    <script type="text/javascript">
      jQuery(document).ready(function() {
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      ////////////////////////////
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    {"id":3562,"date":"2017-02-07T16:30:26","date_gmt":"2017-02-07T22:30:26","guid":{"rendered":"https:\/\/uuu.smartstartcanada.ca\/espace-client\/accident-reported\/"},"modified":"2019-06-12T01:31:52","modified_gmt":"2019-06-12T06:31:52","slug":"accident","status":"publish","type":"page","link":"https:\/\/www.smartstartcanada.ca\/fr\/espace-client\/accident\/","title":{"rendered":"J\u2019ai eu un accident"},"content":{"rendered":"<p>Veuillez remplir le formulaire ci-dessous pour signaler une r\u00e9clamation selon laquelle votre voiture a \u00e9t\u00e9 dans un accident.<br \/>\n<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 gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n\/* ]]> *\/\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform_legacy_markup_wrapper gform-theme--no-framework' data-form-theme='legacy' data-form-index='0' id='gform_wrapper_12' ><form method='post' enctype='multipart\/form-data'  id='gform_12'  action='\/fr\/wp-json\/wp\/v2\/pages\/3562' data-formid='12' novalidate>\n                        <div class='gform-body gform_body'><ul id='gform_fields_12' class='gform_fields top_label form_sublabel_below description_below validation_below'><li id=\"field_12_22\" class=\"gfield gfield--type-honeypot gform_validation_container field_sublabel_below gfield--has-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_12_22'>Name<\/label><div class='ginput_container'><input name='input_22' id='input_12_22' type='text' value='' autocomplete='new-password'\/><\/div><div class='gfield_description' id='gfield_description_12_22'>Ce champ n\u2019est utilis\u00e9 qu\u2019\u00e0 des fins de validation et devrait rester inchang\u00e9.<\/div><\/li><li id=\"field_12_3\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gf_left_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' >Province (requis)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_radio'><ul class='gfield_radio' id='input_12_3'>\n\t\t\t<li class='gchoice gchoice_12_3_0'>\n\t\t\t\t<input name='input_3' type='radio' value='Alberta'  id='choice_12_3_0'    \/>\n\t\t\t\t<label for='choice_12_3_0' id='label_12_3_0' class='gform-field-label gform-field-label--type-inline'>Alberta<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_3_1'>\n\t\t\t\t<input name='input_3' type='radio' value='Columbie-Britannique'  id='choice_12_3_1'    \/>\n\t\t\t\t<label for='choice_12_3_1' id='label_12_3_1' class='gform-field-label gform-field-label--type-inline'>Columbie-Britannique<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_3_2'>\n\t\t\t\t<input name='input_3' type='radio' value='Manitoba'  id='choice_12_3_2'    \/>\n\t\t\t\t<label for='choice_12_3_2' id='label_12_3_2' class='gform-field-label gform-field-label--type-inline'>Manitoba<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_3_3'>\n\t\t\t\t<input name='input_3' type='radio' value='Ontario'  id='choice_12_3_3'    \/>\n\t\t\t\t<label for='choice_12_3_3' id='label_12_3_3' class='gform-field-label gform-field-label--type-inline'>Ontario<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_3_4'>\n\t\t\t\t<input name='input_3' type='radio' value='Saskatchewan'  id='choice_12_3_4'    \/>\n\t\t\t\t<label for='choice_12_3_4' id='label_12_3_4' class='gform-field-label gform-field-label--type-inline'>Saskatchewan<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_3_5'>\n\t\t\t\t<input name='input_3' type='radio' value='Yukon'  id='choice_12_3_5'    \/>\n\t\t\t\t<label for='choice_12_3_5' id='label_12_3_5' class='gform-field-label gform-field-label--type-inline'>Yukon<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_3_6'>\n\t\t\t\t<input name='input_3' type='radio' value='Quebec'  id='choice_12_3_6'    \/>\n\t\t\t\t<label for='choice_12_3_6' id='label_12_3_6' class='gform-field-label gform-field-label--type-inline'>Quebec<\/label>\n\t\t\t<\/li>\n\t\t\t<li class='gchoice gchoice_12_3_7'>\n\t\t\t\t<input name='input_3' type='radio' value='Northwest Territories'  id='choice_12_3_7'    \/>\n\t\t\t\t<label for='choice_12_3_7' id='label_12_3_7' class='gform-field-label gform-field-label--type-inline'>Northwest Territories<\/label>\n\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_4\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_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_12_4'>Pr\u00e9nom (requis)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_4' id='input_12_4' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_12_5\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_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_12_5'>Deuxi\u00e8me pr\u00e9nom<\/label><div class='ginput_container ginput_container_text'><input name='input_5' id='input_12_5' type='text' value='' class='medium'      aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_12_6\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_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_12_6'>Nom de famille (requis)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_6' id='input_12_6' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_12_14\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gf_left_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_12_14'>Date de naissance (requis)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_14' id='input_12_14' type='text' value='' class='datepicker gform-datepicker ymd_dash datepicker_no_icon gdatepicker-no-icon'   placeholder='yyyy-mm-dd' aria-describedby=\"input_12_14_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_12_14_date_format' class='screen-reader-text'>YYYY dash MM dash DD<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_12_14' class='gform_hidden' value='https:\/\/www.smartstartcanada.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_12_16\" class=\"gfield gfield--type-text gfield--input-type-text gf_left_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_12_16'>T\u00e9l\u00e9phone portable ou courriel (requis)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_16' id='input_12_16' type='text' value='' class='medium'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/li><li id=\"field_12_17\" class=\"gfield gfield--type-select gfield--input-type-select gf_left_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_12_17'>Type d&#039;accident<\/label><div class='ginput_container ginput_container_select'><select name='input_17' id='input_12_17' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>-- Choisir --<\/option><option value='Incendie de v\u00e9hicule' >Incendie de v\u00e9hicule<\/option><option value='Front Collision' >Front Collision<\/option><option value='Collision arri\u00e8re' >Collision arri\u00e8re<\/option><option value='S\u00e9v\u00e8re' >S\u00e9v\u00e8re (renversement, etc.)<\/option><\/select><\/div><\/li><li id=\"field_12_18\" class=\"gfield gfield--type-select gfield--input-type-select gf_left_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_12_18'>Emplacement actuel du v\u00e9hicule<\/label><div class='ginput_container ginput_container_select'><select name='input_18' id='input_12_18' class='medium gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>-- Choisir --<\/option><option value='En possession par la compagnie d&#039;assurance' >En possession par la compagnie d&#039;assurance<\/option><option value='Dans une r\u00e9sidence' >Dans une r\u00e9sidence (propre, famille, etc.)<\/option><option value='Remorquage ou mise en fourri\u00e8re' >Remorquage ou mise en fourri\u00e8re<\/option><option value='Atelier de r\u00e9paration' >Atelier de r\u00e9paration<\/option><option value='Still at Location of Accident' >Toujours sur le lieu de l&#039;accident<\/option><\/select><\/div><\/li><li id=\"field_12_19\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-no-icon gf_left_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_12_19'>Date de l&#039;accident (obligatoire)<span class=\"gfield_required\"><span class=\"gfield_required gfield_required_asterisk\">*<\/span><\/span><\/label><div class='ginput_container ginput_container_date'>\n                            <input name='input_19' id='input_12_19' type='text' value='' class='datepicker gform-datepicker ymd_dash datepicker_no_icon gdatepicker-no-icon'   placeholder='yyyy-mm-dd' aria-describedby=\"input_12_19_date_format\" aria-invalid=\"false\" aria-required=\"true\"\/>\n                            <span id='input_12_19_date_format' class='screen-reader-text'>YYYY dash MM dash DD<\/span>\n                        <\/div>\n                        <input type='hidden' id='gforms_calendar_icon_input_12_19' class='gform_hidden' value='https:\/\/www.smartstartcanada.ca\/wp-content\/plugins\/gravityforms\/images\/datepicker\/datepicker.svg'\/><\/li><li id=\"field_12_20\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gf_left_half field_sublabel_below gfield--no-description field_description_below field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label gfield_label_before_complex' >Pi\u00e8ces de l&#039;appareil r\u00e9cup\u00e9r\u00e9es<\/label><div class='ginput_container ginput_container_checkbox'><ul class='gfield_checkbox' id='input_12_20'><li class='gchoice gchoice_12_20_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.1' type='checkbox'  value='Combin\u00e9'  id='choice_12_20_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_20_1' id='label_12_20_1' class='gform-field-label gform-field-label--type-inline'>Combin\u00e9<\/label>\n\t\t\t\t\t\t\t<\/li><li class='gchoice gchoice_12_20_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_20.2' type='checkbox'  value='Corde'  id='choice_12_20_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_12_20_2' id='label_12_20_2' class='gform-field-label gform-field-label--type-inline'>Corde<\/label>\n\t\t\t\t\t\t\t<\/li><\/ul><\/div><\/li><li id=\"field_12_21\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full gf_left_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_12_21'>Broken Down Vehicle Explanation<\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_21' id='input_12_21' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/li><li id=\"field_12_13\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gf_left_half field_sublabel_below gfield--has-description field_description_below hidden_label field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_12_13'>Rapport de police (obligatoire)<\/label><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_12_13' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_12_13&quot;,&quot;container&quot;:&quot;gform_multifile_upload_12_13&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_12_13&quot;,&quot;filelist&quot;:&quot;gform_preview_12_13&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/www.smartstartcanada.ca\\\/fr\\\/?gf_page=ff08b75a84e4cac&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/www.smartstartcanada.ca\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/www.smartstartcanada.ca\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Fichiers autoris\\u00e9s&quot;,&quot;extensions&quot;:&quot;jpg,gif,png,pdf,jpeg&quot;}],&quot;max_file_size&quot;:&quot;2097152b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:12,&quot;field_id&quot;:13,&quot;_gform_file_upload_nonce_12_13&quot;:&quot;6cd035c9d5&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;5&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_12_13&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_12_13' 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'>D\u00e9poser les fichiers ici ou <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_12_13' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_12_13 gfield_description_12_13\"  >S\u00e9lectionnez des fichiers<\/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_12_13'>Types de fichier accept\u00e9s\u00a0: jpg, gif, png, pdf, jpeg, Taille maximum des fichiers : 2 MB, Nombre maximum de fichiers : 5.<\/span> <div id='gform_preview_12_13' class='ginput_preview_list'><\/div><\/div><div class='gfield_description' id='gfield_description_12_13'><strong>Remarque :<\/strong> Les fichiers doivent \u00eatre inf\u00e9rieurs \u00e0 2 Mo chacun.<br \/>\r\n<br \/>\r\n<strong>Veuillez prendre des photos du v\u00e9hicule, car elles seront requises par le gestionnaire des demandes pour compl\u00e9ter votre demande.<\/strong><\/div><\/li><\/ul><\/div>\n        <div class='gform-footer gform_footer top_label'> <input type='submit' id='gform_submit_button_12' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' value='Envoyer'  \/> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_12' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_12' id='gform_theme_12' value='legacy' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_12' id='gform_style_settings_12' value='[]' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_12' value='1' \/>\n            <input type='hidden' 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