{"id":248,"date":"2025-05-16T10:56:57","date_gmt":"2025-05-16T10:56:57","guid":{"rendered":"https:\/\/sypol.be\/fr\/?page_id=248"},"modified":"2025-05-16T12:58:48","modified_gmt":"2025-05-16T12:58:48","slug":"demande-dallocation-de-deces","status":"publish","type":"page","link":"https:\/\/sypol.be\/fr\/pratique\/formulaires\/demande-dallocation-de-deces\/","title":{"rendered":"Demande d&rsquo;indemnit\u00e9 de d\u00e9c\u00e8s"},"content":{"rendered":"<p><a href=\"https:\/\/sypol.be\/fr\/pratique\/formulaires\/\">\u2190 Retour aux formulaires<\/a><\/p>\n<h2>Demandez ici une allocation de d\u00e9c\u00e8s<\/h2>\n<div class='fluentform ff-default fluentform_wrapper_4 ffs_default_wrap'><form data-form_id=\"4\" id=\"fluentform_4\" class=\"frm-fluent-form fluent_form_4 ff-el-form-top ff_form_instance_4_1 ff-form-loading ffs_default\" data-form_instance=\"ff_form_instance_4_1\" method=\"POST\" ><fieldset  style=\"border: none!important;margin: 0!important;padding: 0!important;background-color: transparent!important;box-shadow: none!important;outline: none!important; min-inline-size: 100%;\">\n                    <legend class=\"ff_screen_reader_title\" style=\"display: block; margin: 0!important;padding: 0!important;height: 0!important;text-indent: -999999px;width: 0!important;overflow:hidden;\">Demande d'allocation de d\u00e9c\u00e8s<\/legend><input type='hidden' name='__fluent_form_embded_post_id' value='248' \/><input type=\"hidden\" id=\"_fluentform_4_fluentformnonce\" name=\"_fluentform_4_fluentformnonce\" value=\"2016fb49c6\" \/><input type=\"hidden\" name=\"_wp_http_referer\" value=\"\/fr\/wp-json\/wp\/v2\/pages\/248\" \/><div class='ff-el-group'><div class=\"ff-el-input--label asterisk-right\"><label for='ff_4_dropdown' aria-label=\"Je suis\">Je suis<\/label><\/div><div class='ff-el-input--content'><select name=\"dropdown\" id=\"ff_4_dropdown\" class=\"ff-el-form-control\" data-name=\"dropdown\" data-calc_value=\"0\"  aria-invalid=\"false\" aria-required=false><option value=\"\">- Select -<\/option><option value=\"Veuve\"  >Veuve<\/option><option value=\"Veuf\"  >Veuf<\/option><\/select><\/div><\/div><div data-type=\"name-element\" data-name=\"names\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_names_first_name_' aria-label=\"Pr\u00e9nom\">Pr\u00e9nom<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[first_name]\" id=\"ff_4_names_first_name_\" class=\"ff-el-form-control\" placeholder=\"Pr\u00e9nom\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_names_last_name_' aria-label=\"Nom\">Nom<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names[last_name]\" id=\"ff_4_names_last_name_\" class=\"ff-el-form-control\" placeholder=\"Nom\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_email' aria-label=\"Adresse e-mail\">Adresse e-mail<\/label><\/div><div class='ff-el-input--content'><input type=\"email\" name=\"email\" id=\"ff_4_email\" class=\"ff-el-form-control\" placeholder=\"Adresse e-mail\" data-name=\"email\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_phone' aria-label=\"Num\u00e9ro de t\u00e9l\u00e9phone\">Num\u00e9ro de t\u00e9l\u00e9phone<\/label><\/div><div class='ff-el-input--content'><input name=\"phone\" class=\"ff-el-form-control ff-el-phone\" type=\"tel\" placeholder=\"Num\u00e9ro de t\u00e9l\u00e9phone\" data-name=\"phone\" id=\"ff_4_phone\" inputmode=\"tel\"  aria-invalid='false' aria-required=true><\/div><\/div><div class=\"ff-name-address-wrapper fluent-address\" data-type=\"address-element\" data-name=\"address_1\" ><div class='ff-el-input--label'><label aria-label=Adresse>Adresse<\/label><\/div><div class='ff-el-input--content'><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_address_1_address_line_1_' aria-label=\"Rue\">Rue<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_1]\" id=\"ff_4_address_1_address_line_1_\" class=\"ff-el-form-control\" placeholder=\"Rue\" data-key_name=\"address_line_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_address_1_address_line_2_' aria-label=\"Num\u00e9ro\">Num\u00e9ro<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[address_line_2]\" id=\"ff_4_address_1_address_line_2_\" class=\"ff-el-form-control\" placeholder=\"Num\u00e9ro\" data-key_name=\"address_line_2\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><div class='ff-t-container'><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_address_1_zip_' aria-label=\"Code postal\">Code postal<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[zip]\" id=\"ff_4_address_1_zip_\" class=\"ff-el-form-control\" placeholder=\"Code postal\" data-key_name=\"zip\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><div class='ff-t-cell'><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_address_1_city_' aria-label=\"Commune\">Commune<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"address_1[city]\" id=\"ff_4_address_1_city_\" class=\"ff-el-form-control\" placeholder=\"Commune\" data-key_name=\"city\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><\/div><div data-type=\"name-element\" data-name=\"names_1\" class=\" ff-field_container ff-name-field-wrapper\" ><div class='ff-t-container'><div class='ff-t-cell '><div class='ff-el-group  ff-el-form-top'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_names_1_first_name_' aria-label=\"Nom du d\u00e9funt\">Nom du d\u00e9funt<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"names_1[first_name]\" id=\"ff_4_names_1_first_name_\" class=\"ff-el-form-control\" placeholder=\"Nom du d\u00e9funt\" aria-invalid=\"false\" aria-required=true><\/div><\/div><\/div><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_input_text_1' aria-label=\"Ville du d\u00e9c\u00e8s\">Ville du d\u00e9c\u00e8s<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text_1\" class=\"ff-el-form-control\" placeholder=\"Ville du d\u00e9c\u00e8s\" data-name=\"input_text_1\" id=\"ff_4_input_text_1\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_datetime' aria-label=\"Date du d\u00e9c\u00e8s\">Date du d\u00e9c\u00e8s<\/label><\/div><div class='ff-el-input--content'><input data-type-datepicker data-format='d\/m\/Y' type=\"text\" name=\"datetime\" id=\"ff_4_datetime\" class=\"ff-el-form-control ff-el-datepicker\" placeholder=\"jj\/mm\/aaaa\" data-name=\"datetime\"  aria-invalid='false' aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_input_text' aria-label=\"Num\u00e9ro de compte bancaire pour recevoir la prime\">Num\u00e9ro de compte bancaire pour recevoir la prime<\/label><\/div><div class='ff-el-input--content'><input type=\"text\" name=\"input_text\" class=\"ff-el-form-control\" placeholder=\"Num\u00e9ro de compte bancaire\" data-name=\"input_text\" id=\"ff_4_input_text\"  aria-invalid=\"false\" aria-required=true><\/div><\/div><div class='ff-el-group'><div class=\"ff-el-input--label ff-el-is-required asterisk-right\"><label for='ff_4_file-upload_1' aria-label=\"Acte de d\u00e9c\u00e8s\">Acte de d\u00e9c\u00e8s<\/label><\/div><div class='ff-el-input--content'><label for='ff_4_file-upload_1' class='ff_file_upload_holder'><span class='ff_upload_btn ff-btn'>T\u00e9l\u00e9charger<\/span> <input type=\"file\" name=\"file-upload\" id=\"ff_4_file-upload_1\" class=\"ff-el-form-control  ff-screen-reader-element\" data-name=\"file-upload\" multiple=\"1\"  aria-invalid='false' aria-required=true><\/label><\/div><\/div><div class='ff-el-group ff-text-left ff_submit_btn_wrapper'><button type=\"submit\" class=\"ff-btn ff-btn-submit ff-btn-md ff_btn_style\" >Envoyer<\/button><\/div><\/fieldset><\/form><div id='fluentform_4_errors' class='ff-errors-in-stack ff_form_instance_4_1 ff-form-loading_errors ff_form_instance_4_1_errors'><\/div><\/div>        <script type=\"text\/javascript\">\n            window.fluent_form_ff_form_instance_4_1 = {\"id\":\"4\",\"settings\":{\"layout\":{\"labelPlacement\":\"top\",\"helpMessagePlacement\":\"with_label\",\"errorMessagePlacement\":\"inline\",\"cssClassName\":\"\",\"asteriskPlacement\":\"asterisk-right\"},\"restrictions\":{\"denyEmptySubmission\":{\"enabled\":false}}},\"form_instance\":\"ff_form_instance_4_1\",\"form_id_selector\":\"fluentform_4\",\"rules\":{\"dropdown\":{\"required\":{\"value\":false,\"message\":\"Ce champ est obligatoire\",\"global_message\":\"This field is 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d\u00e9c\u00e8s<\/p>\n","protected":false},"author":3,"featured_media":0,"parent":176,"menu_order":3,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"acf":[],"_links":{"self":[{"href":"https:\/\/sypol.be\/fr\/wp-json\/wp\/v2\/pages\/248"}],"collection":[{"href":"https:\/\/sypol.be\/fr\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/sypol.be\/fr\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/sypol.be\/fr\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/sypol.be\/fr\/wp-json\/wp\/v2\/comments?post=248"}],"version-history":[{"count":6,"href":"https:\/\/sypol.be\/fr\/wp-json\/wp\/v2\/pages\/248\/revisions"}],"predecessor-version":[{"id":449,"href":"https:\/\/sypol.be\/fr\/wp-json\/wp\/v2\/pages\/248\/revisions\/449"}],"up":[{"embeddable":true,"href":"https:\/\/sypol.be\/fr\/wp-json\/wp\/v2\/pages\/176"}],"wp:attachment":[{"href":"https:\/\/sypol.be\/fr\/wp-json\/wp\/v2\/media?parent=248"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}