{"id":19920,"date":"2023-11-21T15:46:42","date_gmt":"2023-11-21T15:46:42","guid":{"rendered":"https:\/\/www.worcestercity.org.uk\/forms\/?page_id=19920"},"modified":"2023-11-21T15:46:42","modified_gmt":"2023-11-21T15:46:42","slug":"property-flood-resilience-grant","status":"publish","type":"page","link":"https:\/\/www.worcestercity.org.uk\/forms\/property-flood-resilience-grant\/","title":{"rendered":"Property Flood Resilience Grant Application"},"content":{"rendered":"<style type=\"text\/css\" id=\"163\" data-form-unique-id=\"14045\" >.arf_heading_div h2.arf_sec_heading_field {\r\n\tfont-size: 20px !important;\r\n}\r\n.alert {\r\n\tcolor: red;\r\n\tborder: 3px solid #000;\r\n\tpadding: 10px;\r\n\tfont-size: 1.3em;\r\n}\r\n.alert2 {\r\n\tcolor: #000;\r\n\tborder: 2px solid #000;\r\n\tpadding: 10px;\r\n\tfont-size: 1.3em;\r\n}\r\n.arf_main_label {\r\n\tmargin-bottom: 10px !important;\r\n\tfont-weight: bolder !important;\r\n\tfont-size: 17px !important;\r\n}\r\ndiv.arf_field_description\t{\r\n\ttext-align: left !important;\r\n}\r\nlabel span.arfcheckrequiredfield {\r\n\tcolor: red !important;\r\n}\r\n.dot {\r\n  height: 10px;\r\n  width: 10px;\r\n  background-color: #000;\r\n  border-radius: 50%;\r\n  display: inline-block;\r\n}\r\n.arf_field_description {\r\n\tfont-size: 14px !important;\r\n}\r\n.arf_repeater_field {\r\n\tborder: 1px solid #CCC;\r\n\tpadding: 15px;\r\n}\r\n\/*\r\n.arf_heading_div {\r\n\tborder: 1px solid #000;\r\n\tmargin-bottom: 30px !important;\r\n\tpadding-right: 10px !important;\r\n}\r\n*\/<\/style><div class=\"arf_form ar_main_div_163 arf_form_outer_wrapper \" id=\"arffrm_163_container\"><div id=\"arf_message_error\" class=\"frm_error_style\" style=\"display:none;\"><div class=\"msg-detail\"><div class=\"msg-description-success\">Form Submission is restricted<\/div><\/div><\/div><div id=\"arf_message_success_popup\" style=\"display:none;\"><div class=\"msg-detail\"><div class=\"msg-description-success\"><p>Thank you for completing this application.<\/p>  \n\n<p>We will review the application, and then confirm eligibility and approval in principle, and provide you with a reference number for use in all further correspondence.<\/p><\/div><\/div><\/div><form enctype=\"multipart\/form-data\" method=\"post\" class=\"arfshowmainform  \" style=\"\" data-form-id=\"form_kzomxd\"  novalidate=\"\" onsubmit=\"return arf_validate_form_submit()\" arf_form_submit = 0 data-id=\"14045\"  data-random-id=\"163_m8olln3tsI\"  data-submission-key=\"x2uiG9fA\"  data-key-validate=\"false\"  data-popup-id=\"\"><label for='arf_filter_input_163_m8olln3tsI' class='arf_hidden_element' style='color:transparent !important;'>Filter<\/label><input id='arf_filter_input_163_m8olln3tsI' type='text' name='arf_filter_input' data-jqvalidate='false' data-random-key='163_m8olln3tsI' value='' style='opacity:0 !important;display:none !important;visibility:hidden !important;' \/><input type='hidden' id='arf_ajax_url' value='https:\/\/www.worcestercity.org.uk\/forms\/wp-admin\/admin-ajax.php' \/><input type=\"hidden\" data-jqvalidate=\"false\" class=\"kpress\" value=\"\" \/><input type=\"hidden\" data-jqvalidate=\"false\" class=\"stime\" value=\"1775666401\" \/><input type=\"hidden\" data-jqvalidate=\"false\" data-id=\"nonce_start_time\" class=\"nonce_start_time\" value=\"form_filter_st\" \/><input type=\"hidden\" data-jqvalidate=\"false\" data-id=\"nonce_keyboard_press\" class=\"nonce_keyboard_press\" value=\"form_filter_kp\" \/><input type=\"hidden\" data-jqvalidate=\"false\" data-id=\"arm_nonce_check\" name=\"arm_nonce_check\" value=\"c4bb7dba38\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_redirect_url_to\" id=\"arf_redirect_url_to\" value=\"same_tab\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_browser_name\" data-id=\"arf_browser_name\" data-version=\"unknown\" value=\"Unknown\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arforms_nonce\" id=\"arforms_nonce\" value=\"18d357a036\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfdecimal_separator\" data-id=\"arfdecimal_separator\" value=\".\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfform_date_formate_163\" data-id=\"arfform_date_formate_163\" value=\"DD\/MM\/YYYY\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_key_163\" data-id=\"form_key_163\" value=\"kzomxd\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_success_message_show_time_163\" data-id=\"arf_success_message_show_time_163\" value=\"30\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_form_hide_after_submit_163\" data-id=\"arf_form_hide_after_submit_163\" value=\"1\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"is_form_preview_163\" data-id=\"is_form_preview_163\" value=\"\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_validate_outside_163\" data-id=\"arf_validate_outside_163\" data-validate=\"0\" value=\"0\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_is_validate_outside_163\" data-id=\"arf_is_validate_outside_163\" data-validate=\"0\" value=\"0\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_is_resetform_aftersubmit_163\" data-id=\"arf_is_resetform_aftersubmit_163\" value=\"1\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_is_resetform_outside_163\" data-id=\"arf_is_resetform_outside_163\" value=\"0\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_form_enable_cookie_163\" data-id=\"arf_form_enable_cookie_163\" value=\"\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_tooltip_settings_163\" data-id=\"arf_tooltip_settings_163\" class=\"arf_front_tooltip_settings\" data-form-id=\"163\" data-color=\"#FFFFFF\" data-position=\"top\" data-width=\"\" data-bg-color=\"#000000\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfsuccessmsgposition_163\" data-id=\"arfsuccessmsgposition_163\"  value=\"top\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfpagebreakstyle_163\" data-id=\"arfpagebreakstyle_163\"  value=\"number\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfpagebreakaddtimer_163\" data-id=\"arfpagebreakaddtimer_163\" value=\"0\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_tooltip_error_163\" data-id=\"form_tooltip_error_163\" data-color=\"\" data-position=\"bottom\" value=\"advance\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arfaction\" value=\"create\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_id\" data-id=\"form_id\" value=\"163\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_data_id\" data-id=\"form_data_id\" value=\"14045\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_key\" data-id=\"form_key\" value=\"kzomxd\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_ajax_url\" value=\"https:\/\/www.worcestercity.org.uk\/forms\/wp-admin\/admin-ajax.php\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_display_type\" data-id=\"form_display_type\" value=\"0|https:\/\/www.worcestercity.org.uk\/forms\/property-flood-resilience-grant\/\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"form_submit_type\" data-id=\"form_submit_type\" value=\"1\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_http_referrer_url\" data-id=\"arf_http_referrer_url\" value=\"\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"entry_key\" value=\"\" \/><input type=\"hidden\" data-jqvalidate=\"false\" name=\"arf_skip_captcha\" data-id=\"arf_skip_captcha\" value=\"\" \/><input type='hidden' id='arf_pb_field_animation_style_front_163' name='arf_pb_field_animation_style_front_163' value='slideInLeft' \/><input type='hidden' id='arf_pb_field_animation_duration_front_163' name='arf_pb_field_animation_duration_front_163' value='' \/><input type='hidden' id='arf_pb_field_animation_delay_front_163' name='arf_pb_field_animation_delay_front_163' value='' \/><input type='hidden' id='arf_pb_field_animation_inherit_163' name='arf_pb_field_animation_inherit_163' value='0' \/><input type='hidden' id='arf_field_animation_style_front_163' name='arf_field_animation_style_front_163' value='' \/><input type='hidden' id='arf_field_animation_duration_front_163' name='arf_field_animation_duration_front_163' value='' \/><input type='hidden' id='arf_field_animation_delay_front_163' name='arf_field_animation_delay_front_163' value='' \/><input type=\"hidden\" id=\"arf_form_site_wide_163\" value=\"\" \/><div class=\"allfields\" style=\"visibility:hidden;height:0;\"><div class=\"arf_fieldset arf_standard_form\" id=\"arf_fieldset_14045\"><div id=\"page_0\" class=\"page_break\"><div id=\"arf_field_3309_14045_container\" class=\"    arfformfield arf_display_to_confirmation_summary control-group arfmainformfield  arf_field_type_html  top_container  top_container arfformfield  arf_field_3309\" data-field-type=\"html\" data-parent_field=\"0\" style='width: 100%'><div class=\"arf_htmlfield_control\">Please note that grants are intended only to fund measures which improve the property\u2019s resilience or resistance to flooding, over and above repairs that would normally be covered by insurance. More advice can be found \n on the <a href=\"https:\/\/www.floodguidance.co.uk\/\" target=\"_new\">Flood Guidance website<\/a>.\n\n<p>Please ensure you have read the <a href=\"https:\/\/www.worcester.gov.uk\/filelink\/fileman-files\/PDF Documents\/Community Safety\/Grants\/Floods\/Flood Resilience Grant\/Property Flood Resilience Grant Terms and Conditions.pdf\" target=\"_new\">Terms and Conditions<\/a> and <a href=\"https:\/\/www.worcester.gov.uk\/filelink\/fileman-files\/PDF Documents\/Community Safety\/Grants\/Floods\/Flood Resilience Grant\/Property Flood Resilience Grant - How the scheme works.pdf\" target=\"_new\">How the Scheme Works Guidance<\/a> before completing this form.<\/p><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3313_14045_container\" class=\"      arfformfield control-group arfmainformfield  arf_horizontal_radio  arffieldrequired arf_field_type_radio   top_container  top_container arfformfield  arf_field_3313\"  style='width: 100%'  data-field-type=\"radio\" data-parent_field=\"0\"><label data-type=\"radio\" for=\"field_sv8fas_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Is your grant application for Property Flood Resilience work that you have already carried out?<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"setting_radio controls arf_standard_radio \" style=\"padding-top:5px;\"><div class=\"arf_radiobutton \"><div class='arf_radio_input_wrapper'><input type=\"radio\" name=\"item_meta[3313]\" data-type=\"radio\" id=\"field_3313-0-14045\" data-unique-id=\"14045\" value=\"Yes\"   class=\" arf_required \" data-validation-minchecked-minchecked=\"1\" data-validation-minchecked-message=\"This field cannot be blank.\" style=\" \" \/><span><\/span><\/div><label data-type=\"radio\" for=\"field_3313-0-14045\" class=\"\">Yes<\/label><\/div><div class=\"arf_radiobutton \"><div class='arf_radio_input_wrapper'><input type=\"radio\" name=\"item_meta[3313]\" data-type=\"radio\" id=\"field_3313-1-14045\" data-unique-id=\"14045\" value=\"No\"   class=\" arf_required \" style=\" \" \/><span><\/span><\/div><label data-type=\"radio\" for=\"field_3313-1-14045\" class=\"\">No<\/label><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3344_14045_container\" class=\"    arfformfield arf_display_to_confirmation_summary control-group arfmainformfield  arf_field_type_html  top_container  top_container arfformfield  arf_field_3344\" data-field-type=\"html\" data-parent_field=\"0\" style='width: 100%'><div class=\"arf_htmlfield_control\"><h2>Applicant Information<\/h2><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3310_14045_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_3310\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><label data-type=\"text\" for=\"field_q8dha1_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Name of applicant<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls\"   ><input   type=\"text\" id=\"field_q8dha1_14045\"  name=\"item_meta[3310]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><\/div><\/div><div style=\"clear:both;\"><\/div><input type=\"hidden\" id=\"arf_repeatable_field_counter_3316\" data-max_add=\"0\" value=\"1\" \/><div id=\"heading_3316\" class=\"arf_heading_div  \"><h2 class='arf_sec_heading_field pos_top  ' style='display:block'; data-field-type='section' >Flooded property address<\/h2><div class=\"arf_field_description arf_heading_description\"><\/div><div id=\"arf_field_3314_14045_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_3314\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"3316\" ><label data-type=\"text\" for=\"field_dhjo0r_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Address 1<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls\"   ><input   type=\"text\" id=\"field_dhjo0r_14045\"  name=\"item_meta[3314]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3312_14045_container\" class=\"    arfformfield control-group arfmainformfield  arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_3312\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"3316\" ><label data-type=\"text\" for=\"field_e7xxkr_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Address 2<\/label><div class=\"controls\"   ><input   type=\"text\" id=\"field_e7xxkr_14045\"  name=\"item_meta[3312]\"   \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3311_14045_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_3311\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"3316\" ><label data-type=\"text\" for=\"field_a9rl2q_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Town\/City<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls\"   ><input   type=\"text\" id=\"field_a9rl2q_14045\"  name=\"item_meta[3311]\"  class=\" arf_required \" value=\"Worcester\"  data-validation-required-message=\"This field cannot be blank.\"   \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3315_14045_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_3315\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"3316\" ><label data-type=\"text\" for=\"field_s30zwh_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Postcode<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls\"   ><input   type=\"text\" id=\"field_s30zwh_14045\"  name=\"item_meta[3315]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><\/div><\/div><div style=\"clear:both;\"><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3318_14045_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_3318\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><label data-type=\"text\" for=\"field_s9v9r5_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Who is the owner of the property?<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls\"   ><input   type=\"text\" id=\"field_s9v9r5_14045\"  name=\"item_meta[3318]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3319_14045_container\" class=\"    arfformfield control-group arfmainformfield  arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_3319\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><label data-type=\"text\" for=\"field_581cmz_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Business name (If applicable)<\/label><div class=\"controls\"   ><input   type=\"text\" id=\"field_581cmz_14045\"  name=\"item_meta[3319]\"   \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3317_14045_container\" class=\"    arfformfield control-group arfmainformfield  arf_field_type_textarea  top_container top_container arfformfield   arf_inline_field_value  arf_field_3317\"  style='width: 100%'  data-field-type=\"textarea\" data-parent_field=\"0\"><label data-type=\"textarea\" for=\"field_8u16bh_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Contact address  (if different from above)<\/label><div class=\"controls\"   ><textarea name=\"item_meta[3317]\" id=\"field_8u16bh_14045\"  rows=\"3\"  ><\/textarea><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3323_14045_container\" class=\"    arfformfield control-group arfmainformfield  arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_3323\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><label data-type=\"text\" for=\"field_dp9p45_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Contact Postcode (if different from above)<\/label><div class=\"controls\"   ><input   type=\"text\" id=\"field_dp9p45_14045\"  name=\"item_meta[3323]\"   \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3322_14045_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_3322\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><label data-type=\"text\" for=\"field_rqtlyl_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Telephone Number<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls\"   ><input   type=\"text\" id=\"field_rqtlyl_14045\"  name=\"item_meta[3322]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3324_14045_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_3324\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><label data-type=\"text\" for=\"field_acut3k_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Mobile Number<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls\"   ><input   type=\"text\" id=\"field_acut3k_14045\"  name=\"item_meta[3324]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3320_14045_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_email  top_container  arf_inline_field_value   top_container arfformfield  arf_field_3320\"  style='width: 100%'  data-field-type=\"email\" data-parent_field=\"0\"><label data-type=\"email\" for=\"field_lukdht_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >E-mail<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls\"   ><input type=\"text\" id=\"field_lukdht_14045\" name=\"item_meta[3320]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"  data-validation-regex-regex=\"[\\p{L}0-9._-]+@[\\p{L}0-9.-]+\\.[\\p{L}]+\" data-validation-regex-message=\"Email is invalid\"  \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3321_14045_container\" class=\"      arfformfield control-group arfmainformfield  arf_horizontal_radio  arffieldrequired arf_field_type_radio   top_container  top_container arfformfield  arf_field_3321\"  style='width: 100%'  data-field-type=\"radio\" data-parent_field=\"0\"><label data-type=\"radio\" for=\"field_zbqfil_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >How would you prefer us to contact you?<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"setting_radio controls arf_standard_radio \" style=\"padding-top:5px;\"><div class=\"arf_radiobutton \"><div class='arf_radio_input_wrapper'><input type=\"radio\" name=\"item_meta[3321]\" data-type=\"radio\" id=\"field_3321-0-14045\" data-unique-id=\"14045\" value=\"Email\"   class=\" arf_required \" data-validation-minchecked-minchecked=\"1\" data-validation-minchecked-message=\"This field cannot be blank.\" style=\" \" \/><span><\/span><\/div><label data-type=\"radio\" for=\"field_3321-0-14045\" class=\"\">Email<\/label><\/div><div class=\"arf_radiobutton \"><div class='arf_radio_input_wrapper'><input type=\"radio\" name=\"item_meta[3321]\" data-type=\"radio\" id=\"field_3321-1-14045\" data-unique-id=\"14045\" value=\"Post\"   class=\" arf_required \" style=\" \" \/><span><\/span><\/div><label data-type=\"radio\" for=\"field_3321-1-14045\" class=\"\">Post<\/label><\/div><div class=\"arf_field_description \">Please note we will use the email address or contact address indicated above.<\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3329_14045_container\" class=\"    arfformfield arf_display_to_confirmation_summary control-group arfmainformfield  arf_field_type_html  top_container  top_container arfformfield  arf_field_3329\" data-field-type=\"html\" data-parent_field=\"0\" style='width: 100%'><div class=\"arf_htmlfield_control\"><h2>Insurance \/ Repair contact details<\/h2><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3325_14045_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_3325\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><label data-type=\"text\" for=\"field_yub1re_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Name of Insurer<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls\"   ><input   type=\"text\" id=\"field_yub1re_14045\"  name=\"item_meta[3325]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3330_14045_container\" class=\"      arfformfield control-group arfmainformfield  arf_horizontal_radio  arffieldrequired arf_field_type_radio   top_container  top_container arfformfield  arf_field_3330\"  style='width: 100%'  data-field-type=\"radio\" data-parent_field=\"0\"><label data-type=\"radio\" for=\"field_gng7zq_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >I agree to allow my insurance company to share data with Worcester City Council.<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"setting_radio controls arf_standard_radio \" style=\"padding-top:5px;\"><div class=\"arf_radiobutton \"><div class='arf_radio_input_wrapper'><input type=\"radio\" name=\"item_meta[3330]\" data-type=\"radio\" id=\"field_3330-0-14045\" data-unique-id=\"14045\" value=\"Yes\"   class=\" arf_required \" data-validation-minchecked-minchecked=\"1\" data-validation-minchecked-message=\"This field cannot be blank.\" style=\" \" \/><span><\/span><\/div><label data-type=\"radio\" for=\"field_3330-0-14045\" class=\"\">Yes<\/label><\/div><div class=\"arf_radiobutton \"><div class='arf_radio_input_wrapper'><input type=\"radio\" name=\"item_meta[3330]\" data-type=\"radio\" id=\"field_3330-1-14045\" data-unique-id=\"14045\" value=\"No\"   class=\" arf_required \" style=\" \" \/><span><\/span><\/div><label data-type=\"radio\" for=\"field_3330-1-14045\" class=\"\">No<\/label><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3327_14045_container\" class=\"      arfformfield control-group arfmainformfield  arf_horizontal_radio  arffieldrequired arf_field_type_radio   top_container  top_container arfformfield  arf_field_3327\"  style='width: 100%'  data-field-type=\"radio\" data-parent_field=\"0\"><label data-type=\"radio\" for=\"field_h36v6c_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >I will be nominating my Insurer to progress my application for PFR Grant on my behalf<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"setting_radio controls arf_standard_radio \" style=\"padding-top:5px;\"><div class=\"arf_radiobutton \"><div class='arf_radio_input_wrapper'><input type=\"radio\" name=\"item_meta[3327]\" data-type=\"radio\" id=\"field_3327-0-14045\" data-unique-id=\"14045\" value=\"Yes\"   class=\" arf_required \" data-validation-minchecked-minchecked=\"1\" data-validation-minchecked-message=\"This field cannot be blank.\" style=\" \" \/><span><\/span><\/div><label data-type=\"radio\" for=\"field_3327-0-14045\" class=\"\">Yes<\/label><\/div><div class=\"arf_radiobutton \"><div class='arf_radio_input_wrapper'><input type=\"radio\" name=\"item_meta[3327]\" data-type=\"radio\" id=\"field_3327-1-14045\" data-unique-id=\"14045\" value=\"No\"   class=\" arf_required \" style=\" \" \/><span><\/span><\/div><label data-type=\"radio\" for=\"field_3327-1-14045\" class=\"\">No<\/label><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3326_14045_container\" class=\"    arfformfield arf_display_to_confirmation_summary control-group arfmainformfield  arf_field_type_html  top_container  top_container arfformfield  arf_field_3326\" data-field-type=\"html\" data-parent_field=\"0\" style='width: 100%'><div class=\"arf_htmlfield_control\"><h2>Flooded Property<\/h2>\n<p>The grant is only available where the habitable living or business area of a property has been damaged by entry of floodwater, necessitating drying out and\/or repairs to the fabric of the building.<\/p>\n\n<p>The following are NOT eligible<\/p>\n<ul>\n<li>Garages, outhouses and storage areas are not eligible.<\/li>\n<li>Second homes and empty homes are not eligible.<\/li>\n<li>Basements or cellars not used as part of the habitable or business area are not eligible<\/li>\n<\/ul><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3331_14045_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_textarea  top_container top_container arfformfield   arf_inline_field_value  arf_field_3331\"  style='width: 100%'  data-field-type=\"textarea\" data-parent_field=\"0\"><label data-type=\"textarea\" for=\"field_fegrq_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Which areas of the property were affected?<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls\"   ><textarea name=\"item_meta[3331]\" id=\"field_fegrq_14045\"  rows=\"3\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"  ><\/textarea><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3332_14045_container\" class=\"      arfformfield control-group arfmainformfield  arf_horizontal_radio  arffieldrequired arf_field_type_radio   top_container  top_container arfformfield  arf_field_3332\"  style='width: 100%'  data-field-type=\"radio\" data-parent_field=\"0\"><label data-type=\"radio\" for=\"field_i41ig7_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Does your application relate to a business premises?<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"setting_radio controls arf_standard_radio \" style=\"padding-top:5px;\"><div class=\"arf_radiobutton \"><div class='arf_radio_input_wrapper'><input type=\"radio\" name=\"item_meta[3332]\" data-type=\"radio\" id=\"field_3332-0-14045\" data-unique-id=\"14045\" value=\"Yes\"   class=\" arf_required \" data-validation-minchecked-minchecked=\"1\" data-validation-minchecked-message=\"This field cannot be blank.\" onChange='arf_cl_apply_v3(14045,[\"3333\"]);' style=\" \" \/><span><\/span><\/div><label data-type=\"radio\" for=\"field_3332-0-14045\" class=\"\">Yes<\/label><\/div><div class=\"arf_radiobutton \"><div class='arf_radio_input_wrapper'><input type=\"radio\" name=\"item_meta[3332]\" data-type=\"radio\" id=\"field_3332-1-14045\" data-unique-id=\"14045\" value=\"No\"   class=\" arf_required \" onChange='arf_cl_apply_v3(14045,[\"3333\"]);' style=\" \" \/><span><\/span><\/div><label data-type=\"radio\" for=\"field_3332-1-14045\" class=\"\">No<\/label><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3333_14045_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_textarea  top_container top_container arfformfield   arf_inline_field_value  arf_field_3333\"  style='width: 100%'  data-field-type=\"textarea\" data-parent_field=\"0\"><label data-type=\"textarea\" for=\"field_msubew_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Please provide details of any other public grant funding received during the last three years<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls\"   ><textarea name=\"item_meta[3333]\" id=\"field_msubew_14045\"  rows=\"3\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"  ><\/textarea><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3334_14045_container\" class=\"      arfformfield control-group arfmainformfield  arf_horizontal_radio  arffieldrequired arf_field_type_radio   top_container  top_container arfformfield  arf_field_3334\"  style='width: 100%'  data-field-type=\"radio\" data-parent_field=\"0\"><label data-type=\"radio\" for=\"field_2kmbw1_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Please confirm whether you are willing to pool grants with your neighbours to fund community level flood protection and resilience work where appropriate.<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"setting_radio controls arf_standard_radio \" style=\"padding-top:5px;\"><div class=\"arf_radiobutton \"><div class='arf_radio_input_wrapper'><input type=\"radio\" name=\"item_meta[3334]\" data-type=\"radio\" id=\"field_3334-0-14045\" data-unique-id=\"14045\" value=\"Yes\"   class=\" arf_required \" data-validation-minchecked-minchecked=\"1\" data-validation-minchecked-message=\"This field cannot be blank.\" style=\" \" \/><span><\/span><\/div><label data-type=\"radio\" for=\"field_3334-0-14045\" class=\"\">Yes<\/label><\/div><div class=\"arf_radiobutton \"><div class='arf_radio_input_wrapper'><input type=\"radio\" name=\"item_meta[3334]\" data-type=\"radio\" id=\"field_3334-1-14045\" data-unique-id=\"14045\" value=\"No\"   class=\" arf_required \" style=\" \" \/><span><\/span><\/div><label data-type=\"radio\" for=\"field_3334-1-14045\" class=\"\">No<\/label><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3338_14045_container\" class=\"    arfformfield arf_display_to_confirmation_summary control-group arfmainformfield  arf_field_type_html  top_container  top_container arfformfield  arf_field_3338\" data-field-type=\"html\" data-parent_field=\"0\" style='width: 100%'><div class=\"arf_htmlfield_control\"><h2>Declaration<\/h2><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3337_14045_container\" class=\"    arfformfield control-group arfmainformfield  arf_horizontal_radio  arffieldrequired arf_field_type_checkbox   top_container  top_container arfformfield  arf_field_3337\"  style='width: 100%'  data-field-type=\"checkbox\" data-parent_field=\"0\"><label data-type=\"checkbox\" for=\"field_rs1oke_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >I confirm that I am the owner of the property (either the freeholder or the owner of a lease longer than 21 years) or have permission from the owner of the property to fill out this application form on their behalf.<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"setting_checkbox controls arf_standard_checkbox\" style=\"padding-top:5px;\" ><div class=\"arf_checkbox_style \" id=\"frm_checkbox_3337-0\"><div class='arf_checkbox_input_wrapper '><input type=\"checkbox\" name=\"item_meta[3337][]\" data-type=\"checkbox\" id=\"field_3337-0-14045\" value=\"I confirm\" data-label=\"I confirm\"    class=\" arf_required \"data-validation-minchecked-minchecked=\"1\" data-validation-minchecked-message=\"This field cannot be blank.\" style=''  \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_3337-0-14045\" aria-label=\"I confirm\">I confirm<\/label><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3339_14045_container\" class=\"    arfformfield control-group arfmainformfield  arf_horizontal_radio  arffieldrequired arf_field_type_checkbox   top_container  top_container arfformfield  arf_field_3339\"  style='width: 100%'  data-field-type=\"checkbox\" data-parent_field=\"0\"><label data-type=\"checkbox\" for=\"field_j681bk_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >I confirm, to the best of my knowledge, the information in this form and all other information given in support of this application is correct.<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"setting_checkbox controls arf_standard_checkbox\" style=\"padding-top:5px;\" ><div class=\"arf_checkbox_style \" id=\"frm_checkbox_3339-0\"><div class='arf_checkbox_input_wrapper '><input type=\"checkbox\" name=\"item_meta[3339][]\" data-type=\"checkbox\" id=\"field_3339-0-14045\" value=\"I confirm\" data-label=\"I confirm\"    class=\" arf_required \"data-validation-minchecked-minchecked=\"1\" data-validation-minchecked-message=\"This field cannot be blank.\" style=''  \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_3339-0-14045\" aria-label=\"I confirm\">I confirm<\/label><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3340_14045_container\" class=\"    arfformfield control-group arfmainformfield  arf_horizontal_radio  arffieldrequired arf_field_type_checkbox   top_container  top_container arfformfield  arf_field_3340\"  style='width: 100%'  data-field-type=\"checkbox\" data-parent_field=\"0\"><label data-type=\"checkbox\" for=\"field_qrfhmk_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >I confirm that I understand the purpose of this form and the reasons for the collection of my\/our personal data and that I agree to my\/our personal data being used as stated.<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"setting_checkbox controls arf_standard_checkbox\" style=\"padding-top:5px;\" ><div class=\"arf_checkbox_style \" id=\"frm_checkbox_3340-0\"><div class='arf_checkbox_input_wrapper '><input type=\"checkbox\" name=\"item_meta[3340][]\" data-type=\"checkbox\" id=\"field_3340-0-14045\" value=\"I confirm\" data-label=\"I confirm\"    class=\" arf_required \"data-validation-minchecked-minchecked=\"1\" data-validation-minchecked-message=\"This field cannot be blank.\" style=''  \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_3340-0-14045\" aria-label=\"I confirm\">I confirm<\/label><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3341_14045_container\" class=\"    arfformfield control-group arfmainformfield  arf_horizontal_radio  arffieldrequired arf_field_type_checkbox   top_container  top_container arfformfield  arf_field_3341\"  style='width: 100%'  data-field-type=\"checkbox\" data-parent_field=\"0\"><label data-type=\"checkbox\" for=\"field_e0k16c_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >I confirm that if any information changes I will inform Worcester City Council immediately<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"setting_checkbox controls arf_standard_checkbox\" style=\"padding-top:5px;\" ><div class=\"arf_checkbox_style \" id=\"frm_checkbox_3341-0\"><div class='arf_checkbox_input_wrapper '><input type=\"checkbox\" name=\"item_meta[3341][]\" data-type=\"checkbox\" id=\"field_3341-0-14045\" value=\"I confirm\" data-label=\"I confirm\"    class=\" arf_required \"data-validation-minchecked-minchecked=\"1\" data-validation-minchecked-message=\"This field cannot be blank.\" style=''  \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_3341-0-14045\" aria-label=\"I confirm\">I confirm<\/label><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3342_14045_container\" class=\"    arfformfield control-group arfmainformfield  arf_horizontal_radio  arffieldrequired arf_field_type_checkbox   top_container  top_container arfformfield  arf_field_3342\"  style='width: 100%'  data-field-type=\"checkbox\" data-parent_field=\"0\"><label data-type=\"checkbox\" for=\"field_2hu81g_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >I confirm I have read and understand the <a href=\"https:\/\/www.worcester.gov.uk\/filelink\/fileman-files\/PDF Documents\/Community Safety\/Grants\/Floods\/Flood Resilience Grant\/Property Flood Resilience Grant Terms and Conditions.pdf\" target=\"_new\">terms and conditions<\/a>.<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"setting_checkbox controls arf_standard_checkbox\" style=\"padding-top:5px;\" ><div class=\"arf_checkbox_style \" id=\"frm_checkbox_3342-0\"><div class='arf_checkbox_input_wrapper '><input type=\"checkbox\" name=\"item_meta[3342][]\" data-type=\"checkbox\" id=\"field_3342-0-14045\" value=\"I confirm\" data-label=\"I confirm\"    class=\" arf_required \"data-validation-minchecked-minchecked=\"1\" data-validation-minchecked-message=\"This field cannot be blank.\" style=''  \/><span><\/span><\/div><label data-type=\"checkbox\" for=\"field_3342-0-14045\" aria-label=\"I confirm\">I confirm<\/label><\/div><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3335_14045_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_text  top_container top_container arfformfield   arf_inline_field_value  arf_field_3335\"  style='width: 100%' data-field-type=\"text\" data-parent_field=\"0\" ><label data-type=\"text\" for=\"field_xoge9d_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Applicant Name<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls\"   ><input   type=\"text\" id=\"field_xoge9d_14045\"  name=\"item_meta[3335]\"  class=\" arf_required \" data-validation-required-message=\"This field cannot be blank.\"   \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3336_14045_container\" class=\"    arfformfield control-group arfmainformfield  arffieldrequired arf_field_type_date  top_container  top_container arfformfield  arf_field_3336\"  style='width: 100%'  data-field-type=\"date\" data-parent_field=\"0\"><label data-type=\"date\" for=\"field_9cufv9_14045\" class=\"arf_main_label arf_main_label_16px\" aria-label = >Date<span class=\"arfcheckrequiredfield\">*<\/span><\/label><div class=\"controls arf_date_main_controls \"   ><input type=\"text\" data-date-format=\"DD\/MM\/YYYY\" data-start-date=\"01\/01\/1876 00:00 AM\" data-cl-format=\"YYYY-MM-DD\" data-date-new-format=\"DD-MM-YYYY\" data-end-date=\"31\/12\/2076 11:59 PM\" data-default-date=\"2026-04-08\" id=\"field_9cufv9_14045\"    class=\" arf_required frm_date arforms_datepicker_control\" data-name='item_meta[3336]' data-format='DD\/MM\/YYYY' data-field-options=\"{&quot;required&quot;:&quot;1&quot;,&quot;required_indicator&quot;:&quot;*&quot;,&quot;blank&quot;:&quot;This field cannot be blank.&quot;,&quot;field_width&quot;:&quot;&quot;,&quot;locale&quot;:&quot;en&quot;,&quot;currentdefaultdate&quot;:&quot;1&quot;,&quot;name&quot;:&quot;Date&quot;,&quot;default_value&quot;:&quot;&quot;,&quot;description&quot;:&quot;&quot;,&quot;placeholdertext&quot;:&quot;21\\\/11\\\/2023&quot;,&quot;show_time_calendar&quot;:&quot;0&quot;,&quot;frm_show_time_calendar_field_indicator&quot;:&quot;&quot;,&quot;clock&quot;:&quot;12&quot;,&quot;step&quot;:&quot;30&quot;,&quot;off_days&quot;:&quot;&quot;,&quot;start_date&quot;:&quot;&quot;,&quot;end_date&quot;:&quot;&quot;,&quot;arf_show_min_current_date&quot;:&quot;0&quot;,&quot;arf_show_max_current_date&quot;:&quot;0&quot;,&quot;arf_tooltip&quot;:&quot;&quot;,&quot;frm_arf_tooltip_field_indicator&quot;:&quot;&quot;,&quot;tooltip_text&quot;:&quot;&quot;,&quot;enable_arf_prefix&quot;:&quot;&quot;,&quot;arf_prefix_icon&quot;:&quot;&quot;,&quot;enable_arf_suffix&quot;:&quot;&quot;,&quot;arf_suffix_icon&quot;:&quot;&quot;,&quot;classes&quot;:&quot;arf_1&quot;,&quot;inner_class&quot;:&quot;arf_1col&quot;,&quot;key&quot;:&quot;9cufv9&quot;,&quot;selectdefaultdate&quot;:&quot;&quot;,&quot;arfnewdateformat&quot;:&quot;&quot;,&quot;css_outer_wrapper&quot;:&quot;&quot;,&quot;css_label&quot;:&quot;&quot;,&quot;css_input_element&quot;:&quot;&quot;,&quot;css_description&quot;:&quot;&quot;,&quot;css_add_icon&quot;:&quot;&quot;,&quot;type&quot;:&quot;date&quot;,&quot;arf_enable_readonly&quot;:&quot;1&quot;,&quot;image_position_from&quot;:&quot;top_left&quot;,&quot;clear_on_focus&quot;:0,&quot;default_blank&quot;:0,&quot;arf_regular_expression&quot;:&quot;&quot;}\" placeholder=\"21\/11\/2023\" readonly=\"readonly\"  data-default-value=\"2026-04-08\" value=\"2026-04-08\" data-validation-required-message=\"This field cannot be blank.\" \/><input type=\"hidden\" name=\"item_meta[3336]\" id=\"field_9cufv9_14045_formatted\" value=\"2026-04-08\" \/><\/div><\/div><div style=\"clear:both;\"><\/div><div id=\"arf_field_3343_14045_container\" class=\"    arfformfield arf_display_to_confirmation_summary control-group arfmainformfield  arf_field_type_html  top_container  top_container arfformfield  arf_field_3343\" data-field-type=\"html\" data-parent_field=\"0\" style='width: 100%'><div class=\"arf_htmlfield_control\"><p><strong>Warning \u2013 if you knowingly or recklessly make a false statement to obtain grant for yourself or anyone else you risk prosecution, and the recovery of all grant payments. By submitting this form you are agreeing that you have read and agree with the above declaration. <\/strong><\/p>\n\n<h2>Privacy Notice<\/h2>\n<p>The information that you supply will be processed by Worcester City Council, who, for the purposes of the Data Protection Act 1998, are the Data Controller. Any personal information you provide will be treated as strictly confidential and will only be used for the purpose it was collected. Your information will not be shared with any other parties with the exception that the Local Authority  are under a duty to protect the public funds it administers and to this end may use the information you have provided on this form for the prevention and detection of fraud.  It may also share this information with other bodies administering public funds solely for these purposes.<\/p>\n<p>This information may be stored onto your application.<\/p><\/div><\/div><div style=\"clear:both;\"><\/div><div style=\"clear:both;height:1px;\">&nbsp;<\/div><\/div><!-- page_break && page_0--><div class=\"arfsubmitbutton top_container\" ><div class=\"arf_submit_div  top_container\"><input type=\"hidden\" data-jqvalidate=\"false\" value=\"1\" name=\"is_submit_form_163\" data-id=\"is_submit_form_163\" \/><input type=\"hidden\" data-jqvalidate=\"false\" value=\"0\" data-val=\"0\" data-max=\"0\" name=\"submit_form_163\" data-id=\"submit_form_163\" \/><button class=\"arf_submit_btn  arf_submit_btn_border   btn-info arfstyle-button  unknown\"  id=\"arf_submit_btn_14045\" name=\"arf_submit_btn_14045\" data-style=\"zoom-in\"  ><span class=\"arfsubmitloader\"><\/span><span class=\"arfstyle-label\">Submit<\/span><\/button><\/div><\/div><div style=\"clear:both\"><\/div><\/div><!-- 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