Velden die gemarkeerd zijn met een * zijn verplichte velden.
Personalia betreffende om wie het gaat
” enable_placeholder=”off” _builder_version=”4.23.1″ _module_preset=”default” form_field_background_color=”#FFFFFF” placeholder_text_font_size=”16px” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Geslacht” admin_title=”Geslacht” field_id=”Field_1″ field_type=”select” select_placeholder=”on” select_placeholder_text=”-Maak uw keuze-” select_options=”%91{%22value%22:%22Dhr%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Vrouw%22,%22checked%22:0,%22dragID%22:0}%93″ field_label_position=”top” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Roepnaam” admin_title=”Roepnaam” field_id=”Field_8″ field_placeholder=”b.v. Jan” description_text=”on” description_text_text=”Roepnaam” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Voornamen” admin_title=”Voornamen” field_id=”Field_8_2″ field_placeholder=”b.v. Johanna Wilhelmina” description_text=”on” description_text_text=”Voornamen” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Tussenvoegsels” admin_title=”Tussenvoegsels” field_id=”Field_8_2_2″ field_placeholder=”b.v. de / van / van der” description_text=”on” description_text_text=”Tussenvoegsels” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Achternaam” admin_title=”Achternaam” field_id=”Achternaam” field_placeholder=”Janssen-Hogenvoorst” description_text=”on” description_text_text=”Achternaam” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Meisjesnaam” admin_title=”Meisjesnaam” field_id=”Meisjesnaam” field_placeholder=”Hogenvoorst” description_text=”on” description_text_text=”Meisjesnaam” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Adres” admin_title=”Adres” field_id=”Adres” field_placeholder=”b.v. Testlaan 1a” description_text=”on” description_text_text=”Adres” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Postcode” admin_title=”Postcode” field_id=”Postcode” field_placeholder=”b.v. 2675 AH” description_text=”on” description_text_text=”Postcode” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Plaats” admin_title=”Plaats” field_id=”Plaats” field_placeholder=”b.v. Amsterdam” description_text=”on” description_text_text=”Plaats” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” BSN (Burgerservicenummer)” admin_title=” BSN (Burgerservicenummer)” field_id=”BSN_(Burgerservicenummer)” field_placeholder=”b.v. 17685432″ description_text=”on” description_text_text=”BSN_(Burgerservicenummer)” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” Burgerlijke staat ” admin_title=” Burgerlijke staat ” field_id=”Burgerlijke_staat” field_type=”select” select_placeholder=”on” select_placeholder_text=”-Maak uw keuze-” select_options=”%91{%22value%22:%22Ongehuwd%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Gehuwd%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Geregistreerd partnerschap%22,%22checked%22:0,%22dragID%22:1},{%22value%22:%22Weduw%22,%22checked%22:0,%22dragID%22:2},{%22value%22:%22Gescheiden%22,%22checked%22:0,%22dragID%22:3},{%22value%22:%22Samenwonend%22,%22checked%22:0,%22dragID%22:4},{%22value%22:%22Uit elkaar%22,%22checked%22:0,%22dragID%22:5}%93″ field_label_position=”top” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Geboortedatum” admin_title=”Geboortedatum” field_id=”Geboortedatum” field_placeholder=”b.v. 01-11-1939″ description_text=”on” description_text_text=”Geboortedatum” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” Geboren in de gemeente” admin_title=” Geboren in de gemeente” field_id=”Geboren_in_de_gemeente” field_placeholder=”b.v. Amsterdam” description_text=”on” description_text_text=” Geboren in de gemeente” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Geboorteland” admin_title=”Geboorteland” field_id=”Geboorteland” field_placeholder=”b.v. Nederland” description_text=”on” description_text_text=”Geboorteland” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Gewicht” admin_title=”Gewicht” field_id=”Gewicht” field_placeholder=”b.v. 75 Kg” description_text=”on” description_text_text=”Gewicht” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Lengte” admin_title=”Lengte” field_id=”Lengte” field_placeholder=”b.v. 1.80″ description_text=”on” description_text_text=”Lengte” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” Pacemaker / icd aanwezig?” admin_title=” Pacemaker / icd aanwezig?” field_id=”Pacemaker_/_icd_aanwezig?” field_type=”select” select_placeholder=”on” select_placeholder_text=”-Maak uw keuze-” select_options=”%91{%22value%22:%22Ja%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Nee%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Geen idee%22,%22checked%22:0,%22dragID%22:1}%93″ field_label_position=”top” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” Behandeld met radionucliden (in de afgelopen 12 maanden) ?” admin_title=” Behandeld met radionucliden (in de afgelopen 12 maanden) ?” field_id=”Behandeld_met_radionucliden_(in_de_afgelopen_12_maanden)_?” field_type=”select” select_placeholder=”on” select_placeholder_text=”-Maak uw keuze-” select_options=”%91{%22value%22:%22Ja%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Nee%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Geen idee%22,%22checked%22:0,%22dragID%22:1}%93″ field_label_position=”top” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” Heeft de overledene een uitvaartverzekering?” admin_title=” Heeft de overledene een uitvaartverzekering?” field_id=”Heeft_de_overledene_een_uitvaartverzekering?” field_type=”select” select_placeholder=”on” select_placeholder_text=”-Maak uw keuze-” select_options=”%91{%22value%22:%22Ja%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Nee%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Geen idee%22,%22checked%22:0,%22dragID%22:1}%93″ field_label_position=”top” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Aantal kinderen” admin_title=”Aan
tal kinderen” field_id=”Aantal_kinderen” field_placeholder=”b.v. 2 kinderen” description_text=”on” description_text_text=”Aantal kinderen” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” id of paspoort voorkant” admin_title=” id of paspoort voorkant” field_id=”Field_4_2_2″ field_type=”image” upload_description=”Select bestand of maak foto” field_placeholder=”Personalia betreffende om wie het gaat” description_text=”on” description_text_text=” id of paspoort voorkant” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” id of paspoort achterkant” admin_title=” id of paspoort achterkant” field_id=”id_of_paspoort_achterkant” field_type=”image” upload_description=”Select bestand of maak foto” description_text=”on” description_text_text=” id of paspoort achterkant” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Overlijdensgegevens indien van toepassing:” admin_title=”Overlijdensgegevens indien van toepassing:” field_id=”Overlijdensgegevens_indien_van_toepassing:” field_type=”html_content” add_field_prefix=”off” html_content_editor=”
Overlijdensgegevens indien van toepassing:
” enable_placeholder=”off” _builder_version=”4.23.1″ _module_preset=”default” form_field_background_color=”#FFFFFF” placeholder_text_font_size=”16px” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” Indicatie periode van overlijden?” admin_title=” Indicatie periode van overlijden?” field_id=”Indicatie_periode_van_overlijden?” field_type=”select” select_placeholder=”on” select_placeholder_text=”-Maak uw keuze-” select_options=”%91{%22value%22:%22Spoed (reeds overleden)%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Voorlopig nog niet aan de orde%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Voorregeling uitvaart%22,%22checked%22:0,%22dragID%22:1}%93″ field_label_position=”top” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Datum overlijden” admin_title=”Datum overlijden” field_id=”Datum_overlijden” field_placeholder=”b.v. 01-11-2023 ” description_text=”on” description_text_text=”Datum overlijden” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Tijd van overlijden” admin_title=”Tijd van overlijden” field_id=”Tijd_van_overlijden” field_placeholder=”b.v. 22:05 uur ” description_text=”on” description_text_text=”Tijd van overlijden” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” Is Covid-19 (Corona) de oorzaak van overlijden?” admin_title=” Is Covid-19 (Corona) de oorzaak van overlijden?” field_id=”Is_Covid-19_(Corona)_de_oorzaak_van_overlijden?” field_type=”select” select_placeholder=”on” select_placeholder_text=”-Maak uw keuze-” select_options=”%91{%22value%22:%22Ja%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Nee%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Geen idee%22,%22checked%22:0,%22dragID%22:1}%93″ field_label_position=”top” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” Is de arts/schouwarts reeds geweest?” admin_title=” Is de arts/schouwarts reeds geweest?” field_id=”Is_de_arts/schouwarts_reeds_geweest?” field_placeholder=”b.v. ja of is onderweg” description_text=”on” description_text_text=” Is de arts/schouwarts reeds geweest?” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Locatie van overlijden” admin_title=”Locatie van overlijden” field_id=”Locatie_van_overlijden” field_placeholder=”b.v. Thuis, Verzorgingstehuis, Ziekenhuis, Hospice” description_text=”on” description_text_text=” Locatie van overlijden” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Adres overlijden” admin_title=”Adres overlijden” field_id=”Adres_overlijden” field_placeholder=”Adres indien anders dan hierboven. ” description_text=”on” description_text_text=”Adres overlijden” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Postcode overlijden” admin_title=”Postcode overlijden” field_id=”Postcode_overlijden” field_placeholder=”Adres indien anders dan hierboven. ” description_text=”on” description_text_text=”Postcode overlijden” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Plaats overlijden” admin_title=”Plaats overlijden” field_id=”Plaats_overlijden” field_placeholder=”Adres indien anders dan hierboven. ” description_text=”on” description_text_text=”Plaats overlijden” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Verdieping” admin_title=”Verdieping” field_id=”Verdieping” field_placeholder=”(indien het een flat is)” description_text=”on” description_text_text=”Verdieping” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Lift aanwezig” admin_title=”Lift aanwezig” field_id=”Lift_aanwezig” field_placeholder=”(indien het een flat is of verzorgingstehuis)” description_text=”on” description_text_text=”Lift aanwezig” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Opdrachtgever / Contactpersoon:” admin_title=”Opdrachtgever / Contactpersoon:” field_id=”Opdrachtgever_/_Contactpersoon:” field_type=”html_content” add_field_prefix=”off” html_content_editor=”
Opdrachtgever / Contactpersoon:
” enable_placeholder=”off” _builder_version=”4.23.1″ _module_preset=”default” form_field_background_color=”#FFFFFF” placeholder_text_font_size=”16px” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” Relatie tot overledene” admin_title=” Relatie tot overledene” field_id=”Relatie_tot_overledene” field_placeholder=”b.v. Partner / Zoon / Dochter” description_text=”on” description_text_text=” Relatie tot overledene” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Roepnaam” admin_title=”Roepnaam” field_id=”Roepnaam” field_placeholder=”.” description_text=”on” description_text_text=”Roepnaam” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Voornamen” admin_title=”Voornamen” field_id=”Voornamen” field_placeholder=”.” description_text=”on” description_text_text=”Voornamen” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” Achternaam ” admin_title=” Achternaam ” field_id=”Achternaam_2″ field_placeholder=”.” description_text=”on” description_text_text=” Achternaam ” view_in_entries=”off” _builder_version=”4.23.1″ _mod
ule_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Adres” admin_title=”Adres” field_id=”Adres_2″ field_placeholder=”.” description_text=”on” description_text_text=”Adres” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Postcode” admin_title=”Postcode” field_id=”Postcode_2″ field_placeholder=”.” description_text=”on” description_text_text=”Postcode” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Plaats” admin_title=”Plaats” field_id=”Plaats_2″ field_placeholder=”.” description_text=”on” description_text_text=”Plaats” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Telefoonnummer*” admin_title=”Telefoonnummer” field_id=”Telefoonnummer” required_mark=”on” field_placeholder=”.” description_text=”on” description_text_text=”Telefoonnummer” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”E-mailadres*” admin_title=”E-mailadres” field_id=”E-mailadres” field_type=”email” required_mark=”on” field_placeholder=”.” description_text=”on” description_text_text=”E-mailadres” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” BSN (Burgerservicenummer)” admin_title=” BSN (Burgerservicenummer)” field_id=”BSN_(Burgerservicenummer)_2″ field_placeholder=”.” description_text=”on” description_text_text=” BSN (Burgerservicenummer)” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” Geboortedatum” admin_title=” Geboortedatum” field_id=”Geboortedatum_2″ field_placeholder=”.” description_text=”on” description_text_text=” Geboortedatum” view_in_entries=”off” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” id of paspoort voorkant” admin_title=” id of paspoort voorkant” field_id=”Field_4″ field_type=”image” upload_description=”Select bestand of maak foto” description_text=”on” description_text_text=” id of paspoort voorkant” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” id of paspoort achterkant” admin_title=” id of paspoort achterkant” field_id=”Field_4_2″ field_type=”image” upload_description=”Select bestand of maak foto” description_text=”on” description_text_text=” id of paspoort voorkant” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Over de uitvaart” admin_title=”Over de uitvaart” field_id=”Over_de_uitvaart” field_type=”html_content” add_field_prefix=”off” html_content_editor=”
Over de uitvaart:
” enable_placeholder=”off” _builder_version=”4.23.1″ _module_preset=”default” form_field_background_color=”#FFFFFF” placeholder_text_font_size=”16px” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” Pakket keuze uitvaart” admin_title=” Pakket keuze uitvaart” field_id=”Pakket_keuze_uitvaart” field_type=”select” select_placeholder=”on” select_placeholder_text=”-Maak uw keuze-” select_options=”%91{%22value%22:%22Stil%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Sober%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Budget%22,%22checked%22:0,%22dragID%22:1},{%22value%22:%22Thuis%22,%22checked%22:0,%22dragID%22:2},{%22value%22:%22Compleet%22,%22checked%22:0,%22dragID%22:3},{%22value%22:%22Excellent%22,%22checked%22:0,%22dragID%22:4},{%22value%22:%22Premium%22,%22checked%22:0,%22dragID%22:5},{%22value%22:%22Zilver%22,%22checked%22:0,%22dragID%22:6},{%22value%22:%22Stijl%22,%22checked%22:0,%22dragID%22:7},{%22value%22:%22In overleg met uitvaartleider%22,%22checked%22:0,%22dragID%22:8}%93″ field_label_position=”top” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” Wilt u de overledene nog bezoeken voor de uitvaart?” admin_title=” Wilt u de overledene nog bezoeken voor de uitvaart?” field_id=”Wilt_u_de_overledene_nog_bezoeken_voor_de_uitvaart?” field_type=”select” select_placeholder=”on” select_placeholder_text=”-Maak uw keuze-” select_options=”%91{%22value%22:%22Ja%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Nee%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Nog niet bekend%22,%22checked%22:0,%22dragID%22:1}%93″ field_label_position=”top” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” Wilt u rouwkaarten?” admin_title=” Wilt u rouwkaarten?” field_id=”Wilt_u_rouwkaarten?” field_type=”select” select_placeholder=”on” select_placeholder_text=”-Maak uw keuze-” select_options=”%91{%22value%22:%22Ja%22,%22checked%22:0,%22dragID%22:-1},{%22value%22:%22Nee%22,%22checked%22:0,%22dragID%22:0},{%22value%22:%22Geen idee%22,%22checked%22:0,%22dragID%22:1}%93″ field_label_position=”top” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” Aanvullende wensen” admin_title=” Aanvullende wensen” field_id=”Aanvullende_wensen” field_type=”text” textarea_rows=”10″ field_placeholder=” Aanvullende wensen” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Over de uitvaart” admin_title=”Over de uitvaart” field_id=”Over_de_uitvaart_2″ field_type=”html_content” add_field_prefix=”off” html_content_editor=”
Ik geef toestemming aan de uitvaartondernemer om bovenstaande gegevens te gebruiken voor de uitvaart Begrafenis en/of Crematie en waar nodig te delen met partijen om de uitvaart naar behoren te kunnen uitvoeren (denk aan het delen van gegevens met de gemeente en bijv. een crematorium of begraafplaats).*
” enable_placeholder=”off” _builder_version=”4.23.1″ _module_preset=”default” form_field_background_color=”#FFFFFF” placeholder_text_font_size=”16px” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Ik geef toestemming” admin_title=”Ik geef toestemming” field_id=”Ik_geef_toestemming_2″ field_type=”radio” radio_options=”%91{%22value%22:%22Ik geef toestemming*%22,%22checked%22:0,%22dragID%22:-1}%93″ select_options=”%91{%22value%22:%22%22,%22checked%22:0,%22dragID%22:-1}%93″ _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=” Ik ga akkoord met de algemene voorwaarden* ” admin_title=” Ik ga akkoord met de algemene voorwaarden* ” field_id=”Ik_ga_akkoord_met_de_algemene_voorwaarden*” field_type=”radio” radio_options=”%91{%22value%22:%22Ik ga akkoord met de algemene voorwaarden*%22,%22checked%22:0,%22dragID%22:0}%93″ select_options=”%91{%22value%22:%22%22,%22checked%22:0,%22dragID%22:-1}%93″ _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][de_fb_form_field field_title=”Handtekening” admin_title=”Handtekening” field_id=”Field_2″ field_type=”signature” signature_pencolor=”#015799″ signature_clear_icon=”l||divi||400″ signature_clear_icon_color=”#735DA3″ signature_clear_icon_size=”31px” signature_clear_icon_top=”0px”
required_mark=”on” field_placeholder=”Handtekening” description_text=”on” description_text_text=”Handtekening*” _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}” form_step=”0″ current_step=”0″][/de_fb_form_field][/de_fb_form]
