd3a7eb4da38&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/kvg-bus.de\\\/heidekreis\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/kvg-bus.de\\\/heidekreis\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Archivos permitidos&quot;,&quot;extensions&quot;:&quot;*&quot;}],&quot;max_file_size&quot;:&quot;33554432b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:22,&quot;field_id&quot;:76,&quot;_gform_file_upload_nonce_22_76&quot;:&quot;7afcd5afed&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:0,&quot;message_id&quot;:&quot;gform_multifile_messages_22_76&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_22_76' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Suelta archivos aqu\u00ed o <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_22_76' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_22_76\"  >Seleccionar archivos<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_22_76'>Tama\u00f1o m\u00e1ximo de archivo: 32 MB.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_22_76'><\/ul> <div id='gform_preview_22_76' class='ginput_preview_list'><\/div><\/div><\/div><div id=\"field_22_23\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Testigos<\/h3><\/div><fieldset id=\"field_22_81\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfHay testigos?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_81'>\n\t\t\t<div class='gchoice gchoice_22_81_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Ja'  id='choice_22_81_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_81_0' id='label_22_81_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_81_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_81' type='radio' value='Nein'  id='choice_22_81_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_81_1' id='label_22_81_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_22_20\" class=\"gfield gfield--type-name gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nombre<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_22_20'>\n                            \n                            <span id='input_22_20_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_20.3' id='input_22_20_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_20_3' class='gform-field-label gform-field-label--type-sub'>Nombre<\/label>\n                                                <\/span>\n                            \n                            <span id='input_22_20_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_20.6' id='input_22_20_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_20_6' class='gform-field-label gform-field-label--type-sub'>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_22_17\" class=\"gfield gfield--type-address gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >direcci\u00f3n<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_22_17' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_22_17_1_container' >\n                                        <input type='text' name='input_17.1' id='input_22_17_1' value=''    aria-required='true'    \/>\n                                        <label for='input_22_17_1' id='input_22_17_1_label' class='gform-field-label gform-field-label--type-sub'>Direcci\u00f3n<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_22_17_3_container' >\n                                    <input type='text' name='input_17.3' id='input_22_17_3' value=''    aria-required='true'    \/>\n                                    <label for='input_22_17_3' id='input_22_17_3_label' class='gform-field-label gform-field-label--type-sub'>Ciudad<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_17.4' id='input_22_17_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_22_17_5_container' >\n                                    <input type='text' name='input_17.5' id='input_22_17_5' value=''    aria-required='true'    \/>\n                                    <label for='input_22_17_5' id='input_22_17_5_label' class='gform-field-label gform-field-label--type-sub'>ZIP \/ C\u00f3digo Postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_17.6' id='input_22_17_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_22_21\" class=\"gfield gfield--type-phone gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_21'>Tel\u00e9fono<\/label><div class='ginput_container ginput_container_phone'><input name='input_21' id='input_22_21' type='tel' value='' class='large'    aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_22_80\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfHay m\u00e1s testigos?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_80'>\n\t\t\t<div class='gchoice gchoice_22_80_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Ja'  id='choice_22_80_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_80_0' id='label_22_80_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_80_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_80' type='radio' value='Nein'  id='choice_22_80_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_80_1' id='label_22_80_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_22_24\" class=\"gfield gfield--type-name gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nombre<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_22_24'>\n                            \n                            <span id='input_22_24_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_24.3' id='input_22_24_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_24_3' class='gform-field-label gform-field-label--type-sub'>Nombre<\/label>\n                                                <\/span>\n                            \n                            <span id='input_22_24_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_24.6' id='input_22_24_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_24_6' class='gform-field-label gform-field-label--type-sub'>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_22_25\" class=\"gfield gfield--type-address gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >direcci\u00f3n<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_22_25' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_22_25_1_container' >\n                                        <input type='text' name='input_25.1' id='input_22_25_1' value=''    aria-required='true'    \/>\n                                        <label for='input_22_25_1' id='input_22_25_1_label' class='gform-field-label gform-field-label--type-sub'>Direcci\u00f3n<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_22_25_3_container' >\n                                    <input type='text' name='input_25.3' id='input_22_25_3' value=''    aria-required='true'    \/>\n                                    <label for='input_22_25_3' id='input_22_25_3_label' class='gform-field-label gform-field-label--type-sub'>Ciudad<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_25.4' id='input_22_25_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_22_25_5_container' >\n                                    <input type='text' name='input_25.5' id='input_22_25_5' value=''    aria-required='true'    \/>\n                                    <label for='input_22_25_5' id='input_22_25_5_label' class='gform-field-label gform-field-label--type-sub'>ZIP \/ C\u00f3digo Postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_25.6' id='input_22_25_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_22_26\" class=\"gfield gfield--type-phone gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_26'>Tel\u00e9fono<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_26' id='input_22_26' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_27\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Grabaci\u00f3n policial<\/h3><\/div><div id=\"field_22_28\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_28'>Oficina<\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_22_28' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_82\" class=\"gfield gfield--type-text gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_82'>N\u00famero de transacci\u00f3n<\/label><div class='ginput_container ginput_container_text'><input name='input_82' id='input_22_82' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_22_30\" class=\"gfield gfield--type-address gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >direcci\u00f3n<\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip ginput_container_address gform-grid-row' id='input_22_30' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_22_30_1_container' >\n                                        <input type='text' name='input_30.1' id='input_22_30_1' value=''    aria-required='false'    \/>\n                                        <label for='input_22_30_1' id='input_22_30_1_label' class='gform-field-label gform-field-label--type-sub'>Direcci\u00f3n<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_22_30_3_container' >\n                                    <input type='text' name='input_30.3' id='input_22_30_3' value=''    aria-required='false'    \/>\n                                    <label for='input_22_30_3' id='input_22_30_3_label' class='gform-field-label gform-field-label--type-sub'>Ciudad<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_30.4' id='input_22_30_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_22_30_5_container' >\n                                    <input type='text' name='input_30.5' id='input_22_30_5' value=''    aria-required='false'    \/>\n                                    <label for='input_22_30_5' id='input_22_30_5_label' class='gform-field-label gform-field-label--type-sub'>ZIP \/ C\u00f3digo Postal<\/label>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_30.6' id='input_22_30_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_22_77\" class=\"gfield gfield--type-fileupload gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_77'>Archivo<\/label><div class='ginput_container ginput_container_fileupload'><input type='hidden' name='MAX_FILE_SIZE' value='33554432' \/><input name='input_77' id='input_22_77' type='file' class='large' aria-describedby=\"gfield_upload_rules_22_77\" onchange='javascript:gformValidateFileSize( this, 33554432 );'  \/><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_22_77'>Tama\u00f1o m\u00e1ximo de archivo: 32 MB.<\/span><div class='gfield_description validation_message gfield_validation_message validation_message--hidden-on-empty' id='live_validation_message_22_77'><\/div> <\/div><\/div><div id=\"field_22_31\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Da\u00f1os materiales<\/h3><\/div><fieldset id=\"field_22_72\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfHay da\u00f1os materiales?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_72'>\n\t\t\t<div class='gchoice gchoice_22_72_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Ja'  id='choice_22_72_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_72_0' id='label_22_72_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_72_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_72' type='radio' value='Nein'  id='choice_22_72_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_72_1' id='label_22_72_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_22_32\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_32'>\u00bfQu\u00e9 se ha da\u00f1ado?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_32' id='input_22_32' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_22_33\" class=\"gfield gfield--type-name gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Propietario (posiblemente arrendador)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_22_33'>\n                            \n                            <span id='input_22_33_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_33.3' id='input_22_33_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_33_3' class='gform-field-label gform-field-label--type-sub'>Nombre<\/label>\n                                                <\/span>\n                            \n                            <span id='input_22_33_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_33.6' id='input_22_33_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_33_6' class='gform-field-label gform-field-label--type-sub'>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_22_34\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfTiene derecho a deducir el IVA soportado?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_34'>\n\t\t\t<div class='gchoice gchoice_22_34_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Ja'  id='choice_22_34_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_34_0' id='label_22_34_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_34_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_34' type='radio' value='Nein'  id='choice_22_34_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_34_1' id='label_22_34_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_22_35\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Da\u00f1os a veh\u00edculos de motor (coches, camiones, etc.) (si se dispone de ellos)<\/h3><\/div><fieldset id=\"field_22_73\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfHay da\u00f1os en un veh\u00edculo a motor?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_73'>\n\t\t\t<div class='gchoice gchoice_22_73_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Ja'  id='choice_22_73_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_73_0' id='label_22_73_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_73_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Nein'  id='choice_22_73_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_73_1' id='label_22_73_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_22_36\" class=\"gfield gfield--type-select gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_36'>Amable<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_36' id='input_22_36' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='PKW (Auto)' >Coche<\/option><option value='Nutzfahrzeuge (LKW)' >Veh\u00edculos comerciales (camiones)<\/option><option value='Zweirad (Roller, Motorrad)' >Veh\u00edculo de dos ruedas (scooter, moto)<\/option><option value='Land-\/ Baumaschinen' >Maquinaria agr\u00edcola y de construcci\u00f3n<\/option><option value='Wohnmobil\/Wohnwagen' >Autocaravana\/caravana<\/option><\/select><\/div><\/div><div id=\"field_22_37\" class=\"gfield gfield--type-text gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_37'>Fabricante<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_37' id='input_22_37' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_38\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_38'>Tipo<\/label><div class='ginput_container ginput_container_text'><input name='input_38' id='input_22_38' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_39\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_39'>N\u00famero de matr\u00edcula oficial<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_39' id='input_22_39' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_40\" class=\"gfield gfield--type-text gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_40'>seguro<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_40' id='input_22_40' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_41\" class=\"gfield gfield--type-section gsection field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Da\u00f1os corporales<\/h3><\/div><fieldset id=\"field_22_74\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfHay da\u00f1os personales?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_74'>\n\t\t\t<div class='gchoice gchoice_22_74_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Ja'  id='choice_22_74_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_74_0' id='label_22_74_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_74_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_74' type='radio' value='Nein'  id='choice_22_74_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_74_1' id='label_22_74_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_22_42\" class=\"gfield gfield--type-select gfield--width-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_42'>Saludo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_42' id='input_22_42' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Herr' >Sr.<\/option><option value='Frau' >Sra.<\/option><option value='Keine Angabe' >No especificado<\/option><\/select><\/div><\/div><fieldset id=\"field_22_43\" class=\"gfield gfield--type-name gfield--width-three-quarter gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nombre<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_22_43'>\n                            \n                            <span id='input_22_43_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_43.3' id='input_22_43_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_43_3' class='gform-field-label gform-field-label--type-sub'>Nombre<\/label>\n                                                <\/span>\n                            \n                            <span id='input_22_43_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_43.6' id='input_22_43_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_43_6' class='gform-field-label gform-field-label--type-sub'>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_22_44\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >direcci\u00f3n<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_22_44' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_22_44_1_container' >\n                                        <input type='text' name='input_44.1' id='input_22_44_1' value=''    aria-required='true'    \/>\n                                        <label for='input_22_44_1' id='input_22_44_1_label' class='gform-field-label gform-field-label--type-sub'>Direcci\u00f3n<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_22_44_3_container' >\n                                    <input type='text' name='input_44.3' id='input_22_44_3' value=''    aria-required='true'    \/>\n                                    <label for='input_22_44_3' id='input_22_44_3_label' class='gform-field-label gform-field-label--type-sub'>Ciudad<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_44.4' id='input_22_44_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_22_44_5_container' >\n                                    <input type='text' name='input_44.5' id='input_22_44_5' value=''    aria-required='true'    \/>\n                                    <label for='input_22_44_5' id='input_22_44_5_label' class='gform-field-label gform-field-label--type-sub'>ZIP \/ C\u00f3digo Postal<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_22_44_6_container' >\n                                        <select name='input_44.6' id='input_22_44_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanist\u00e1n' >Afghanist\u00e1n<\/option><option value='Albania' >Albania<\/option><option value='Alemania' >Alemania<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguila<\/option><option value='Antigua y Barbuda' >Antigua y Barbuda<\/option><option value='Ant\u00e1rtida' >Ant\u00e1rtida<\/option><option value='Arabia Saudita' >Arabia Saudita<\/option><option value='Argelia' >Argelia<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaiy\u00e1n' >Azerbaiy\u00e1n<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Bar\u00e9in' >Bar\u00e9in<\/option><option value='Belice' >Belice<\/option><option value='Benin' >Ben\u00edn<\/option><option value='Bermuda' >Bermudas<\/option><option value='Bhut\u00e1n' >But\u00e1n<\/option><option value='Bielorusia' >Bielorrusia<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, San Eustaquio y Saba' >Bonaire, San Eustaquio y Saba<\/option><option value='Bosnia y Herzegovina' >Bosnia y Herzegovina<\/option><option value='Botswana' >Botsuana<\/option><option value='Brasil' >Brasil<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='B\u00e9lgica' >B\u00e9lgica<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Camboya' >Camboya<\/option><option value='Camer\u00fan' >Camer\u00fan<\/option><option value='Canada' >Canad\u00e1<\/option><option value='Chad' >Chad<\/option><option value='Chequia' >Chequia<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Chipre' >Chipre<\/option><option value='Colombia' >Colombia<\/option><option value='Comoras' >Comoras<\/option><option value='Congo' >Congo<\/option><option value='Congo, Rep\u00fablica Democr\u00e1tica del' >Congo, Rep\u00fablica Democr\u00e1tica del<\/option><option value='Corea, Rep\u00fablica Popular Democr\u00e1tica de' >Corea, Rep\u00fablica Popular Democr\u00e1tica de<\/option><option value='Corea, Rep\u00fablica de' >Corea, Rep\u00fablica de<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Costa de Marfil' >Costa de Marfil<\/option><option value='Croacia' >Croacia<\/option><option value='Cuba' >Cuba<\/option><option value='Curazao' >Curazao<\/option><option value='Dinamarca' >Dinamarca<\/option><option value='Djibouti' >Yibuti<\/option><option value='Dominica' >Dominica<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egipto' >Egipto<\/option><option value='El Salvador' >El Salvador<\/option><option value='Emiratos \u00c1rabes Unidos' >Emiratos \u00c1rabes Unidos<\/option><option value='Eritrea' >Eritrea<\/option><option value='Eslovaquia' >Eslovaquia<\/option><option value='Eslovenia' >Eslovenia<\/option><option value='Espa\u00f1a' >Espa\u00f1a<\/option><option value='Estados Unidos' >Estados Unidos<\/option><option value='Estonia' >Estonia<\/option><option value='Esuatini' >Esuatini<\/option><option value='Etiop\u00eda' >Etiop\u00eda<\/option><option value='Federaci\u00f3n Rusa' >Federaci\u00f3n Rusa<\/option><option value='Fiji' >Fiyi<\/option><option value='Filipinas' >Filipinas<\/option><option value='Finlandia' >Finlandia<\/option><option value='Francia' >Francia<\/option><option value='Gab\u00f3n' >Gab\u00f3n<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Granada' >Granada<\/option><option value='Grecia' >Grecia<\/option><option value='Groenlandia' >Groenlandia<\/option><option value='Guadalupe' >Guadalupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guayana' >Guayana Francesa<\/option><option value='Guayana Francesa' >Guayana Francesa<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea Bissau' >Guinea Bissau<\/option><option value='Guinea Ecuatorial' >Guinea Ecuatorial<\/option><option value='Hait\u00ed' >Hait\u00ed<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungr\u00eda' >Hungr\u00eda<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iraq' >Iraq<\/option><option value='Irlanda' >Irlanda<\/option><option value='Ir\u00e1n' >Ir\u00e1n<\/option><option value='Isla Bouvet' >Isla Bouvet<\/option><option value='Isla Norfolk' >Isla Norfolk<\/option><option value='Isla de Man' >Isla de Man<\/option><option value='Isla de Navidad' >Isla de Navidad<\/option><option value='Islandia' >Islandia<\/option><option value='Islas Caim\u00e1n' >Islas Caim\u00e1n<\/option><option value='Islas Cocos' >Islas Cocos<\/option><option value='Islas Cook' >Islas Cook<\/option><option value='Islas Faroe' >Islas Feroe<\/option><option value='Islas Heard y McDonald' >Islas Heard y McDonald<\/option><option value='Islas Malvinas' >Islas Malvinas<\/option><option value='Islas Marianas del Norte' >Islas Marianas del Norte<\/option><option value='Islas Marshall' >Islas Marshall<\/option><option value='Islas Salom\u00f3n' >Islas Salom\u00f3n<\/option><option value='Islas Turcas y Caicos' >Islas Turcas y Caicos<\/option><option value='Islas Ultramarinas Menores de Estados Unidos' >Islas Ultramarinas Menores de Estados Unidos<\/option><option value='Islas V\u00edrgenes Brit\u00e1nicas' >Islas V\u00edrgenes Brit\u00e1nicas<\/option><option value='Islas V\u00edrgenes de los Estados Unidos' >Islas V\u00edrgenes de los Estados Unidos<\/option><option value='Islas \u00c5land' >Islas \u00c5land<\/option><option value='Israel' >Israel<\/option><option value='Italia' >Italia<\/option><option value='Jamaica' >Jamaica<\/option><option value='Jap\u00f3n' >Jap\u00f3n<\/option><option value='Jersey' >Jersey<\/option><option value='Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy' >Ji\u017en\u00ed Georgie y Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='Jord\u00e1n' >Jord\u00e1n<\/option><option value='Kazajist\u00e1n' >Kazajist\u00e1n<\/option><option value='Kenia' >Kenia<\/option><option value='Kirguist\u00e1n' >Kirguist\u00e1n<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kuwait' >Kuwait<\/option><option value='LIbia' >LIbia<\/option><option value='Lesoto' >Lesoto<\/option><option value='Liberia' >Liberia<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituania' >Lituania<\/option><option value='Lituania' >Lituania<\/option><option value='Luxemburgo' >Luxemburgo<\/option><option value='L\u00edbano' >L\u00edbano<\/option><option value='Macau' >Macao<\/option><option value='Macedonia del Norte' >Macedonia del Norte<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malasia' >Malasia<\/option><option value='Malawi' >Malawi<\/option><option value='Maldivas' >Maldivas<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marruecos' >Marruecos<\/option><option value='Martinica' >Martinica<\/option><option value='Mauricio' >Mauricio<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mayotte' >Mayotte<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldavia' >Moldavia<\/option><option value='Monaco' >M\u00f3naco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='M\u00e9xico' >M\u00e9xico<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Noruega' >Noruega<\/option><option value='Nueva Caledonia' >Nueva Caledonia<\/option><option value='Nueva Zelanda' >Nueva Zelanda<\/option><option value='N\u00edger' >N\u00edger<\/option><option value='Om\u00e1n' >Om\u00e1n<\/option><option value='Paises Bajos' >Pa\u00edses Bajos<\/option><option value='Pakist\u00e1n' >Pakist\u00e1n<\/option><option value='Palau' >Palau<\/option><option value='Palestina, Estado de' >Palestina, Estado de<\/option><option value='Panam\u00e1' >Panam\u00e1<\/option><option value='Pap\u00faa Nueva Guinea' >Pap\u00faa Nueva Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Per\u00fa' >Per\u00fa<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Polinesia Francesa' >Polinesia Francesa<\/option><option value='Polonia' >Polonia<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Reino Unido' >Reino Unido<\/option><option value='Rep\u00fablica Centroafricana' >Rep\u00fablica Centroafricana<\/option><option value='Rep\u00fablica Democr\u00e1tica Popular de Laos' >Rep\u00fablica Democr\u00e1tica Popular de Laos<\/option><option value='Rep\u00fablica Dominicana' >Rep\u00fablica Dominicana<\/option><option value='Rep\u00fablica \u00c1rabe de Siria' >Rep\u00fablica \u00c1rabe de Siria<\/option><option value='Reuni\u00f3n' >Reuni\u00f3n<\/option><option value='Ruanda' >Ruanda<\/option><option value='Ruman\u00eda' >Ruman\u00eda<\/option><option value='Sahara Occidental' >Sahara Occidental<\/option><option value='Samoa' >Samoa<\/option><option value='Samoa Americana' >Samoa Americana<\/option><option value='San Bartolom\u00e9' >San Bartolom\u00e9<\/option><option value='San Crist\u00f3bal y Nieves' >San Crist\u00f3bal y Nieves<\/option><option value='San Marino' >San Marino<\/option><option value='San Mart\u00edn' >San Mart\u00edn<\/option><option value='San Pedro y Miquel\u00f3n' >San Pedro y Miquel\u00f3n<\/option><option value='San Vicente y las Granadinas' >San Vicente y las Granadinas<\/option><option value='Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a' >Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option value='Santa Luc\u00eda' >Santa Luc\u00eda<\/option><option value='Santa Sede' >Santa Sede<\/option><option value='Santo Tom\u00e9 y Principe' >Santo Tom\u00e9 y Pr\u00edncipe<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leona' >Sierra Leona<\/option><option value='Singapur' >Singapur<\/option><option value='Sint Maarten' >San Mart\u00edn<\/option><option value='Somalia' >Somalia<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sud\u00e1frica' >Sud\u00e1frica<\/option><option value='Sud\u00e1n' >Sud\u00e1n<\/option><option value='Sud\u00e1n del Sur' >Sud\u00e1n del Sur<\/option><option value='Suecia' >Suecia<\/option><option value='Suiza' >Suiza<\/option><option value='Surinam' >Surinam<\/option><option value='Svalbard y Jan Mayen' >Svalbard y Jan Mayen<\/option><option value='Tailandia' >Tailandia<\/option><option value='Taiwan' >Taiw\u00e1n<\/option><option value='Tanzania (Rep\u00fablica Unida de)' >Tanzania (Rep\u00fablica Unida de)<\/option><option value='Tayikist\u00e1n' >Tayikist\u00e1n<\/option><option value='Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico' >Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option value='Tierras Australes y Ant\u00e1rticas Francesas' >Tierras Australes y Ant\u00e1rticas Francesas<\/option><option value='Timor Oriental' >Timor Oriental<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad y Tobago' >Trinidad y Tobago<\/option><option value='Turkmenist\u00e1n' >Turkmenist\u00e1n<\/option><option value='Turqu\u00eda' >Turqu\u00eda<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fanez' >T\u00fanez<\/option><option value='Ucrania' >Ucrania<\/option><option value='Uganda' >Uganda<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekist\u00e1n' >Uzbekist\u00e1n<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Wallis y Futuna' >Wallis y Futuna<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbaue' >Cimbaue<\/option><\/select>\n                                        <label for='input_22_44_6' id='input_22_44_6_label' class='gform-field-label gform-field-label--type-sub'>Pa\u00eds<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_22_45\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_45'>Tel\u00e9fono<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_45' id='input_22_45' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_46\" class=\"gfield gfield--type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_46'>correo electr\u00f3nico<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_46' id='input_22_46' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_22_47\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_47'>Naturaleza y alcance del perjuicio<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_47' id='input_22_47' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_22_49\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfCintur\u00f3n de seguridad abrochado?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_49'>\n\t\t\t<div class='gchoice gchoice_22_49_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='Ja'  id='choice_22_49_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_49_0' id='label_22_49_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_49_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_49' type='radio' value='Nein'  id='choice_22_49_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_49_1' id='label_22_49_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_22_50\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfHospitalizaci\u00f3n?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_50'>\n\t\t\t<div class='gchoice gchoice_22_50_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='Ja'  id='choice_22_50_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_50_0' id='label_22_50_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_50_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_50' type='radio' value='Nein'  id='choice_22_50_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_50_1' id='label_22_50_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_22_51\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_51'>\u00bfEn qu\u00e9 hospital?<\/label><div class='ginput_container ginput_container_text'><input name='input_51' id='input_22_51' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_22_63\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfSe produjo el accidente al ir o volver del trabajo?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_63'>\n\t\t\t<div class='gchoice gchoice_22_63_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Ja'  id='choice_22_63_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_63_0' id='label_22_63_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_63_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_63' type='radio' value='Nein'  id='choice_22_63_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_63_1' id='label_22_63_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_22_64\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfEst\u00e1 cubierto el lesionado por el seguro obligatorio de pensiones?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_64'>\n\t\t\t<div class='gchoice gchoice_22_64_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Ja'  id='choice_22_64_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_64_0' id='label_22_64_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_64_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_64' type='radio' value='Nein'  id='choice_22_64_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_64_1' id='label_22_64_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_22_75\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfHubo otras personas heridas?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_75'>\n\t\t\t<div class='gchoice gchoice_22_75_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='Ja'  id='choice_22_75_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_75_0' id='label_22_75_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_75_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_75' type='radio' value='Nein'  id='choice_22_75_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_75_1' id='label_22_75_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_22_52\" class=\"gfield gfield--type-select gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_52'>Saludo<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_52' id='input_22_52' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='Herr' >Sr.<\/option><option value='Frau' >Sra.<\/option><option value='Keine Angabe' >No especificado<\/option><\/select><\/div><\/div><fieldset id=\"field_22_53\" class=\"gfield gfield--type-name gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Nombre<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_complex ginput_container ginput_container--name no_prefix has_first_name no_middle_name has_last_name no_suffix gf_name_has_2 ginput_container_name gform-grid-row' id='input_22_53'>\n                            \n                            <span id='input_22_53_3_container' class='name_first gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_53.3' id='input_22_53_3' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_53_3' class='gform-field-label gform-field-label--type-sub'>Nombre<\/label>\n                                                <\/span>\n                            \n                            <span id='input_22_53_6_container' class='name_last gform-grid-col gform-grid-col--size-auto' >\n                                                    <input type='text' name='input_53.6' id='input_22_53_6' value=''   aria-required='true'     \/>\n                                                    <label for='input_22_53_6' class='gform-field-label gform-field-label--type-sub'>Apellidos<\/label>\n                                                <\/span>\n                            \n                        <\/div><\/fieldset><fieldset id=\"field_22_54\" class=\"gfield gfield--type-address gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >direcci\u00f3n<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_city has_zip has_country ginput_container_address gform-grid-row' id='input_22_54' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_22_54_1_container' >\n                                        <input type='text' name='input_54.1' id='input_22_54_1' value=''    aria-required='true'    \/>\n                                        <label for='input_22_54_1' id='input_22_54_1_label' class='gform-field-label gform-field-label--type-sub'>Direcci\u00f3n<\/label>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_22_54_3_container' >\n                                    <input type='text' name='input_54.3' id='input_22_54_3' value=''    aria-required='true'    \/>\n                                    <label for='input_22_54_3' id='input_22_54_3_label' class='gform-field-label gform-field-label--type-sub'>Ciudad<\/label>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_54.4' id='input_22_54_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_22_54_5_container' >\n                                    <input type='text' name='input_54.5' id='input_22_54_5' value=''    aria-required='true'    \/>\n                                    <label for='input_22_54_5' id='input_22_54_5_label' class='gform-field-label gform-field-label--type-sub'>ZIP \/ C\u00f3digo Postal<\/label>\n                                <\/span><span class='ginput_left address_country ginput_address_country gform-grid-col' id='input_22_54_6_container' >\n                                        <select name='input_54.6' id='input_22_54_6'   aria-required='true'    ><option value='' ><\/option><option value='Afghanist\u00e1n' >Afghanist\u00e1n<\/option><option value='Albania' >Albania<\/option><option value='Alemania' >Alemania<\/option><option value='Andorra' >Andorra<\/option><option value='Angola' >Angola<\/option><option value='Anguilla' >Anguila<\/option><option value='Antigua y Barbuda' >Antigua y Barbuda<\/option><option value='Ant\u00e1rtida' >Ant\u00e1rtida<\/option><option value='Arabia Saudita' >Arabia Saudita<\/option><option value='Argelia' >Argelia<\/option><option value='Argentina' >Argentina<\/option><option value='Armenia' >Armenia<\/option><option value='Aruba' >Aruba<\/option><option value='Australia' >Australia<\/option><option value='Austria' >Austria<\/option><option value='Azerbaiy\u00e1n' >Azerbaiy\u00e1n<\/option><option value='Bahamas' >Bahamas<\/option><option value='Bangladesh' >Bangladesh<\/option><option value='Barbados' >Barbados<\/option><option value='Bar\u00e9in' >Bar\u00e9in<\/option><option value='Belice' >Belice<\/option><option value='Benin' >Ben\u00edn<\/option><option value='Bermuda' >Bermudas<\/option><option value='Bhut\u00e1n' >But\u00e1n<\/option><option value='Bielorusia' >Bielorrusia<\/option><option value='Bolivia' >Bolivia<\/option><option value='Bonaire, San Eustaquio y Saba' >Bonaire, San Eustaquio y Saba<\/option><option value='Bosnia y Herzegovina' >Bosnia y Herzegovina<\/option><option value='Botswana' >Botsuana<\/option><option value='Brasil' >Brasil<\/option><option value='Brunei Darussalam' >Brunei Darussalam<\/option><option value='Bulgaria' >Bulgaria<\/option><option value='Burkina Faso' >Burkina Faso<\/option><option value='Burundi' >Burundi<\/option><option value='B\u00e9lgica' >B\u00e9lgica<\/option><option value='Cabo Verde' >Cabo Verde<\/option><option value='Camboya' >Camboya<\/option><option value='Camer\u00fan' >Camer\u00fan<\/option><option value='Canada' >Canad\u00e1<\/option><option value='Chad' >Chad<\/option><option value='Chequia' >Chequia<\/option><option value='Chile' >Chile<\/option><option value='China' >China<\/option><option value='Chipre' >Chipre<\/option><option value='Colombia' >Colombia<\/option><option value='Comoras' >Comoras<\/option><option value='Congo' >Congo<\/option><option value='Congo, Rep\u00fablica Democr\u00e1tica del' >Congo, Rep\u00fablica Democr\u00e1tica del<\/option><option value='Corea, Rep\u00fablica Popular Democr\u00e1tica de' >Corea, Rep\u00fablica Popular Democr\u00e1tica de<\/option><option value='Corea, Rep\u00fablica de' >Corea, Rep\u00fablica de<\/option><option value='Costa Rica' >Costa Rica<\/option><option value='Costa de Marfil' >Costa de Marfil<\/option><option value='Croacia' >Croacia<\/option><option value='Cuba' >Cuba<\/option><option value='Curazao' >Curazao<\/option><option value='Dinamarca' >Dinamarca<\/option><option value='Djibouti' >Yibuti<\/option><option value='Dominica' >Dominica<\/option><option value='Ecuador' >Ecuador<\/option><option value='Egipto' >Egipto<\/option><option value='El Salvador' >El Salvador<\/option><option value='Emiratos \u00c1rabes Unidos' >Emiratos \u00c1rabes Unidos<\/option><option value='Eritrea' >Eritrea<\/option><option value='Eslovaquia' >Eslovaquia<\/option><option value='Eslovenia' >Eslovenia<\/option><option value='Espa\u00f1a' >Espa\u00f1a<\/option><option value='Estados Unidos' >Estados Unidos<\/option><option value='Estonia' >Estonia<\/option><option value='Esuatini' >Esuatini<\/option><option value='Etiop\u00eda' >Etiop\u00eda<\/option><option value='Federaci\u00f3n Rusa' >Federaci\u00f3n Rusa<\/option><option value='Fiji' >Fiyi<\/option><option value='Filipinas' >Filipinas<\/option><option value='Finlandia' >Finlandia<\/option><option value='Francia' >Francia<\/option><option value='Gab\u00f3n' >Gab\u00f3n<\/option><option value='Gambia' >Gambia<\/option><option value='Georgia' >Georgia<\/option><option value='Ghana' >Ghana<\/option><option value='Gibraltar' >Gibraltar<\/option><option value='Granada' >Granada<\/option><option value='Grecia' >Grecia<\/option><option value='Groenlandia' >Groenlandia<\/option><option value='Guadalupe' >Guadalupe<\/option><option value='Guam' >Guam<\/option><option value='Guatemala' >Guatemala<\/option><option value='Guayana' >Guayana Francesa<\/option><option value='Guayana Francesa' >Guayana Francesa<\/option><option value='Guernsey' >Guernsey<\/option><option value='Guinea' >Guinea<\/option><option value='Guinea Bissau' >Guinea Bissau<\/option><option value='Guinea Ecuatorial' >Guinea Ecuatorial<\/option><option value='Hait\u00ed' >Hait\u00ed<\/option><option value='Honduras' >Honduras<\/option><option value='Hong Kong' >Hong Kong<\/option><option value='Hungr\u00eda' >Hungr\u00eda<\/option><option value='India' >India<\/option><option value='Indonesia' >Indonesia<\/option><option value='Iraq' >Iraq<\/option><option value='Irlanda' >Irlanda<\/option><option value='Ir\u00e1n' >Ir\u00e1n<\/option><option value='Isla Bouvet' >Isla Bouvet<\/option><option value='Isla Norfolk' >Isla Norfolk<\/option><option value='Isla de Man' >Isla de Man<\/option><option value='Isla de Navidad' >Isla de Navidad<\/option><option value='Islandia' >Islandia<\/option><option value='Islas Caim\u00e1n' >Islas Caim\u00e1n<\/option><option value='Islas Cocos' >Islas Cocos<\/option><option value='Islas Cook' >Islas Cook<\/option><option value='Islas Faroe' >Islas Feroe<\/option><option value='Islas Heard y McDonald' >Islas Heard y McDonald<\/option><option value='Islas Malvinas' >Islas Malvinas<\/option><option value='Islas Marianas del Norte' >Islas Marianas del Norte<\/option><option value='Islas Marshall' >Islas Marshall<\/option><option value='Islas Salom\u00f3n' >Islas Salom\u00f3n<\/option><option value='Islas Turcas y Caicos' >Islas Turcas y Caicos<\/option><option value='Islas Ultramarinas Menores de Estados Unidos' >Islas Ultramarinas Menores de Estados Unidos<\/option><option value='Islas V\u00edrgenes Brit\u00e1nicas' >Islas V\u00edrgenes Brit\u00e1nicas<\/option><option value='Islas V\u00edrgenes de los Estados Unidos' >Islas V\u00edrgenes de los Estados Unidos<\/option><option value='Islas \u00c5land' >Islas \u00c5land<\/option><option value='Israel' >Israel<\/option><option value='Italia' >Italia<\/option><option value='Jamaica' >Jamaica<\/option><option value='Jap\u00f3n' >Jap\u00f3n<\/option><option value='Jersey' >Jersey<\/option><option value='Ji\u017en\u00ed Georgie a Ji\u017en\u00ed Sandwichovy ostrovy' >Ji\u017en\u00ed Georgie y Ji\u017en\u00ed Sandwichovy ostrovy<\/option><option value='Jord\u00e1n' >Jord\u00e1n<\/option><option value='Kazajist\u00e1n' >Kazajist\u00e1n<\/option><option value='Kenia' >Kenia<\/option><option value='Kirguist\u00e1n' >Kirguist\u00e1n<\/option><option value='Kiribati' >Kiribati<\/option><option value='Kuwait' >Kuwait<\/option><option value='LIbia' >LIbia<\/option><option value='Lesoto' >Lesoto<\/option><option value='Liberia' >Liberia<\/option><option value='Liechtenstein' >Liechtenstein<\/option><option value='Lituania' >Lituania<\/option><option value='Lituania' >Lituania<\/option><option value='Luxemburgo' >Luxemburgo<\/option><option value='L\u00edbano' >L\u00edbano<\/option><option value='Macau' >Macao<\/option><option value='Macedonia del Norte' >Macedonia del Norte<\/option><option value='Madagascar' >Madagascar<\/option><option value='Malasia' >Malasia<\/option><option value='Malawi' >Malawi<\/option><option value='Maldivas' >Maldivas<\/option><option value='Mali' >Mali<\/option><option value='Malta' >Malta<\/option><option value='Marruecos' >Marruecos<\/option><option value='Martinica' >Martinica<\/option><option value='Mauricio' >Mauricio<\/option><option value='Mauritania' >Mauritania<\/option><option value='Mayotte' >Mayotte<\/option><option value='Micronesia' >Micronesia<\/option><option value='Moldavia' >Moldavia<\/option><option value='Monaco' >M\u00f3naco<\/option><option value='Mongolia' >Mongolia<\/option><option value='Montenegro' >Montenegro<\/option><option value='Montserrat' >Montserrat<\/option><option value='Mozambique' >Mozambique<\/option><option value='Myanmar' >Myanmar<\/option><option value='M\u00e9xico' >M\u00e9xico<\/option><option value='Namibia' >Namibia<\/option><option value='Nauru' >Nauru<\/option><option value='Nepal' >Nepal<\/option><option value='Nicaragua' >Nicaragua<\/option><option value='Nigeria' >Nigeria<\/option><option value='Niue' >Niue<\/option><option value='Noruega' >Noruega<\/option><option value='Nueva Caledonia' >Nueva Caledonia<\/option><option value='Nueva Zelanda' >Nueva Zelanda<\/option><option value='N\u00edger' >N\u00edger<\/option><option value='Om\u00e1n' >Om\u00e1n<\/option><option value='Paises Bajos' >Pa\u00edses Bajos<\/option><option value='Pakist\u00e1n' >Pakist\u00e1n<\/option><option value='Palau' >Palau<\/option><option value='Palestina, Estado de' >Palestina, Estado de<\/option><option value='Panam\u00e1' >Panam\u00e1<\/option><option value='Pap\u00faa Nueva Guinea' >Pap\u00faa Nueva Guinea<\/option><option value='Paraguay' >Paraguay<\/option><option value='Per\u00fa' >Per\u00fa<\/option><option value='Pitcairn' >Pitcairn<\/option><option value='Polinesia Francesa' >Polinesia Francesa<\/option><option value='Polonia' >Polonia<\/option><option value='Portugal' >Portugal<\/option><option value='Puerto Rico' >Puerto Rico<\/option><option value='Qatar' >Qatar<\/option><option value='Reino Unido' >Reino Unido<\/option><option value='Rep\u00fablica Centroafricana' >Rep\u00fablica Centroafricana<\/option><option value='Rep\u00fablica Democr\u00e1tica Popular de Laos' >Rep\u00fablica Democr\u00e1tica Popular de Laos<\/option><option value='Rep\u00fablica Dominicana' >Rep\u00fablica Dominicana<\/option><option value='Rep\u00fablica \u00c1rabe de Siria' >Rep\u00fablica \u00c1rabe de Siria<\/option><option value='Reuni\u00f3n' >Reuni\u00f3n<\/option><option value='Ruanda' >Ruanda<\/option><option value='Ruman\u00eda' >Ruman\u00eda<\/option><option value='Sahara Occidental' >Sahara Occidental<\/option><option value='Samoa' >Samoa<\/option><option value='Samoa Americana' >Samoa Americana<\/option><option value='San Bartolom\u00e9' >San Bartolom\u00e9<\/option><option value='San Crist\u00f3bal y Nieves' >San Crist\u00f3bal y Nieves<\/option><option value='San Marino' >San Marino<\/option><option value='San Mart\u00edn' >San Mart\u00edn<\/option><option value='San Pedro y Miquel\u00f3n' >San Pedro y Miquel\u00f3n<\/option><option value='San Vicente y las Granadinas' >San Vicente y las Granadinas<\/option><option value='Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a' >Santa Elena, Ascensi\u00f3n y Trist\u00e1n de Acu\u00f1a<\/option><option value='Santa Luc\u00eda' >Santa Luc\u00eda<\/option><option value='Santa Sede' >Santa Sede<\/option><option value='Santo Tom\u00e9 y Principe' >Santo Tom\u00e9 y Pr\u00edncipe<\/option><option value='Senegal' >Senegal<\/option><option value='Serbia' >Serbia<\/option><option value='Seychelles' >Seychelles<\/option><option value='Sierra Leona' >Sierra Leona<\/option><option value='Singapur' >Singapur<\/option><option value='Sint Maarten' >San Mart\u00edn<\/option><option value='Somalia' >Somalia<\/option><option value='Sri Lanka' >Sri Lanka<\/option><option value='Sud\u00e1frica' >Sud\u00e1frica<\/option><option value='Sud\u00e1n' >Sud\u00e1n<\/option><option value='Sud\u00e1n del Sur' >Sud\u00e1n del Sur<\/option><option value='Suecia' >Suecia<\/option><option value='Suiza' >Suiza<\/option><option value='Surinam' >Surinam<\/option><option value='Svalbard y Jan Mayen' >Svalbard y Jan Mayen<\/option><option value='Tailandia' >Tailandia<\/option><option value='Taiwan' >Taiw\u00e1n<\/option><option value='Tanzania (Rep\u00fablica Unida de)' >Tanzania (Rep\u00fablica Unida de)<\/option><option value='Tayikist\u00e1n' >Tayikist\u00e1n<\/option><option value='Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico' >Territorio Brit\u00e1nico del Oc\u00e9ano \u00cdndico<\/option><option value='Tierras Australes y Ant\u00e1rticas Francesas' >Tierras Australes y Ant\u00e1rticas Francesas<\/option><option value='Timor Oriental' >Timor Oriental<\/option><option value='Togo' >Togo<\/option><option value='Tokelau' >Tokelau<\/option><option value='Tonga' >Tonga<\/option><option value='Trinidad y Tobago' >Trinidad y Tobago<\/option><option value='Turkmenist\u00e1n' >Turkmenist\u00e1n<\/option><option value='Turqu\u00eda' >Turqu\u00eda<\/option><option value='Tuvalu' >Tuvalu<\/option><option value='T\u00fanez' >T\u00fanez<\/option><option value='Ucrania' >Ucrania<\/option><option value='Uganda' >Uganda<\/option><option value='Uruguay' >Uruguay<\/option><option value='Uzbekist\u00e1n' >Uzbekist\u00e1n<\/option><option value='Vanuatu' >Vanuatu<\/option><option value='Venezuela' >Venezuela<\/option><option value='Vietnam' >Vietnam<\/option><option value='Wallis y Futuna' >Wallis y Futuna<\/option><option value='Yemen' >Yemen<\/option><option value='Zambia' >Zambia<\/option><option value='Zimbaue' >Cimbaue<\/option><\/select>\n                                        <label for='input_22_54_6' id='input_22_54_6_label' class='gform-field-label gform-field-label--type-sub'>Pa\u00eds<\/label>\n                                    <\/span>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_22_55\" class=\"gfield gfield--type-phone gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_55'>Tel\u00e9fono<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_phone'><input name='input_55' id='input_22_55' type='tel' value='' class='large'   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_22_56\" class=\"gfield gfield--type-email gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_56'>correo electr\u00f3nico<\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_56' id='input_22_56' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><div id=\"field_22_57\" class=\"gfield gfield--type-text gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_57'>Naturaleza y alcance del perjuicio<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_57' id='input_22_57' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_22_58\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfCintur\u00f3n de seguridad abrochado?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_58'>\n\t\t\t<div class='gchoice gchoice_22_58_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='Ja'  id='choice_22_58_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_58_0' id='label_22_58_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_58_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_58' type='radio' value='Nein'  id='choice_22_58_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_58_1' id='label_22_58_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_22_59\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-third gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfHospitalizaci\u00f3n?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_59'>\n\t\t\t<div class='gchoice gchoice_22_59_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='Ja'  id='choice_22_59_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_59_0' id='label_22_59_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_59_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_59' type='radio' value='Nein'  id='choice_22_59_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_59_1' id='label_22_59_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_22_60\" class=\"gfield gfield--type-text gfield--width-third field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_60'>\u00bfEn qu\u00e9 hospital?<\/label><div class='ginput_container ginput_container_text'><input name='input_60' id='input_22_60' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_22_65\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfSe produjo el accidente al ir o volver del trabajo?<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_65'>\n\t\t\t<div class='gchoice gchoice_22_65_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Ja'  id='choice_22_65_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_65_0' id='label_22_65_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_65_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_65' type='radio' value='Nein'  id='choice_22_65_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_65_1' id='label_22_65_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_22_66\" class=\"gfield gfield--type-radio gfield--type-choice gfield--width-half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' >\u00bfEst\u00e1 cubierto el lesionado por el seguro obligatorio de pensiones?<\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_22_66'>\n\t\t\t<div class='gchoice gchoice_22_66_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Ja'  id='choice_22_66_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_66_0' id='label_22_66_0' class='gform-field-label gform-field-label--type-inline'>S\u00ed<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_22_66_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_66' type='radio' value='Nein'  id='choice_22_66_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_22_66_1' id='label_22_66_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_22_78\" class=\"gfield gfield--type-consent gfield--type-choice gfield--width-full gfield_contains_required field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' >Consentimiento<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/legend><div class='ginput_container ginput_container_consent'><input name='input_78.1' id='input_22_78_1' type='checkbox' value='1'   aria-required=\"true\" aria-invalid=\"false\"   \/> <label class=\"gform-field-label gform-field-label--type-inline gfield_consent_label\" for='input_22_78_1' >Acepto la pol\u00edtica de privacidad.<\/label><input type='hidden' name='input_78.2' value='Ich stimme der Datenschutzerkl\u00e4rung zu.' class='gform_hidden' \/><input type='hidden' name='input_78.3' value='6' class='gform_hidden' \/><\/div><\/fieldset><div id=\"field_22_79\" class=\"gfield gfield--type-captcha gfield--width-full field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_22_79'>CAPTCHA<\/label><div id='input_22_79' class='ginput_container ginput_recaptcha' data-sitekey=''  data-theme='light' data-tabindex='-1' data-size='invisible' data-badge='bottomright'><\/div><\/div><\/div><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_22' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='ENVIAR'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_22' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_22' id='gform_theme_22' value='gravity-theme' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_22' id='gform_style_settings_22' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_22' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='22' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_22' 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class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-a9f3481 elementor-section-stretched elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"a9f3481\" data-element_type=\"section\" data-settings=\"{&quot;stretch_section&quot;:&quot;section-stretched&quot;,&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-top-column elementor-element elementor-element-efc7f0b\" data-id=\"efc7f0b\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-5fcb4b7 elementor-widget elementor-widget-menu-anchor\" data-id=\"5fcb4b7\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-menu-anchor\" id=\"PDFSchadenabwicklung\"><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d6cbf2a elementor-widget elementor-widget-heading\" data-id=\"d6cbf2a\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h3 class=\"elementor-heading-title elementor-size-default\">Cuestionario para solicitantes en formato descargable<\/h3>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-2f5602d elementor-widget elementor-widget-text-editor\" data-id=\"2f5602d\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>Si se decide por la opci\u00f3n escrita, env\u00edenosla -preferiblemente por correo electr\u00f3nico- a\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-aaae2eb elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"aaae2eb\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"mailto:versicherung@kvg-bus.de\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-paper-plane\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">versicherung@kvg-bus.de<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-home-lg-alt\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">Verkehrsbetriebe Bachstein GmbH | Nienburger Stra\u00dfe 50, 29225 Celle<\/span>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ebfc7ea elementor-widget elementor-widget-button\" data-id=\"ebfc7ea\" data-element_type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-sm\" href=\"https:\/\/kvg-bus.de\/stade\/wp-content\/uploads\/sites\/14\/formular-fuer-anspruchsteller_schadensabwicklung-kvg.pdf\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t<span class=\"elementor-button-icon\">\n\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-file-pdf\"><\/i>\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">AL CUESTIONARIO EN PDF<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t<div class=\"elementor-element elementor-element-3db0c8a e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"3db0c8a\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-a5392af elementor-widget elementor-widget-spacer\" data-id=\"a5392af\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bddd347 elementor-widget elementor-widget-menu-anchor\" data-id=\"bddd347\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-menu-anchor\" id=\"KontaktSchadenabwicklung\"><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9585a90 elementor-widget elementor-widget-heading\" data-id=\"9585a90\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Su contacto con nosotros<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-97431b6 elementor-widget elementor-widget-text-editor\" data-id=\"97431b6\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>\u00bfTiene alguna pregunta o quiere decirnos algo? Puede localizarnos los jueves de 8.00 a 16.00 horas y los viernes de 8.00 a 12.00 horas.\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a4b65f2 elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"a4b65f2\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"tel:051414870854\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-paper-plane\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">05141 48708-54<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"mailto:versicherung@kvg-bus.de\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-paper-plane\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">versicherung@kvg-bus.de<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-1cbcd05 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"1cbcd05\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-ea4631b elementor-widget elementor-widget-spacer\" data-id=\"ea4631b\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-ff63a7a elementor-widget elementor-widget-menu-anchor\" data-id=\"ff63a7a\" data-element_type=\"widget\" data-widget_type=\"menu-anchor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-menu-anchor\" id=\"KontaktSchadenabwicklung\"><\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3796148 elementor-widget elementor-widget-heading\" data-id=\"3796148\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Su contacto con nosotros<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-022f421 elementor-widget elementor-widget-text-editor\" data-id=\"022f421\" data-element_type=\"widget\" data-widget_type=\"text-editor.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<p>\u00bfTiene alguna pregunta o quiere decirnos algo? Puede localizarnos los jueves de 8.00 a 16.00 horas y los viernes de 8.00 a 12.00 horas.\u00a0<\/p>\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-92bbe3f elementor-icon-list--layout-traditional elementor-list-item-link-full_width elementor-widget elementor-widget-icon-list\" data-id=\"92bbe3f\" data-element_type=\"widget\" data-widget_type=\"icon-list.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<ul class=\"elementor-icon-list-items\">\n\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"tel:051414870854\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-paper-plane\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">05141 48708-54<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t\t\t<li class=\"elementor-icon-list-item\">\n\t\t\t\t\t\t\t\t\t\t\t<a href=\"mailto:versicherung@kvg-bus.de\">\n\n\t\t\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-icon\">\n\t\t\t\t\t\t\t<i aria-hidden=\"true\" class=\"fas fa-paper-plane\"><\/i>\t\t\t\t\t\t<\/span>\n\t\t\t\t\t\t\t\t\t\t<span class=\"elementor-icon-list-text\">versicherung@kvg-bus.de<\/span>\n\t\t\t\t\t\t\t\t\t\t\t<\/a>\n\t\t\t\t\t\t\t\t\t<\/li>\n\t\t\t\t\t\t<\/ul>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-868f9a9 e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no e-con e-parent\" data-id=\"868f9a9\" data-element_type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-30befe7 elementor-widget elementor-widget-spacer\" data-id=\"30befe7\" data-element_type=\"widget\" data-widget_type=\"spacer.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-spacer\">\n\t\t\t<div class=\"elementor-spacer-inner\"><\/div>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-fc4fab4 elementor-widget elementor-widget-elementor-extension-gravity-forms\" data-id=\"fc4fab4\" data-element_type=\"widget\" data-widget_type=\"elementor-extension-gravity-forms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\n                <div class='gf_browser_gecko gform_wrapper gravity-theme gform-theme--no-framework' data-form-theme='gravity-theme' data-form-index='0' id='gform_wrapper_18' ><form method='post' enctype='multipart\/form-data'  id='gform_18'  action='\/heidekreis\/es\/wp-json\/wp\/v2\/pages\/1667' data-formid='18' novalidate data-trp-original-action=\"\/heidekreis\/es\/wp-json\/wp\/v2\/pages\/1667\">\n                        <div class='gform-body gform_body'><div id='gform_fields_18' class='gform_fields top_label form_sublabel_below description_below validation_below'><div id=\"field_18_1\" class=\"gfield gfield--type-survey gfield--input-type-rating field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible gsurvey-survey-field\"  data-field-class=\"gsurvey-survey-field\" ><label class='gfield_label gform-field-label' >\u00bfQu\u00e9 le parece nuestro sitio web?<\/label><div class='ginput_container gsurvey-rating-wrapper'><div class='gsurvey-rating' id='input_18_1'><input name='input_1' type='radio' value='grating172b515f7'  id='choice_18_1_0'    \/><label for='choice_18_1_0' title='Destacado'><span>Destacado<\/span><\/label><input name='input_1' type='radio' value='grating15b90bab7'  id='choice_18_1_1'    \/><label for='choice_18_1_1' title='Predominantemente bueno'><span>Predominantemente bueno<\/span><\/label><input name='input_1' type='radio' value='grating196111746'  id='choice_18_1_2'    \/><label 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No hay problema, estaremos encantados de ayudarle. Si ha tenido un accidente con KVG, p\u00f3ngase en contacto con nosotros antes de dar cualquier otro paso. Puede rellenar el cuestionario para reclamantes en l\u00ednea o descargarlo en formato PDF. Por favor, adjunte a su carta toda la informaci\u00f3n y documentos relevantes relacionados con el accidente (por ejemplo, fotos, declaraciones de testigos, informe policial) para que podamos tramitar su solicitud r\u00e1pidamente. Cuestionario para solicitantes \u201e*\u201c indica campos obligatorios Datos personales Salutaci\u00f3n*Se\u00f1oraSin datos Apellidos*Nombre Apellidos Tel\u00e9fono*Email* Direcci\u00f3n* Direcci\u00f3n Ciudad C\u00f3digo postal Afganist\u00e1nAlbaniaAlgeriaAmerica-SamoaAmericanasIslas V\u00edrgenes AmericanasAndorraAngolaAnguilaAnt\u00e1rtidaAntigua y BarbudaArgentinaArmeniaArubaAzerbaiy\u00e1nAustraliaBahamasBahr\u00e9inBangladeshBarbadosB\u00e9lgicaBeliceBen\u00ednBermudasBhut\u00e1nBoliviaBosnia y HerzegovinaBotsuanaIsla BouvetBrasilIslas V\u00edrgenes Brit\u00e1nicasTerritorio Brit\u00e1nico del Oc\u00e9ano \u00cdndicoBrunei Oc\u00e9ano \u00cdndicoBrunei DarussalamBulgariaBurkina FasoBurundiIslas Caim\u00e1nChileChinaIslas CookCosta RicaCura\u00e7aoCosta de MarfilRep\u00fablica Popular Democr\u00e1tica de LaosDinamarcaDjiboutiDominicaRep\u00fablica DominicanaEcuadorEl SalvadorEritreaEstoniaEswatiniIslas MalvinasFijiFinlandiaFranciaGuayana FrancesaFranciaPolinesia FrancesaGuayana FrancesaPolinesia FrancesaTerritorios Australes y Ant\u00e1rticos FrancesesFutuna (Wallis y Futuna)Islas FeroeGab\u00f3nGambiaGeorgiaGhanaGibraltarGranadaGreciaGran Breta\u00f1aGroenlandiaGuadalupeGuamGuatemalaGuerneseyGuineaGuinea-BissauGuyanaHait\u00edHeard y McDonaldIslasHolandaSanta SedeHondurasHong KongIndiaIndonesiaIraqIr\u00e1nIrlandaIsla de ManIsraelItaliaJamaicaJap\u00f3nJerseyJordaniaCamboyaCamer\u00fanCanad\u00e1Cabo VerdePa\u00edses Bajos del CaribeKazajst\u00e1nKeniaKirguist\u00e1nKiribatiCocosIslasCongoCongo, Rep\u00fablica Democr\u00e1tica delCorea Democr\u00e1tica deCroaciaCubaKuwaitLesothoLetoniaL\u00edbanoLiberiaLibiaLiechtensteinLituaniaLuxemburgoMacaoMadagascarMalawiMalasiaMaldivasMal\u00edMaltaMarruecosMarshall-IslasMartinicaMauritaniaMauricioMayotteM\u00e9xicoMicronesiaMoldaviaM\u00f3nacoMongoliaMontenegroMontserratMozambiqueMyanmarNamibiaNauruNepalNueva CaledoniaNueva ZelandaNicaraguaPa\u00edses BajosN\u00edgerNigeriaNiueNorte MacedoniaIslas NorfolkNoruegaIslas Marianas del NorteOm\u00e1nTimor OrientalPakist\u00e1nPalauPalestina, PalauPalestinePanamaPapua Nueva GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoRwandaRomaniaRussian FederationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre y MiquelonSalomon IslandsZambiaSamoaSan MarinoSaudi ArabiaSwedenSenegalSerbiaSeychellesSierra LeoneZimbabweSingaporeSint MaartenSloveniaSlovakiaSomaliaSpainSri LankaSt. Helena, Ascensi\u00f3n y Trist\u00e1n da CunhaSt. Kitts y NevisSt. LuciaSt. MartinSt. Vicente y las GranadinasSud\u00e1nSurinamSvalbard y Jan MayenSiria, Rep\u00fablica \u00c1rabeSanto Tom\u00e9 y Pr\u00edncipeSud\u00e1fricaGeorgia del Sur y las Islas Sandwich del SurCorea del SurSud\u00e1n del SurTayikist\u00e1nTaiw\u00e1nTanzania, Rep\u00fablica Unida deTailandiaTogoTokelauTongaTrinidad y TobagoRep\u00fablica ChecaT\u00fanezTurkmenist\u00e1nTurcos e Islas CaicosTuvalu y CaicosTuvaluTurqu\u00edaIslas menores de los Estados UnidosUgandaUcraniaHungr\u00edaUruguayUsbekist\u00e1nVanuatuVenezuelaEmiratos \u00c1rabes UnidosEstados Unidos de Am\u00e9ricaVietnamIsla de NavidadBielorrusiaS\u00e1hara OccidentalRep\u00fablica CentroafricanaChipreEgipto\u00c4Guinea Ecuatorial\u00c4tiop\u00eda\u00c5land IslandsAustria Pa\u00eds Detalles del accidente Lugar*Fecha* TagTag12345678910111213141516171819202122232425262728293031MonatMonat123456789101112JahrJahr20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Hora* Horas : Minutos Calle\/Cruce*L\u00ednea\/N\u00famero de viaje*ParadaMatr\u00edcula de autob\u00fasNombre Conductor Se\u00f1alizaci\u00f3n de accidentes*Archivo Arrastre archivos aqu\u00ed o Seleccione archivos Tama\u00f1o m\u00e1x. del archivo 32 MB. Tama\u00f1o del archivo: 32 MB. Testigos \u00bfHay alg\u00fan testigo?* S\u00ed No Apellidos* Nombre Apellidos Direcci\u00f3n* Direcci\u00f3n Ciudad C\u00f3digo postal Tel\u00e9fono \u00bfHay alg\u00fan otro testigo?* S\u00ed No Apellidos* Nombre Apellidos Direcci\u00f3n* Direcci\u00f3n Ciudad C\u00f3digo postal Tel\u00e9fono* Departamento de Polic\u00eda N\u00famero de incidente Direcci\u00f3n Direcci\u00f3n Ciudad C\u00f3digo postal Tama\u00f1o m\u00e1ximo del archivo 32 MB. Tama\u00f1o del archivo: 32 MB. Da\u00f1os materiales \u00bfHay da\u00f1os materiales?* S\u00ed No \u00bfQu\u00e9 se ha da\u00f1ado?* Propietario (posiblemente arrendador)* Nombre Apellidos \u00bfDerecho a deducci\u00f3n del IVA soportado?* S\u00ed No Da\u00f1os a veh\u00edculos de motor - coches, camiones, etc. (si los hay) \u00bfHay da\u00f1os a un veh\u00edculo de motor?* S\u00ed No Tipo*Coche (turismo)Veh\u00edculo industrial (cami\u00f3n)Veh\u00edculo de dos ruedas (scooter, moto)Maquinaria agr\u00edcola\/de construcci\u00f3nMotorcaravana\/Fabricante*TipoN\u00famero de matr\u00edcula*Seguro* Da\u00f1os personales \u00bfHay da\u00f1os personales?* S\u00ed No Saludo*Se\u00f1orSe\u00f1oraDetalles Apellido* Nombre Apellido Direcci\u00f3n* Direcci\u00f3n Ciudad C\u00f3digo postal Afganist\u00e1nAlbaniaAlgeriaAmerica-SamoaAmericanasIslas V\u00edrgenes AmericanasAndorraAngolaAnguilaAnt\u00e1rtidaAntigua y BarbudaArgentinaArmeniaArubaAzerbaiy\u00e1nAustraliaBahamasBahreinBangladeshBarbadosB\u00e9lgicaBeliceBen\u00ednBermudasBhut\u00e1nBoliviaBosnia y HerzegovinaBotsuanaIsla BouvetBrasilIslas V\u00edrgenes Brit\u00e1nicasTerritorio Brit\u00e1nico del Oc\u00e9ano \u00cdndicoBrunei Oc\u00e9ano \u00cdndicoBrunei DarussalamBulgariaBurkina FasoBurundiIslas Caim\u00e1nChileChinaIslas CookCosta RicaCura\u00e7aoCosta de MarfilRep\u00fablica Popular Democr\u00e1tica de LaosDinamarcaDjiboutiDominicaRep\u00fablica DominicanaEcuadorEl SalvadorEritreaEstoniaEswatiniIslas MalvinasFijiFinlandiaFranciaGuayana FrancesaFranciaPolinesia FrancesaGuayana FrancesaPolinesia FrancesaTerritorios Australes y Ant\u00e1rticos FrancesesFutuna (Wallis y Futuna)Islas FeroeGab\u00f3nGambiaGeorgiaGhanaGibraltarGranadaGreciaGran Breta\u00f1aGroenlandiaGuadalupeGuamGuatemalaGuerneseyGuineaGuinea-BissauGuyanaHait\u00edHeard y McDonaldIslasHolandaSanta SedeHondurasHong KongIndiaIndonesiaIraqIr\u00e1nIrlandaIsla de ManIsraelItaliaJamaicaJap\u00f3nJerseyJordaniaCamboyaCamer\u00fanCanad\u00e1Cabo VerdePa\u00edses Bajos del CaribeKazajst\u00e1nKeniaKirguist\u00e1nKiribatiCocosIslasCongoCongo, Rep\u00fablica Democr\u00e1tica delCorea Democr\u00e1tica deCroaciaCubaKuwaitLesothoLetoniaL\u00edbanoLiberiaLibiaLiechtensteinLituaniaLuxemburgoMacaoMadagascarMalawiMalasiaMaldivasMal\u00edMaltaMarruecosMarshall-IslasMartinicaMauritaniaMauricioMayotteM\u00e9xicoMicronesiaMoldaviaM\u00f3nacoMongoliaMontenegroMontserratMozambiqueMyanmarNamibiaNauruNepalNueva CaledoniaNueva ZelandaNicaraguaPa\u00edses BajosN\u00edgerNigeriaNiueNorte MacedoniaIslas NorfolkNoruegaIslas Marianas del NorteOm\u00e1nTimor OrientalPakist\u00e1nPalauPalestina, PalauPalestinePanamaPapua Nueva GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoRwandaRomaniaRussian FederationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre y MiquelonSalomon IslandsZambiaSamoaSan MarinoSaudi ArabiaSwedenSenegalSerbiaSeychellesSierra LeoneZimbabweSingaporeSint MaartenSloveniaSlovakiaSomaliaSpainSri LankaSt. Helena, Ascensi\u00f3n y Trist\u00e1n da CunhaSt. Kitts y NevisSt. LuciaSt. MartinSt. Vicente y las GranadinasSud\u00e1nSurinamSvalbard y Jan MayenSiria, Rep\u00fablica \u00c1rabeSanto Tom\u00e9 y Pr\u00edncipeSud\u00e1fricaGeorgia del Sur y las Islas Sandwich del SurCorea del SurSud\u00e1n del SurTayikist\u00e1nTaiw\u00e1nTanzania, Rep\u00fablica Unida deTailandiaTogoTokelauTongaTrinidad y TobagoRep\u00fablica ChecaT\u00fanezTurkmenist\u00e1nTurcos e Islas CaicosTuvalu y CaicosTuvaluTurqu\u00edaIslas Menores de los EE.UU.UgandaUcraniaHungr\u00edaUruguayUsbekist\u00e1nVanuatuVenezuelaEmiratos \u00c1rabes UnidosEstados Unidos de Am\u00e9ricaVietnamIsla de NavidadBielorrusiaS\u00e1hara OccidentalRep\u00fablica CentroafricanaChipreEgiptoGuinea Ecuatorial\u00c4tiop\u00eda\u00c5Islas V\u00edrgenes Brit\u00e1nicasAustria Pa\u00eds Tel\u00e9fono*Correo electr\u00f3nico Tipo y alcance de la lesi\u00f3n* \u00bfLlevaba puesto el cintur\u00f3n de seguridad? S\u00ed No Hospitalizaci\u00f3n* S\u00ed No \u00bfEn qu\u00e9 hospital? \u00bfEl accidente se produjo al ir o al volver del trabajo?* S\u00ed No \u00bfEst\u00e1 el herido cubierto por el seguro obligatorio de pensiones? S\u00ed No \u00bfOtras personas resultaron heridas?* S\u00ed No T\u00edtulo*Sr.\/Sra.\/MujerSin datos Apellidos* Nombre Apellidos Direcci\u00f3n* Direcci\u00f3n Ciudad C\u00f3digo postal Afganist\u00e1nAlbaniaArgeliaSamoa americanaIslas V\u00edrgenes americanasSamoaAmericanasIslas V\u00edrgenes AmericanasAndorraAngolaAnguilaAnt\u00e1rtidaAntigua y BarbudaArgentinaArmeniaArubaAzerbaiy\u00e1nAustraliaBahamasBahr\u00e9inBangladeshBarbadosB\u00e9lgicaBeliceBen\u00ednBermudasBhut\u00e1nBoliviaBosnia y HerzegovinaBotsuanaIsla BouvetBrasilIslas V\u00edrgenes Brit\u00e1nicasTerritorio Brit\u00e1nico del Oc\u00e9ano \u00cdndicoBrunei Oc\u00e9ano \u00cdndicoBrunei DarussalamBulgariaBurkina FasoBurundiIslas Caim\u00e1nChileChinaIslas CookCosta RicaCura\u00e7aoCosta de MarfilRep\u00fablica Popular Democr\u00e1tica de LaosDinamarcaDjiboutiDominicaRep\u00fablica DominicanaEcuadorEl SalvadorEritreaEstoniaEswatiniIslas MalvinasFijiFinlandiaFranciaGuayana FrancesaFranciaPolinesia FrancesaGuayana FrancesaPolinesia FrancesaTerritorios Australes y Ant\u00e1rticos FrancesesFutuna (Wallis y Futuna)Islas FeroeGab\u00f3nGambiaGeorgiaGhanaGibraltarGranadaGreciaGran Breta\u00f1aGroenlandiaGuadalupeGuamGuatemalaGuerneseyGuineaGuinea-BissauGuyanaHait\u00edHeard y McDonaldIslasHolandaSanta SedeHondurasHong KongIndiaIndonesiaIraqIr\u00e1nIrlandaIsla de ManIsraelItaliaJamaicaJap\u00f3nJerseyJordaniaCamboyaCamer\u00fanCanad\u00e1Cabo VerdePa\u00edses Bajos del CaribeKazajst\u00e1nKeniaKirguist\u00e1nKiribatiCocosIslasCongoCongo, Rep\u00fablica Democr\u00e1tica delCorea Democr\u00e1tica deCroaciaCubaKuwaitLesothoLetoniaL\u00edbanoLiberiaLibiaLiechtensteinLituaniaLuxemburgoMacaoMadagascarMalawiMalasiaMaldivasMal\u00edMaltaMarruecosMarshall-IslasMartinicaMauritaniaMauricioMayotteM\u00e9xicoMicronesiaMoldaviaM\u00f3nacoMongoliaMontenegroMontserratMozambiqueMyanmarNamibiaNauruNepalNueva CaledoniaNueva ZelandaNicaraguaPa\u00edses BajosN\u00edgerNigeriaNiueNorte MacedoniaIslas NorfolkNoruegaIslas Marianas del NorteOm\u00e1nTimor OrientalPakist\u00e1nPalauPalestina, PalauPalestinePanamaPapua Nueva GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoRwandaRomaniaRussian FederationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre y MiquelonSalomon IslandsZambiaSamoaSan MarinoSaudi ArabiaSwedenSenegalSerbiaSeychellesSierra LeoneZimbabweSingaporeSint MaartenSloveniaSlovakiaSomaliaSpainSri LankaSt. Helena, Ascensi\u00f3n y Trist\u00e1n da CunhaSt. Kitts y NevisSt. LuciaSt. MartinSt. Vicente y las GranadinasSud\u00e1nSurinamSvalbard y Jan MayenSiria, Rep\u00fablica \u00c1rabeSanto Tom\u00e9 y Pr\u00edncipeSud\u00e1fricaGeorgia del Sur y las Islas Sandwich del SurCorea del SurSud\u00e1n del SurTayikist\u00e1nTaiw\u00e1nTanzania, Rep\u00fablica Unida deTailandiaTogoTokelauTongaTrinidad y TobagoRep\u00fablica ChecaT\u00fanezTurkmenist\u00e1nTurcos e Islas CaicosTuvalu y CaicosTuvaluTurqu\u00edaIslas Menores de los EE.UU.UgandaUcraniaHungr\u00edaUruguayUsbekist\u00e1nVanuatuVenezuelaEmiratos \u00c1rabes UnidosEstados Unidos de Am\u00e9ricaVietnamIsla de NavidadBielorrusiaS\u00e1hara OccidentalRep\u00fablica CentroafricanaChipreEgiptoGuinea Ecuatorial\u00c4tiop\u00eda\u00c5Islas V\u00edrgenes Brit\u00e1nicasAustria Pa\u00eds Tel\u00e9fono*Correo electr\u00f3nico Tipo y alcance de la lesi\u00f3n* \u00bfLlevaba puesto el cintur\u00f3n de seguridad? S\u00ed No Hospitalizaci\u00f3n* S\u00ed No \u00bfEn qu\u00e9 hospital? \u00bfEl accidente se produjo al ir o al volver del trabajo?* S\u00ed No \u00bfTiene el lesionado un seguro obligatorio de pensiones? S\u00ed No Consentimiento* Acepto la pol\u00edtica de privacidad. CAPTCHA cuestionario para demandantes como descarga Si se decide por la opci\u00f3n escrita, env\u00edenosla - preferiblemente por correo electr\u00f3nico - a versicherung@kvg-bus.de Verkehrsbetriebe Bachstein GmbH | Nienburger Stra\u00dfe 50, 29225 Celle AL CUESTIONARIO COMO PDF \u00a1Su contacto con nosotros! \u00bfTiene alguna pregunta o quiere decirnos algo? Estamos a su disposici\u00f3n los jueves de 8 a 16 horas y los viernes de 8 a 12 horas. 05141 48708-54 versicherung@kvg-bus.de \u00a1Cont\u00e1ctenos! \u00bfTiene alguna pregunta o quiere decirnos algo? Puede ponerse en contacto con nosotros los jueves de 8.00 a 16.00 horas y los viernes de 8.00 a 12.00 horas. 05141 48708-54 versicherung@kvg-bus.de \u00bfQu\u00e9 le parece nuestro sitio web? SobresalienteMuy bienNeutralNo est\u00e1 bienNo tiene miedo\u00bfEn qu\u00e9 p\u00e1gina se encuentra?(obligatorio) \u00bfDesea decirnos algo m\u00e1s?<\/p>","protected":false},"author":4,"featured_media":1567,"parent":16,"menu_order":27,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1667","page","type-page","status-publish","has-post-thumbnail","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Schadenabwicklung - KVG Heidekreis<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/kvg-bus.de\/heidekreis\/servicio\/liquidacion-de-siniestros\/\" \/>\n<meta property=\"og:locale\" content=\"es_ES\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Schadenabwicklung - KVG Heidekreis\" \/>\n<meta property=\"og:description\" content=\"SCHADENABWICKLUNG BEI UNF\u00c4LLEN Du hattest einen Unfall mit einem unserer Fahrzeugen? Kein Problem wir helfen dir gerne weiter. Wenn du einen Unfall mit der KVG hattest, bitten wir dich, vor Einleitung weiterer Schritte Kontakt mit uns aufzunehmen. Den Fragebogen f\u00fcr Antragsteller kannst du\u00a0online ausf\u00fcllen oder als PDF herunterladen. Bitte f\u00fcgen deinem Schreiben alle relevanten Informationen und Unterlagen zum Unfall (z. B. Fotos, Zeugenaussagen, Polizeibericht) bei, damit wir dein Anliegen z\u00fcgig bearbeiten k\u00f6nnen. Fragebogen f\u00fcr Anspruchssteller \u201e*\u201c zeigt erforderliche Felder an Pers\u00f6nliche Angaben Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Telefon*E-Mail* Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#039;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Angaben zum Unfall Ort* Datum* TagTag12345678910111213141516171819202122232425262728293031MonatMonat123456789101112JahrJahr20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Zeit* Stunden : Minuten Stra\u00dfe\/Kreuzung*Linie\/Fahrtnummer*HaltestelleBus-KennzeichenName Fahrer\/-inUnfallschilderung*Datei Ziehe Dateien hier her oder W\u00e4hle Dateien aus Max. Dateigr\u00f6\u00dfe: 32 MB. Zeugen Gibt es Zeugen?* Ja Nein Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ Telefon Gibt es weitere Zeugen?* Ja Nein Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ Telefon* Polizeiaufnahme DienststelleVorgangsnummer Anschrift Anschrift Stadt PLZ DateiMax. Dateigr\u00f6\u00dfe: 32 MB. Sachsch\u00e4den Liegt eine Sachbesch\u00e4digung vor?* Ja Nein Was wurde besch\u00e4digt?* Eigent\u00fcmer (evtl. Leasinggeber)* Vorname Nachname Vorsteuerabzugsberechtigt?* Ja Nein Besch\u00e4digung an Kraftfahrzeugen &#8211; PKW, LKW etc. (falls vorhanden) Liegt eine Besch\u00e4digung an einem Kraftfahrzeug vor?* Ja Nein Art*PKW (Auto)Nutzfahrzeuge (LKW)Zweirad (Roller, Motorrad)Land-\/ BaumaschinenWohnmobil\/WohnwagenHersteller*TypAmtl. Kennzeichen*Versicherung* Personensch\u00e4den Liegen Personensch\u00e4den vor?* Ja Nein Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#039;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Telefon*E-Mail Art und Umfang der Verletzung* Sicherheitsgurt angelegt? Ja Nein Krankenhausaufenthalt?* Ja Nein Welches Krankenhaus? Ereignete sich der Unfall auf dem Weg von oder zur Arbeit?* Ja Nein Ist der Verletzte gesetzlich rentenversichert? Ja Nein Wurden weitere Personen verletzt?* Ja Nein Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#039;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Telefon*E-Mail Art und Umfang der Verletzung* Sicherheitsgurt angelegt? Ja Nein Krankenhausaufenthalt?* Ja Nein Welches Krankenhaus? Ereignete sich der Unfall auf dem Weg von oder zur Arbeit?* Ja Nein Ist der Verletzte gesetzlich rentenversichert? Ja Nein Einwilligung* Ich stimme der Datenschutzerkl\u00e4rung zu. CAPTCHA Fragebogen f\u00fcr Anspruchssteller als Download Solltest du dich f\u00fcr die schriftliche M\u00f6glichkeit entscheide sende uns diesen &#8211; bevorzugt per E-Mail &#8211; an\u00a0 versicherung@kvg-bus.de Verkehrsbetriebe Bachstein GmbH | Nienburger Stra\u00dfe 50, 29225 Celle ZUM FRAGEBOGEN ALS PDF Dein Kontakt zu uns! Du hast Fragen oder m\u00f6chtest uns etwas mitteilen? Wir sind donnerstags von 8 &#8211; 16 Uhr und freitags von 8 &#8211; 12 Uhr f\u00fcr dich erreichbar.\u00a0 05141 48708-54 versicherung@kvg-bus.de Dein Kontakt zu uns! Du hast Fragen oder m\u00f6chtest uns etwas mitteilen? Wir sind donnerstags von 8 &#8211; 16 Uhr und freitags von 8 &#8211; 12 Uhr f\u00fcr dich erreichbar.\u00a0 05141 48708-54 versicherung@kvg-bus.de Wie gut gef\u00e4llt dir unsere Website?HerausragendVorwiegend gutNeutralNicht gutFurchtbarAuf welcher Seite befindest du dich?(erforderlich) M\u00f6chtest du uns sonst noch etwas sagen?\" \/>\n<meta property=\"og:url\" content=\"https:\/\/kvg-bus.de\/heidekreis\/servicio\/liquidacion-de-siniestros\/\" \/>\n<meta property=\"og:site_name\" content=\"KVG Heidekreis\" \/>\n<meta property=\"article:modified_time\" content=\"2025-10-30T08:32:11+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/kvg-bus.de\/heidekreis\/service\/schadenabwicklung\/\",\"url\":\"https:\/\/kvg-bus.de\/heidekreis\/service\/schadenabwicklung\/\",\"name\":\"Schadenabwicklung - KVG Heidekreis\",\"isPartOf\":{\"@id\":\"https:\/\/kvg-bus.de\/heidekreis\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/kvg-bus.de\/heidekreis\/service\/schadenabwicklung\/#primaryimage\"},\"image\":{\"@id\":\"https:\/\/kvg-bus.de\/heidekreis\/service\/schadenabwicklung\/#primaryimage\"},\"thumbnailUrl\":\"https:\/\/kvg-bus.de\/heidekreis\/wp-content\/uploads\/sites\/14\/header_fuer_den_fahrgast.png\",\"datePublished\":\"2025-10-09T11:57:19+00:00\",\"dateModified\":\"2025-10-30T08:32:11+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/kvg-bus.de\/heidekreis\/service\/schadenabwicklung\/#breadcrumb\"},\"inLanguage\":\"es\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/kvg-bus.de\/heidekreis\/service\/schadenabwicklung\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"es\",\"@id\":\"https:\/\/kvg-bus.de\/heidekreis\/service\/schadenabwicklung\/#primaryimage\",\"url\":\"https:\/\/kvg-bus.de\/heidekreis\/wp-content\/uploads\/sites\/14\/header_fuer_den_fahrgast.png\",\"contentUrl\":\"https:\/\/kvg-bus.de\/heidekreis\/wp-content\/uploads\/sites\/14\/header_fuer_den_fahrgast.png\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/kvg-bus.de\/heidekreis\/service\/schadenabwicklung\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Startseite\",\"item\":\"https:\/\/kvg-bus.de\/heidekreis\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Service\",\"item\":\"https:\/\/kvg-bus.de\/heidekreis\/service\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Schadenabwicklung\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/kvg-bus.de\/heidekreis\/#website\",\"url\":\"https:\/\/kvg-bus.de\/heidekreis\/\",\"name\":\"KVG Heidekreis\",\"description\":\"\",\"publisher\":{\"@id\":\"https:\/\/kvg-bus.de\/heidekreis\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\/\/kvg-bus.de\/heidekreis\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"es\"},{\"@type\":\"Organization\",\"@id\":\"https:\/\/kvg-bus.de\/heidekreis\/#organization\",\"name\":\"KVG Heidekreis\",\"url\":\"https:\/\/kvg-bus.de\/heidekreis\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"es\",\"@id\":\"https:\/\/kvg-bus.de\/heidekreis\/#\/schema\/logo\/image\/\",\"url\":\"https:\/\/kvg-bus.de\/heidekreis\/wp-content\/uploads\/sites\/14\/kvg_logo-1.svg\",\"contentUrl\":\"https:\/\/kvg-bus.de\/heidekreis\/wp-content\/uploads\/sites\/14\/kvg_logo-1.svg\",\"caption\":\"KVG Heidekreis\"},\"image\":{\"@id\":\"https:\/\/kvg-bus.de\/heidekreis\/#\/schema\/logo\/image\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Liquidaci\u00f3n de siniestros - KVG Heidekreis","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/kvg-bus.de\/heidekreis\/servicio\/liquidacion-de-siniestros\/","og_locale":"es_ES","og_type":"article","og_title":"Schadenabwicklung - KVG Heidekreis","og_description":"SCHADENABWICKLUNG BEI UNF\u00c4LLEN Du hattest einen Unfall mit einem unserer Fahrzeugen? Kein Problem wir helfen dir gerne weiter. Wenn du einen Unfall mit der KVG hattest, bitten wir dich, vor Einleitung weiterer Schritte Kontakt mit uns aufzunehmen. Den Fragebogen f\u00fcr Antragsteller kannst du\u00a0online ausf\u00fcllen oder als PDF herunterladen. Bitte f\u00fcgen deinem Schreiben alle relevanten Informationen und Unterlagen zum Unfall (z. B. Fotos, Zeugenaussagen, Polizeibericht) bei, damit wir dein Anliegen z\u00fcgig bearbeiten k\u00f6nnen. Fragebogen f\u00fcr Anspruchssteller \u201e*\u201c zeigt erforderliche Felder an Pers\u00f6nliche Angaben Anrede*HerrFrauKeine Angabe Name* Vorname Nachname Telefon*E-Mail* Anschrift* Anschrift Stadt PLZ AfghanistanAlbanienAlgerienAmerikanisch-SamoaAmerikanische JungferninselnAndorraAngolaAnguillaAntarktisAntigua und BarbudaArgentinienArmenienArubaAserbaidschanAustralienBahamasBahrainBangladeshBarbadosBelgienBelizeBeninBermudaBhutanBolivienBosnien und HerzegowinaBotswanaBouvetinselBrasilienBritische JungferninselnBritisches Territorium im Indischen OzeanBrunei DarussalamBulgarienBurkina FasoBurundiCaymen InselnChileChinaCookinselnCosta RicaCura\u00e7aoC\u00f4te d&#039;IvoireDemokratische Volksrepublik LaosDeutschlandDjiboutiDominicaDominikanische RepublikD\u00e4nemarkEcuadorEl SalvadorEritreaEstlandEswatiniFalklandinselnFidschiFinnlandFrankreichFranz\u00f6sisch-GuayanaFranz\u00f6sisch-PolynesienFranz\u00f6sische S\u00fcd- und AntarktisgebieteFutuna (Wallis und Futuna)F\u00e4r\u00f6er-InselnGabunGambiaGeorgiaGhanaGibraltarGrenadaGriechenlandGro\u00dfbritannienGr\u00f6nlandGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard und McDonaldinselnHeiliger StuhlHondurasHongkongIndienIndonesienIrakIranIrlandIslandIsle of ManIsraelItalienJamaikaJapanJemenJerseyJordanienKambodschaKamerunKanadaKap VerdeKaribische NiederlandeKasachstanKatarKeniaKirgistanKiribatiKokosinselnKolumbienKomorenKongoKongo, Demokratische Republik desKorea. Demokratische VolksrepublikKroatienKubaKuwaitLesothoLettlandLibanonLiberiaLibyenLiechtensteinLitauenLuxemburgMacauMadagaskarMalawiMalaysiaMaledivenMaliMaltaMarokkoMarshall-InselnMartiniqueMauretanienMauritiusMayotteMexikoMikronesienMoldawienMonacoMongoleiMontenegroMontserratMosambikMyanmarNamibiaNauruNepalNeukaledonienNeuseelandNicaraguaNiederlandeNigerNigeriaNiueNordmazedonienNorfolkinselNorwegenN\u00f6rdliche MarianenOmanOsttimorPakistanPalauPal\u00e4stina, BundesstaatPanamaPapua Neu GuineaParaguayPeruPhilippinenPitcairninselnPolenPortugalPuerto RicoRuandaRum\u00e4nienRussische F\u00f6derationR\u00e9unionSaint-Barth\u00e9lemySaint-Pierre und MiquelonSalomonenSambiaSamoaSan MarinoSaudi-ArabienSchwedenSchweizSenegalSerbienSeychellenSierra LeoneSimbabweSingapurSint MaartenSlovenienSlowakeiSomaliaSpanienSri LankaSt. Helena, Ascension und Tristan da CunhaSt. Kitts und NevisSt. LuciaSt. MartinSt. Vincent und die GrenadinenSudanSurinamSvalbard und Jan MayenSyrien, Arabische RepublikS\u00e3o Tom\u00e9 und Pr\u00edncipeS\u00fcdafrikaS\u00fcdgeorgien und die S\u00fcdlichen SandwichinselnS\u00fcdkoreaS\u00fcdsudanTadschikistanTaiwanTansania, Vereinte RepublikThailandTogoTokelauTongaTrinidad und TobagoTschadTschechienTunesienTurkmenistanTurks- und CaicosinselnTuvaluT\u00fcrkeiUS Minor Outlying IslandsUgandaUkraineUngarnUruguayUsbekistanVanuatuVenezuelaVereinigte Arabische EmirateVereinigte Staaten von AmerikaVietnamWeihnachtsinselWei\u00dfrusslandWestsaharaZentralafrikanische RepublikZypern\u00c4gypten\u00c4quatorial Guinea\u00c4thopien\u00c5landinseln\u00d6sterreich Land Angaben zum Unfall Ort* Datum* TagTag12345678910111213141516171819202122232425262728293031MonatMonat123456789101112JahrJahr20262025202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920 Zeit* Stunden : Minuten Stra\u00dfe\/Kreuzung*Linie\/Fahrtnummer*HaltestelleBus-KennzeichenName Fahrer\/-inUnfallschilderung*Datei Ziehe Dateien hier her oder W\u00e4hle Dateien aus Max. 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