/*
 * Copyright 2022 Adobe. All rights reserved.
 * This file is licensed to you under the Apache License, Version 2.0 (the "License");
 * you may not use this file except in compliance with the License. You may obtain a copy
 * of the License at http://www.apache.org/licenses/LICENSE-2.0
 *
 * Unless required by applicable law or agreed to in writing, software distributed under
 * the License is distributed on an "AS IS" BASIS, WITHOUT WARRANTIES OR REPRESENTATIONS
 * OF ANY KIND, either express or implied. See the License for the specific language
 * governing permissions and limitations under the License.
 */
export const claimFormContent = `
<div class="formcontainer"><form method="POST" action="/submit-a-claim" id="new_form" name="new_form" enctype="multipart/form-data" class="cmp-form aem-Grid aem-Grid--12 aem-Grid--default--12" data-use-email-to-link="true" data-re-captcha-site-key="6Lc8rwYaAAAAAGsJKqZhD-FjPHtuq1D56kx47AnM">
    
    <input type="hidden" name=":formstart" value="/content/stewart/stewartcom/en/contact-us/submit-a-claim/jcr:content/root/responsivegrid/genericpagesection_c/section-content/columnrow_1891568698_752689719/container">
    <input type="hidden" name=":recaptchatoken" value="03AFcWeA7XSd71s59vARDksUWHD7IE9v7XZCE9UERe8YK3GfQW7fifNpFBN_E5wG7h6o1jcczgvSVrze2XyWrNgO7xUA3JA1w0ZEIWDuYn5zUn1TinMS3h-y9VQGbnugHNK2ScvA-iRUIetj_-pt3yKZqyHHNQ7-yMT3p6SRh_dWi5XpsbX6mO-xoLpW99xyAtrNuzXwcoEoNeGPI3ZT4WRok_PauHLGmVy_oMXGDp8dujAOFsJKHPDEpeUelaoGdKZkLKXYEDmwzl4HhiALyLuFclqiPNqb2hdr__YWAsTJSC-pozENpGYote6sk1m9LkI1CjJsowYTVG-WW4RyQ6bOPlIWoNQNs191mJ1CGhuAoajWBDht7QZuPzrNjHpSQK6gvnmIKEZiD9GRzBluyfjgBOHf9XF8MHny9qUTssCw9tJfdjNRJFuIvF2NYC4UajtOhit9-Jk8unGeM9lo-2Z6eej1dn1zXfmdhuvAe_OPnhNMsgqvq8JHELrR1zUdXrvqPn3pAj2oOH_z-tN7o5ziHNamjiQyTs4hwo5xDQukj3WiTdIvouVmI">
    <input type="hidden" name="_charset_" value="utf-8">
    <input type="hidden" name=":redirect" value="/content/stewart/stewartcom/en/thank-you.html">
    
    <div class="columnrow aem-GridColumn aem-GridColumn--default--12">
    
    <div class="row cmp-columnrow">
        <div class="col-12 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="contentcontainer ss-containerpresentationtype-box">

    
    
    
    <div id="contentcontainer-31641f89c2" class="cmp-container">
        
        <div class="columnrow">
    
    <div class="row cmp-columnrow">
        <div class="col-12 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
<div id="text-c77115ecca" class="cmp-text">
    <p><b>Your Contact Information</b></p>

</div>

    

</div>

        </div>
<div class="col-md-3 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-464327926">Your Name </label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-464327926" name="Your Name" required="" maxlength="3" minlength="2">
</div></div>

        </div>
<div class="col-md-3 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-465165881">Your Address </label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-465165881" name="Your Address" required="">
</div></div>

        </div>
<div class="col-md-3 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-465338087">Your City </label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-465338087" name="Your City" required="">
</div></div>

        </div>
<div class="col-md-3 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="options">
    <fieldset role="none" class="cmp-form-options cmp-form-options--drop-down">
        
        
            <label class="cmp-form-options__label" for="form-options-607533444">Your State</label>
            <select class="cmp-form-options__field cmp-form-options__field--drop-down" name="Your State" id="form-options-607533444" data-cmp-hook-form-option="input">
                <option value="" selected="true">Select a State</option>
                <option value="AL">Alabama</option>
            
                
                <option value="AK">Alaska</option>
            
                
                <option value="AZ">Arizona</option>
            
                
                <option value="AR">Arkansas</option>
            
                
                <option value="CA">California</option>
            
                
                <option value="CO">Colorado</option>
            
                
                <option value="CT">Connecticut</option>
            
                
                <option value="DE">Delaware</option>
            
                
                <option value="DC">District of Columbia</option>
            
                
                <option value="FL">Florida</option>
            
                
                <option value="GA">Georgia</option>
            
                
                <option value="GU">Guam</option>
            
                
                <option value="HI">Hawaii</option>
            
                
                <option value="ID">Idaho</option>
            
                
                <option value="IL">Illinois</option>
            
                
                <option value="IN">Indiana</option>
            
                
                <option value="IA">Iowa</option>
            
                
                <option value="KS">Kansas</option>
            
                
                <option value="KY">Kentucky</option>
            
                
                <option value="LA">Louisiana</option>
            
                
                <option value="ME">Maine</option>
            
                
                <option value="MD">Maryland</option>
            
                
                <option value="MA">Massachusetts</option>
            
                
                <option value="MI">Michigan</option>
            
                
                <option value="MN">Minnesota</option>
            
                
                <option value="MS">Mississippi</option>
            
                
                <option value="MO">Missouri</option>
            
                
                <option value="MT">Montana</option>
            
                
                <option value="NE">Nebraska</option>
            
                
                <option value="NV">Nevada</option>
            
                
                <option value="NH">New Hampshire</option>
            
                
                <option value="NJ">New Jersey</option>
            
                
                <option value="NM">New Mexico</option>
            
                
                <option value="NY">New York</option>
            
                
                <option value="NC">North Carolina</option>
            
                
                <option value="ND">North Dakota</option>
            
                
                <option value="OH">Ohio</option>
            
                
                <option value="OK">Oklahoma</option>
            
                
                <option value="OR">Oregon</option>
            
                
                <option value="PA">Pennsylvania</option>
            
                
                <option value="PR">Puerto Rico</option>
            
                
                <option value="RI">Rhode Island</option>
            
                
                <option value="MP">Saipan</option>
            
                
                <option value="SC">South Carolina</option>
            
                
                <option value="SD">South Dakota</option>
            
                
                <option value="TN">Tennessee</option>
            
                
                <option value="TX">Texas</option>
            
                
                <option value="UT">Utah</option>
            
                
                <option value="VT">Vermont</option>
            
                
                <option value="VI">Virgin Islands</option>
            
                
                <option value="VA">Virginia</option>
            
                
                <option value="WA">Washington</option>
            
                
                <option value="WV">West Virginia</option>
            
                
                <option value="WI">Wisconsin</option>
            
                
                <option value="WY">Wyoming</option>
            </select>
        
        
    </fieldset>


    

</div>

        </div>
<div class="col-md-4 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-490214598">Your Zip/Postal Code </label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="number" id="form-text-490214598" name="Your Zip/Postal Code" required="" max="99999" min="90000">
</div></div>

        </div>
<div class="col-md-4 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-489356233">Your Province/Region <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-489356233" name="Your Province/Region">
</div></div>

        </div>
<div class="col-md-4 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-490099087">Your Country </label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-490099087" name="Your Country" required="">
</div></div>

        </div>
<div class="col-md-4 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-550395236">Your Phone Number </label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="tel" id="form-text-550395236" name="Your Phone Number" required="">
</div></div>

        </div>
<div class="col-md-4 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-551196683">Your Fax Number <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="tel" id="form-text-551196683" name="Your Fax Number">
</div></div>

        </div>
<div class="col-md-4 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-551316651">Your E-mail Address </label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="email" id="form-text-551316651" name="Your E-mail Address" required="">
</div></div>

        </div>

    </div>
    
</div>

        
    </div>

</div>

        </div>
<div class="col-12 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="contentcontainer ss-containerpresentationtype-box">

    
    
    
    <div id="contentcontainer-c125a4e49e" class="cmp-container">
        
        <div class="columnrow">
    
    <div class="row cmp-columnrow">
        <div class="col-12 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
<div id="text-090cd096b4" class="cmp-text">
    <p><b>Insured Property Information</b>&nbsp;(if different from above)</p>

</div>

    

</div>

        </div>
<div class="col-md-6 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-1540022731">Insured Property Address <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-1540022731" name="Insured Property Address">
</div></div>

        </div>
<div class="col-md-3 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-1540860686"> City <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-1540860686" name="Insured Property City">
</div></div>

        </div>
<div class="col-md-3 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="options">
    <fieldset role="none" class="cmp-form-options cmp-form-options--drop-down">
        
        
            <label class="cmp-form-options__label" for="form-options-1683228249">Your State</label>
            <select class="cmp-form-options__field cmp-form-options__field--drop-down" name="Insured Property State" id="form-options-1683228249" data-cmp-hook-form-option="input">
                <option value="" selected="true">Select a State</option>
                <option value="AL">Alabama</option>
            
                
                <option value="AK">Alaska</option>
            
                
                <option value="AZ">Arizona</option>
            
                
                <option value="AR">Arkansas</option>
            
                
                <option value="CA">California</option>
            
                
                <option value="CO">Colorado</option>
            
                
                <option value="CT">Connecticut</option>
            
                
                <option value="DE">Delaware</option>
            
                
                <option value="DC">District of Columbia</option>
            
                
                <option value="FL">Florida</option>
            
                
                <option value="GA">Georgia</option>
            
                
                <option value="GU">Guam</option>
            
                
                <option value="HI">Hawaii</option>
            
                
                <option value="ID">Idaho</option>
            
                
                <option value="IL">Illinois</option>
            
                
                <option value="IN">Indiana</option>
            
                
                <option value="IA">Iowa</option>
            
                
                <option value="KS">Kansas</option>
            
                
                <option value="KY">Kentucky</option>
            
                
                <option value="LA">Louisiana</option>
            
                
                <option value="ME">Maine</option>
            
                
                <option value="MD">Maryland</option>
            
                
                <option value="MA">Massachusetts</option>
            
                
                <option value="MI">Michigan</option>
            
                
                <option value="MN">Minnesota</option>
            
                
                <option value="MS">Mississippi</option>
            
                
                <option value="MO">Missouri</option>
            
                
                <option value="MT">Montana</option>
            
                
                <option value="NE">Nebraska</option>
            
                
                <option value="NV">Nevada</option>
            
                
                <option value="NH">New Hampshire</option>
            
                
                <option value="NJ">New Jersey</option>
            
                
                <option value="NM">New Mexico</option>
            
                
                <option value="NY">New York</option>
            
                
                <option value="NC">North Carolina</option>
            
                
                <option value="ND">North Dakota</option>
            
                
                <option value="OH">Ohio</option>
            
                
                <option value="OK">Oklahoma</option>
            
                
                <option value="OR">Oregon</option>
            
                
                <option value="PA">Pennsylvania</option>
            
                
                <option value="PR">Puerto Rico</option>
            
                
                <option value="RI">Rhode Island</option>
            
                
                <option value="MP">Saipan</option>
            
                
                <option value="SC">South Carolina</option>
            
                
                <option value="SD">South Dakota</option>
            
                
                <option value="TN">Tennessee</option>
            
                
                <option value="TX">Texas</option>
            
                
                <option value="UT">Utah</option>
            
                
                <option value="VT">Vermont</option>
            
                
                <option value="VI">Virgin Islands</option>
            
                
                <option value="VA">Virginia</option>
            
                
                <option value="WA">Washington</option>
            
                
                <option value="WV">West Virginia</option>
            
                
                <option value="WI">Wisconsin</option>
            
                
                <option value="WY">Wyoming</option>
            </select>
        
        
    </fieldset>


    

</div>

        </div>
<div class="col-md-4 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-1626891488">Zip/Postal Code <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="number" id="form-text-1626891488" name="Insured Property Zip/Postal Code">
</div></div>

        </div>
<div class="col-md-4 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-1541032892">Province/Region <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-1541032892" name="Insured Property Province/Region">
</div></div>

        </div>
<div class="col-md-4 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-1626090041">Country <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-1626090041" name="Insured Property Country">
</div></div>

        </div>

    </div>
    
</div>

        
    </div>

</div>

        </div>
<div class="col-12 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="contentcontainer ss-containerpresentationtype-box">

    
    
    
    <div id="contentcontainer-2c0681ff85" class="cmp-container">
        
        <div class="columnrow">
    
    <div class="row cmp-columnrow">
        <div class="col-12 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
<div id="text-f4e69f9687" class="cmp-text">
    <p><b>Alt. Contact Information&nbsp;</b>(person to respond to if different from above)</p>

</div>

    

</div>

        </div>
<div class="col-md-3 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-287505700">Name <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-287505700" name="Alt. Contact Name">
</div></div>

        </div>
<div class="col-md-3 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-287620993"> Address <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-287620993" name="Alt. Contact Address">
</div></div>

        </div>
<div class="col-md-3 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-288429466">City <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-288429466" name="Alt. Contact City">
</div></div>

        </div>
<div class="col-md-3 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="options">
    <fieldset role="none" class="cmp-form-options cmp-form-options--drop-down">
        
        
            <label class="cmp-form-options__label" for="form-options-288578209">State</label>
            <select class="cmp-form-options__field cmp-form-options__field--drop-down" name="Alt. Contact State" id="form-options-288578209" data-cmp-hook-form-option="input">
                <option value="" selected="true">Select a State</option>
                <option value="AL">Alabama</option>
            
                
                <option value="AK">Alaska</option>
            
                
                <option value="AZ">Arizona</option>
            
                
                <option value="AR">Arkansas</option>
            
                
                <option value="CA">California</option>
            
                
                <option value="CO">Colorado</option>
            
                
                <option value="CT">Connecticut</option>
            
                
                <option value="DE">Delaware</option>
            
                
                <option value="DC">District of Columbia</option>
            
                
                <option value="FL">Florida</option>
            
                
                <option value="GA">Georgia</option>
            
                
                <option value="GU">Guam</option>
            
                
                <option value="HI">Hawaii</option>
            
                
                <option value="ID">Idaho</option>
            
                
                <option value="IL">Illinois</option>
            
                
                <option value="IN">Indiana</option>
            
                
                <option value="IA">Iowa</option>
            
                
                <option value="KS">Kansas</option>
            
                
                <option value="KY">Kentucky</option>
            
                
                <option value="LA">Louisiana</option>
            
                
                <option value="ME">Maine</option>
            
                
                <option value="MD">Maryland</option>
            
                
                <option value="MA">Massachusetts</option>
            
                
                <option value="MI">Michigan</option>
            
                
                <option value="MN">Minnesota</option>
            
                
                <option value="MS">Mississippi</option>
            
                
                <option value="MO">Missouri</option>
            
                
                <option value="MT">Montana</option>
            
                
                <option value="NE">Nebraska</option>
            
                
                <option value="NV">Nevada</option>
            
                
                <option value="NH">New Hampshire</option>
            
                
                <option value="NJ">New Jersey</option>
            
                
                <option value="NM">New Mexico</option>
            
                
                <option value="NY">New York</option>
            
                
                <option value="NC">North Carolina</option>
            
                
                <option value="ND">North Dakota</option>
            
                
                <option value="OH">Ohio</option>
            
                
                <option value="OK">Oklahoma</option>
            
                
                <option value="OR">Oregon</option>
            
                
                <option value="PA">Pennsylvania</option>
            
                
                <option value="PR">Puerto Rico</option>
            
                
                <option value="RI">Rhode Island</option>
            
                
                <option value="MP">Saipan</option>
            
                
                <option value="SC">South Carolina</option>
            
                
                <option value="SD">South Dakota</option>
            
                
                <option value="TN">Tennessee</option>
            
                
                <option value="TX">Texas</option>
            
                
                <option value="UT">Utah</option>
            
                
                <option value="VT">Vermont</option>
            
                
                <option value="VI">Virgin Islands</option>
            
                
                <option value="VA">Virginia</option>
            
                
                <option value="WA">Washington</option>
            
                
                <option value="WV">West Virginia</option>
            
                
                <option value="WI">Wisconsin</option>
            
                
                <option value="WY">Wyoming</option>
            </select>
        
        
    </fieldset>


    

</div>

        </div>
<div class="col-md-3 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-428181962">Zip/Postal Code <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="number" id="form-text-428181962" name="Alt. Contact Zip/Postal Code">
</div></div>

        </div>
<div class="col-md-3 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-427315172">Province/Region <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-427315172" name="Alt. Contact Province/Region">
</div></div>

        </div>
<div class="col-md-3 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-427439298">Country <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-427439298" name="Alt. Contact Country">
</div></div>

        </div>
<div class="col-md-3 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-431040125">Phone Number <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="tel" id="form-text-431040125" name="Alt. Contact Phone Number">
</div></div>

        </div>

    </div>
    
</div>

        
    </div>

</div>

        </div>
<div class="col-12 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="contentcontainer ss-containerpresentationtype-box">

    
    
    
    <div id="contentcontainer-186b616ccf" class="cmp-container">
        
        <div class="columnrow">
    
    <div class="row cmp-columnrow">
        <div class="col-12 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
<div id="text-e138d79fa1" class="cmp-text">
    <p><b>Policy Information</b></p>

</div>

    

</div>

        </div>
<div class="col-md-6 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-960330882">Policy Date <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="date" id="form-text-960330882" name="Policy Date">
</div></div>

        </div>
<div class="col-md-6 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-1012942750">Policy Number <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-1012942750" name="Policy Number">
</div></div>

        </div>
<div class="col-md-4 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-1011988472">Name of Issuing Agent <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-1011988472" name="Name of Issuing Agent">
</div></div>

        </div>
<div class="col-md-4 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-1011034415">Agent's File Number/GF # <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-1011034415" name="Agent's File Number/GF #">
</div></div>

        </div>
<div class="col-md-4 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-1010167384">Name of Insured or Borrower <span class="optional">(Optional)</span></label>
 
 
 
 <input class="cmp-form-text__text" data-cmp-hook-form-text="input" type="text" id="form-text-1010167384" name="Name of Insured or Borrower">
</div></div>

        </div>
<div class="col-12 cmp-columnrow__item" data-cmp-hook-columnrow="item">
            <div class="text">
  <div class="cmp-form-text">
 <label for="form-text-952967920">Briefly Describe Your Concern <span class="optional">(Optional)</span></label>
 
 
 <textarea class="cmp-form-text__textarea" data-cmp-hook-form-text="input" id="form-text-952967920" name="Briefly Describe Your Concern" rows="8"></textarea>
 
</div></div>

        </div>

    </div>
    
</div>

        
    </div>

</div>

        </div>

    </div>
    
</div>
<div class="text ss-textpadding-top aem-GridColumn aem-GridColumn--default--12">
<div id="text-6b35bceebe" class="cmp-text">
    <p><b>After you have filled in all required information, click on the “Review” button. This will open an email in your default email tool set to email to the proper Stewart contact address. Review the information and attach all pertinent documents to the email. Be sure to attach a copy of your policy.</b></p>
<p>You will be sent a letter acknowledging receipt of your information and providing you with the name of the Stewart representative who will be processing your inquiry. Your representative will provide further instructions on where to send your backup documentation.<br>
</p>
<p><i><b>Note:&nbsp;</b>You should receive a written response within 5-10 days. If you do not receive a response, please contact the National Legal Department at 800-729-1902.</i></p>

</div>

    

</div>
<div class="button aem-GridColumn aem-GridColumn--default--12">
<button type="SUBMIT" id="form-button-498615320" class="cmp-form-button">Review</button>
</div>

    
    <div class="contentcontainer containerpresentationtype-box">
        <input type="hidden" name="clientIpAddress" value="130.248.127.34">
        <input type="hidden" name="userAgent" value="Mozilla/5.0 (Macintosh; Intel Mac OS X 10_15_7) AppleWebKit/537.36 (KHTML, like Gecko) Chrome/119.0.0.0 Safari/537.36">
        <input type="hidden" name="serverTime" value="12/06/2023 05:38 AM">
    </div>
</form>

</div>`;

export const claimFormED = {
  name: 'new_form',
  stats: {
    name: 'new_form',
    isMarketToForm: false,
    fields: 31,
    hiddenFields: 0,
    attachmentsUsed: false,
    recaptchaUsed: true,
    isPDF: false,
  },
  data: [
    {
      Name: 'Your Name',
      Type: 'text',
      Max: 3,
      Min: 2,
      Label: 'Your Name',
      Mandatory: true,
    },
    {
      Name: 'Your Address',
      Type: 'text',
      Label: 'Your Address',
      Mandatory: true,
    },
    {
      Name: 'Your City',
      Type: 'text',
      Label: 'Your City',
      Mandatory: true,
    },
    {
      Name: 'Your State',
      Type: 'select',
      Label: 'Your State',
      Options: ',AL,AK,AZ,AR,CA,CO,CT,DE,DC,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OK,OR,PA,PR,RI,MP,SC,SD,TN,TX,UT,VT,VI,VA,WA,WV,WI,WY',
      OptionNames: [
        'Select a State',
        'Alabama',
        'Alaska',
        'Arizona',
        'Arkansas',
        'California',
        'Colorado',
        'Connecticut',
        'Delaware',
        'District of Columbia',
        'Florida',
        'Georgia',
        'Guam',
        'Hawaii',
        'Idaho',
        'Illinois',
        'Indiana',
        'Iowa',
        'Kansas',
        'Kentucky',
        'Louisiana',
        'Maine',
        'Maryland',
        'Massachusetts',
        'Michigan',
        'Minnesota',
        'Mississippi',
        'Missouri',
        'Montana',
        'Nebraska',
        'Nevada',
        'New Hampshire',
        'New Jersey',
        'New Mexico',
        'New York',
        'North Carolina',
        'North Dakota',
        'Ohio',
        'Oklahoma',
        'Oregon',
        'Pennsylvania',
        'Puerto Rico',
        'Rhode Island',
        'Saipan',
        'South Carolina',
        'South Dakota',
        'Tennessee',
        'Texas',
        'Utah',
        'Vermont',
        'Virgin Islands',
        'Virginia',
        'Washington',
        'West Virginia',
        'Wisconsin',
        'Wyoming',
      ],
    },
    {
      Name: 'Your Zip/Postal Code',
      Type: 'number',
      Label: 'Your Zip/Postal Code',
      Mandatory: true,
      Max: '99999',
      Min: '90000',
    },
    {
      Name: 'Your Province/Region',
      Type: 'text',
      Label: 'Your Province/Region (Optional)',
    },
    {
      Name: 'Your Country',
      Type: 'text',
      Label: 'Your Country',
      Mandatory: true,
    },
    {
      Name: 'Your Phone Number',
      Type: 'tel',
      Label: 'Your Phone Number',
      Mandatory: true,
    },
    {
      Name: 'Your Fax Number',
      Type: 'tel',
      Label: 'Your Fax Number (Optional)',
    },
    {
      Name: 'Your E-mail Address',
      Type: 'email',
      Label: 'Your E-mail Address',
      Mandatory: true,
    },
    {
      Name: 'Insured Property Address',
      Type: 'text',
      Label: 'Insured Property Address (Optional)',
    },
    {
      Name: 'Insured Property City',
      Type: 'text',
      Label: 'City (Optional)',
    },
    {
      Name: 'Insured Property State',
      Type: 'select',
      Label: 'Your State',
      Options: ',AL,AK,AZ,AR,CA,CO,CT,DE,DC,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OK,OR,PA,PR,RI,MP,SC,SD,TN,TX,UT,VT,VI,VA,WA,WV,WI,WY',
      OptionNames: [
        'Select a State',
        'Alabama',
        'Alaska',
        'Arizona',
        'Arkansas',
        'California',
        'Colorado',
        'Connecticut',
        'Delaware',
        'District of Columbia',
        'Florida',
        'Georgia',
        'Guam',
        'Hawaii',
        'Idaho',
        'Illinois',
        'Indiana',
        'Iowa',
        'Kansas',
        'Kentucky',
        'Louisiana',
        'Maine',
        'Maryland',
        'Massachusetts',
        'Michigan',
        'Minnesota',
        'Mississippi',
        'Missouri',
        'Montana',
        'Nebraska',
        'Nevada',
        'New Hampshire',
        'New Jersey',
        'New Mexico',
        'New York',
        'North Carolina',
        'North Dakota',
        'Ohio',
        'Oklahoma',
        'Oregon',
        'Pennsylvania',
        'Puerto Rico',
        'Rhode Island',
        'Saipan',
        'South Carolina',
        'South Dakota',
        'Tennessee',
        'Texas',
        'Utah',
        'Vermont',
        'Virgin Islands',
        'Virginia',
        'Washington',
        'West Virginia',
        'Wisconsin',
        'Wyoming',
      ],
    },
    {
      Name: 'Insured Property Zip/Postal Code',
      Type: 'number',
      Label: 'Zip/Postal Code (Optional)',
    },
    {
      Name: 'Insured Property Province/Region',
      Type: 'text',
      Label: 'Province/Region (Optional)',
    },
    {
      Name: 'Insured Property Country',
      Type: 'text',
      Label: 'Country (Optional)',
    },
    {
      Name: 'Alt. Contact Name',
      Type: 'text',
      Label: 'Name (Optional)',
    },
    {
      Name: 'Alt. Contact Address',
      Type: 'text',
      Label: 'Address (Optional)',
    },
    {
      Name: 'Alt. Contact City',
      Type: 'text',
      Label: 'City (Optional)',
    },
    {
      Name: 'Alt. Contact State',
      Type: 'select',
      Label: 'State',
      Options: ',AL,AK,AZ,AR,CA,CO,CT,DE,DC,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OK,OR,PA,PR,RI,MP,SC,SD,TN,TX,UT,VT,VI,VA,WA,WV,WI,WY',
      OptionNames: [
        'Select a State',
        'Alabama',
        'Alaska',
        'Arizona',
        'Arkansas',
        'California',
        'Colorado',
        'Connecticut',
        'Delaware',
        'District of Columbia',
        'Florida',
        'Georgia',
        'Guam',
        'Hawaii',
        'Idaho',
        'Illinois',
        'Indiana',
        'Iowa',
        'Kansas',
        'Kentucky',
        'Louisiana',
        'Maine',
        'Maryland',
        'Massachusetts',
        'Michigan',
        'Minnesota',
        'Mississippi',
        'Missouri',
        'Montana',
        'Nebraska',
        'Nevada',
        'New Hampshire',
        'New Jersey',
        'New Mexico',
        'New York',
        'North Carolina',
        'North Dakota',
        'Ohio',
        'Oklahoma',
        'Oregon',
        'Pennsylvania',
        'Puerto Rico',
        'Rhode Island',
        'Saipan',
        'South Carolina',
        'South Dakota',
        'Tennessee',
        'Texas',
        'Utah',
        'Vermont',
        'Virgin Islands',
        'Virginia',
        'Washington',
        'West Virginia',
        'Wisconsin',
        'Wyoming',
      ],
    },
    {
      Name: 'Alt. Contact Zip/Postal Code',
      Type: 'number',
      Label: 'Zip/Postal Code (Optional)',
    },
    {
      Name: 'Alt. Contact Province/Region',
      Type: 'text',
      Label: 'Province/Region (Optional)',
    },
    {
      Name: 'Alt. Contact Country',
      Type: 'text',
      Label: 'Country (Optional)',
    },
    {
      Name: 'Alt. Contact Phone Number',
      Type: 'tel',
      Label: 'Phone Number (Optional)',
    },
    {
      Name: 'Policy Date',
      Type: 'date',
      Label: 'Policy Date (Optional)',
    },
    {
      Name: 'Policy Number',
      Type: 'text',
      Label: 'Policy Number (Optional)',
    },
    {
      Name: 'Name of Issuing Agent',
      Type: 'text',
      Label: 'Name of Issuing Agent (Optional)',
    },
    {
      Name: "Agent's File Number/GF #",
      Type: 'text',
      Label: "Agent's File Number/GF # (Optional)",
    },
    {
      Name: 'Name of Insured or Borrower',
      Type: 'text',
      Label: 'Name of Insured or Borrower (Optional)',
    },
    {
      Name: 'Briefly Describe Your Concern',
      Type: 'textarea',
      Label: 'Briefly Describe Your Concern (Optional)',
    },
    {
      Name: 'form-button-498615320',
      Type: 'submit',
      Label: 'Review',
    },
  ],
};

export const claimForm = {
  adaptiveform: '0.10.0',
  metadata: {
    grammar: 'json-formula-1.0.0',
    version: '1.0.0',
  },
  properties: {},
  items: [
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your Name',
      fieldType: 'text-input',
      required: false,
      label: {
        value: 'Your Name',
      },
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your Address',
      fieldType: 'text-input',
      required: false,
      label: {
        value: 'Your Address',
      },
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your City',
      fieldType: 'text-input',
      required: false,
      label: {
        value: 'Your City',
      },
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your State',
      fieldType: 'drop-down',
      enum: [
        '',
        'AL',
        'AK',
        'AZ',
        'AR',
        'CA',
        'CO',
        'CT',
        'DE',
        'DC',
        'FL',
        'GA',
        'GU',
        'HI',
        'ID',
        'IL',
        'IN',
        'IA',
        'KS',
        'KY',
        'LA',
        'ME',
        'MD',
        'MA',
        'MI',
        'MN',
        'MS',
        'MO',
        'MT',
        'NE',
        'NV',
        'NH',
        'NJ',
        'NM',
        'NY',
        'NC',
        'ND',
        'OH',
        'OK',
        'OR',
        'PA',
        'PR',
        'RI',
        'MP',
        'SC',
        'SD',
        'TN',
        'TX',
        'UT',
        'VT',
        'VI',
        'VA',
        'WA',
        'WV',
        'WI',
        'WY',
      ],
      enumNames: [
        'Select a State',
        'Alabama',
        'Alaska',
        'Arizona',
        'Arkansas',
        'California',
        'Colorado',
        'Connecticut',
        'Delaware',
        'District of Columbia',
        'Florida',
        'Georgia',
        'Guam',
        'Hawaii',
        'Idaho',
        'Illinois',
        'Indiana',
        'Iowa',
        'Kansas',
        'Kentucky',
        'Louisiana',
        'Maine',
        'Maryland',
        'Massachusetts',
        'Michigan',
        'Minnesota',
        'Mississippi',
        'Missouri',
        'Montana',
        'Nebraska',
        'Nevada',
        'New Hampshire',
        'New Jersey',
        'New Mexico',
        'New York',
        'North Carolina',
        'North Dakota',
        'Ohio',
        'Oklahoma',
        'Oregon',
        'Pennsylvania',
        'Puerto Rico',
        'Rhode Island',
        'Saipan',
        'South Carolina',
        'South Dakota',
        'Tennessee',
        'Texas',
        'Utah',
        'Vermont',
        'Virgin Islands',
        'Virginia',
        'Washington',
        'West Virginia',
        'Wisconsin',
        'Wyoming',
      ],
      label: {
        value: 'Your State',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your Zip/Postal Code',
      fieldType: 'number-input',
      required: false,
      label: {
        value: 'Your Zip/Postal Code',
      },
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your Province/Region',
      fieldType: 'text-input',
      label: {
        value: 'Your Province/Region (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your Country',
      fieldType: 'text-input',
      required: false,
      label: {
        value: 'Your Country',
      },
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your Phone Number',
      fieldType: 'tel',
      required: false,
      label: {
        value: 'Your Phone Number',
      },
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your Fax Number',
      fieldType: 'tel',
      label: {
        value: 'Your Fax Number (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your E-mail Address',
      fieldType: 'email',
      required: false,
      label: {
        value: 'Your E-mail Address',
      },
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Insured Property Address',
      fieldType: 'text-input',
      label: {
        value: 'Insured Property Address (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Insured Property City',
      fieldType: 'text-input',
      label: {
        value: 'City (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Insured Property State',
      fieldType: 'drop-down',
      enum: [
        '',
        'AL',
        'AK',
        'AZ',
        'AR',
        'CA',
        'CO',
        'CT',
        'DE',
        'DC',
        'FL',
        'GA',
        'GU',
        'HI',
        'ID',
        'IL',
        'IN',
        'IA',
        'KS',
        'KY',
        'LA',
        'ME',
        'MD',
        'MA',
        'MI',
        'MN',
        'MS',
        'MO',
        'MT',
        'NE',
        'NV',
        'NH',
        'NJ',
        'NM',
        'NY',
        'NC',
        'ND',
        'OH',
        'OK',
        'OR',
        'PA',
        'PR',
        'RI',
        'MP',
        'SC',
        'SD',
        'TN',
        'TX',
        'UT',
        'VT',
        'VI',
        'VA',
        'WA',
        'WV',
        'WI',
        'WY',
      ],
      enumNames: [
        'Select a State',
        'Alabama',
        'Alaska',
        'Arizona',
        'Arkansas',
        'California',
        'Colorado',
        'Connecticut',
        'Delaware',
        'District of Columbia',
        'Florida',
        'Georgia',
        'Guam',
        'Hawaii',
        'Idaho',
        'Illinois',
        'Indiana',
        'Iowa',
        'Kansas',
        'Kentucky',
        'Louisiana',
        'Maine',
        'Maryland',
        'Massachusetts',
        'Michigan',
        'Minnesota',
        'Mississippi',
        'Missouri',
        'Montana',
        'Nebraska',
        'Nevada',
        'New Hampshire',
        'New Jersey',
        'New Mexico',
        'New York',
        'North Carolina',
        'North Dakota',
        'Ohio',
        'Oklahoma',
        'Oregon',
        'Pennsylvania',
        'Puerto Rico',
        'Rhode Island',
        'Saipan',
        'South Carolina',
        'South Dakota',
        'Tennessee',
        'Texas',
        'Utah',
        'Vermont',
        'Virgin Islands',
        'Virginia',
        'Washington',
        'West Virginia',
        'Wisconsin',
        'Wyoming',
      ],
      label: {
        value: 'Your State',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Insured Property Zip/Postal Code',
      fieldType: 'number-input',
      label: {
        value: 'Zip/Postal Code (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Insured Property Province/Region',
      fieldType: 'text-input',
      label: {
        value: 'Province/Region (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Insured Property Country',
      fieldType: 'text-input',
      label: {

        value: 'Country (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Alt. Contact Name',
      fieldType: 'text-input',
      label: {
        value: 'Name (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Alt. Contact Address',
      fieldType: 'text-input',
      label: {
        value: 'Address (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Alt. Contact City',
      fieldType: 'text-input',
      label: {
        value: 'City (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Alt. Contact State',
      fieldType: 'drop-down',
      enum: [
        '',
        'AL',
        'AK',
        'AZ',
        'AR',
        'CA',
        'CO',
        'CT',
        'DE',
        'DC',
        'FL',
        'GA',
        'GU',
        'HI',
        'ID',
        'IL',
        'IN',
        'IA',
        'KS',
        'KY',
        'LA',
        'ME',
        'MD',
        'MA',
        'MI',
        'MN',
        'MS',
        'MO',
        'MT',
        'NE',
        'NV',
        'NH',
        'NJ',
        'NM',
        'NY',
        'NC',
        'ND',
        'OH',
        'OK',
        'OR',
        'PA',
        'PR',
        'RI',
        'MP',
        'SC',
        'SD',
        'TN',
        'TX',
        'UT',
        'VT',
        'VI',
        'VA',
        'WA',
        'WV',
        'WI',
        'WY',
      ],
      enumNames: [
        'Select a State',
        'Alabama',
        'Alaska',
        'Arizona',
        'Arkansas',
        'California',
        'Colorado',
        'Connecticut',
        'Delaware',
        'District of Columbia',
        'Florida',
        'Georgia',
        'Guam',
        'Hawaii',
        'Idaho',
        'Illinois',
        'Indiana',
        'Iowa',
        'Kansas',
        'Kentucky',
        'Louisiana',
        'Maine',
        'Maryland',
        'Massachusetts',
        'Michigan',
        'Minnesota',
        'Mississippi',
        'Missouri',
        'Montana',
        'Nebraska',
        'Nevada',
        'New Hampshire',
        'New Jersey',
        'New Mexico',
        'New York',
        'North Carolina',
        'North Dakota',
        'Ohio',
        'Oklahoma',
        'Oregon',
        'Pennsylvania',
        'Puerto Rico',
        'Rhode Island',
        'Saipan',
        'South Carolina',
        'South Dakota',
        'Tennessee',
        'Texas',
        'Utah',
        'Vermont',
        'Virgin Islands',
        'Virginia',
        'Washington',
        'West Virginia',
        'Wisconsin',
        'Wyoming',
      ],
      label: {
        value: 'State',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Alt. Contact Zip/Postal Code',
      fieldType: 'number-input',
      label: {
        value: 'Zip/Postal Code (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Alt. Contact Province/Region',
      fieldType: 'text-input',
      label: {
        value: 'Province/Region (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Alt. Contact Country',
      fieldType: 'text-input',
      label: {
        value: 'Country (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Alt. Contact Phone Number',
      fieldType: 'tel',
      label: {
        value: 'Phone Number (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Policy Date',
      fieldType: 'date',
      label: {
        value: 'Policy Date (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Policy Number',
      fieldType: 'text-input',
      label: {
        value: 'Policy Number (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Name of Issuing Agent',
      fieldType: 'text-input',
      label: {
        value: 'Name of Issuing Agent (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: "Agent's File Number/GF #",
      fieldType: 'text-input',
      label: {
        value: "Agent's File Number/GF # (Optional)",
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Name of Insured or Borrower',
      fieldType: 'text-input',
      label: {
        value: 'Name of Insured or Borrower (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Briefly Describe Your Concern',
      fieldType: 'multiline-input',
      label: {
        value: 'Briefly Describe Your Concern (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'form-button-498615320',
      fieldType: 'submit',
      label: {
        value: 'Review',
      },
      required: false,
    },
  ],
};

export const claimFormWithoutPanel = {
  adaptiveform: '0.10.0',
  metadata: {
    grammar: 'json-formula-1.0.0',
    version: '1.0.0',
  },
  name: 'new_form',
  properties: {},
  items: [
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your Name',
      fieldType: 'text-input',
      required: true,
      label: {
        value: 'Your Name',
      },
      maxLength: 3,
      minLength: 2,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your Address',
      fieldType: 'text-input',
      required: true,
      label: {
        value: 'Your Address',
      },
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your City',
      fieldType: 'text-input',
      required: true,
      label: {
        value: 'Your City',
      },
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your State',
      fieldType: 'drop-down',
      enum: [
        '',
        'AL',
        'AK',
        'AZ',
        'AR',
        'CA',
        'CO',
        'CT',
        'DE',
        'DC',
        'FL',
        'GA',
        'GU',
        'HI',
        'ID',
        'IL',
        'IN',
        'IA',
        'KS',
        'KY',
        'LA',
        'ME',
        'MD',
        'MA',
        'MI',
        'MN',
        'MS',
        'MO',
        'MT',
        'NE',
        'NV',
        'NH',
        'NJ',
        'NM',
        'NY',
        'NC',
        'ND',
        'OH',
        'OK',
        'OR',
        'PA',
        'PR',
        'RI',
        'MP',
        'SC',
        'SD',
        'TN',
        'TX',
        'UT',
        'VT',
        'VI',
        'VA',
        'WA',
        'WV',
        'WI',
        'WY',
      ],
      enumNames: [
        'Select a State',
        'Alabama',
        'Alaska',
        'Arizona',
        'Arkansas',
        'California',
        'Colorado',
        'Connecticut',
        'Delaware',
        'District of Columbia',
        'Florida',
        'Georgia',
        'Guam',
        'Hawaii',
        'Idaho',
        'Illinois',
        'Indiana',
        'Iowa',
        'Kansas',
        'Kentucky',
        'Louisiana',
        'Maine',
        'Maryland',
        'Massachusetts',
        'Michigan',
        'Minnesota',
        'Mississippi',
        'Missouri',
        'Montana',
        'Nebraska',
        'Nevada',
        'New Hampshire',
        'New Jersey',
        'New Mexico',
        'New York',
        'North Carolina',
        'North Dakota',
        'Ohio',
        'Oklahoma',
        'Oregon',
        'Pennsylvania',
        'Puerto Rico',
        'Rhode Island',
        'Saipan',
        'South Carolina',
        'South Dakota',
        'Tennessee',
        'Texas',
        'Utah',
        'Vermont',
        'Virgin Islands',
        'Virginia',
        'Washington',
        'West Virginia',
        'Wisconsin',
        'Wyoming',
      ],
      label: {
        value: 'Your State',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your Zip/Postal Code',
      fieldType: 'number-input',
      required: true,
      maxLength: '99999',
      minLength: '90000',
      label: {
        value: 'Your Zip/Postal Code',
      },
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your Province/Region',
      fieldType: 'text-input',
      label: {
        value: 'Your Province/Region (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your Country',
      fieldType: 'text-input',
      required: true,
      label: {
        value: 'Your Country',
      },
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your Phone Number',
      fieldType: 'tel',
      required: true,
      label: {
        value: 'Your Phone Number',
      },
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your Fax Number',
      fieldType: 'tel',
      label: {
        value: 'Your Fax Number (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Your E-mail Address',
      fieldType: 'email',
      required: true,
      label: {
        value: 'Your E-mail Address',
      },
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Insured Property Address',
      fieldType: 'text-input',
      label: {
        value: 'Insured Property Address (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Insured Property City',
      fieldType: 'text-input',
      label: {
        value: 'City (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Insured Property State',
      fieldType: 'drop-down',
      enum: [
        '',
        'AL',
        'AK',
        'AZ',
        'AR',
        'CA',
        'CO',
        'CT',
        'DE',
        'DC',
        'FL',
        'GA',
        'GU',
        'HI',
        'ID',
        'IL',
        'IN',
        'IA',
        'KS',
        'KY',
        'LA',
        'ME',
        'MD',
        'MA',
        'MI',
        'MN',
        'MS',
        'MO',
        'MT',
        'NE',
        'NV',
        'NH',
        'NJ',
        'NM',
        'NY',
        'NC',
        'ND',
        'OH',
        'OK',
        'OR',
        'PA',
        'PR',
        'RI',
        'MP',
        'SC',
        'SD',
        'TN',
        'TX',
        'UT',
        'VT',
        'VI',
        'VA',
        'WA',
        'WV',
        'WI',
        'WY',
      ],
      enumNames: [
        'Select a State',
        'Alabama',
        'Alaska',
        'Arizona',
        'Arkansas',
        'California',
        'Colorado',
        'Connecticut',
        'Delaware',
        'District of Columbia',
        'Florida',
        'Georgia',
        'Guam',
        'Hawaii',
        'Idaho',
        'Illinois',
        'Indiana',
        'Iowa',
        'Kansas',
        'Kentucky',
        'Louisiana',
        'Maine',
        'Maryland',
        'Massachusetts',
        'Michigan',
        'Minnesota',
        'Mississippi',
        'Missouri',
        'Montana',
        'Nebraska',
        'Nevada',
        'New Hampshire',
        'New Jersey',
        'New Mexico',
        'New York',
        'North Carolina',
        'North Dakota',
        'Ohio',
        'Oklahoma',
        'Oregon',
        'Pennsylvania',
        'Puerto Rico',
        'Rhode Island',
        'Saipan',
        'South Carolina',
        'South Dakota',
        'Tennessee',
        'Texas',
        'Utah',
        'Vermont',
        'Virgin Islands',
        'Virginia',
        'Washington',
        'West Virginia',
        'Wisconsin',
        'Wyoming',
      ],
      label: {
        value: 'Your State',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Insured Property Zip/Postal Code',
      fieldType: 'number-input',
      label: {
        value: 'Zip/Postal Code (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Insured Property Province/Region',
      fieldType: 'text-input',
      label: {
        value: 'Province/Region (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Insured Property Country',
      fieldType: 'text-input',
      label: {

        value: 'Country (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Alt. Contact Name',
      fieldType: 'text-input',
      label: {
        value: 'Name (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Alt. Contact Address',
      fieldType: 'text-input',
      label: {
        value: 'Address (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Alt. Contact City',
      fieldType: 'text-input',
      label: {
        value: 'City (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Alt. Contact State',
      fieldType: 'drop-down',
      enum: [
        '',
        'AL',
        'AK',
        'AZ',
        'AR',
        'CA',
        'CO',
        'CT',
        'DE',
        'DC',
        'FL',
        'GA',
        'GU',
        'HI',
        'ID',
        'IL',
        'IN',
        'IA',
        'KS',
        'KY',
        'LA',
        'ME',
        'MD',
        'MA',
        'MI',
        'MN',
        'MS',
        'MO',
        'MT',
        'NE',
        'NV',
        'NH',
        'NJ',
        'NM',
        'NY',
        'NC',
        'ND',
        'OH',
        'OK',
        'OR',
        'PA',
        'PR',
        'RI',
        'MP',
        'SC',
        'SD',
        'TN',
        'TX',
        'UT',
        'VT',
        'VI',
        'VA',
        'WA',
        'WV',
        'WI',
        'WY',
      ],
      enumNames: [
        'Select a State',
        'Alabama',
        'Alaska',
        'Arizona',
        'Arkansas',
        'California',
        'Colorado',
        'Connecticut',
        'Delaware',
        'District of Columbia',
        'Florida',
        'Georgia',
        'Guam',
        'Hawaii',
        'Idaho',
        'Illinois',
        'Indiana',
        'Iowa',
        'Kansas',
        'Kentucky',
        'Louisiana',
        'Maine',
        'Maryland',
        'Massachusetts',
        'Michigan',
        'Minnesota',
        'Mississippi',
        'Missouri',
        'Montana',
        'Nebraska',
        'Nevada',
        'New Hampshire',
        'New Jersey',
        'New Mexico',
        'New York',
        'North Carolina',
        'North Dakota',
        'Ohio',
        'Oklahoma',
        'Oregon',
        'Pennsylvania',
        'Puerto Rico',
        'Rhode Island',
        'Saipan',
        'South Carolina',
        'South Dakota',
        'Tennessee',
        'Texas',
        'Utah',
        'Vermont',
        'Virgin Islands',
        'Virginia',
        'Washington',
        'West Virginia',
        'Wisconsin',
        'Wyoming',
      ],
      label: {
        value: 'State',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Alt. Contact Zip/Postal Code',
      fieldType: 'number-input',
      label: {
        value: 'Zip/Postal Code (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Alt. Contact Province/Region',
      fieldType: 'text-input',
      label: {
        value: 'Province/Region (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Alt. Contact Country',
      fieldType: 'text-input',
      label: {
        value: 'Country (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Alt. Contact Phone Number',
      fieldType: 'tel',
      label: {
        value: 'Phone Number (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Policy Date',
      fieldType: 'date',
      label: {
        value: 'Policy Date (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Policy Number',
      fieldType: 'text-input',
      label: {
        value: 'Policy Number (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Name of Issuing Agent',
      fieldType: 'text-input',
      label: {
        value: 'Name of Issuing Agent (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: "Agent's File Number/GF #",
      fieldType: 'text-input',
      label: {
        value: "Agent's File Number/GF # (Optional)",
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Name of Insured or Borrower',
      fieldType: 'text-input',
      label: {
        value: 'Name of Insured or Borrower (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'Briefly Describe Your Concern',
      fieldType: 'multiline-input',
      label: {
        value: 'Briefly Describe Your Concern (Optional)',
      },
      required: false,
    },
    {
      constraintMessages: {
        required: 'Please fill in this field.',
      },
      name: 'form-button-498615320',
      buttonType: 'submit',
      fieldType: 'button',
      label: {
        value: 'Review',
      },
      required: false,
      properties: {
        'fd:buttonType': 'submit',
      },
    },
  ],
};

export const claimFormWithPanel = {
  adaptiveform: '0.10.0',
  metadata: { grammar: 'json-formula-1.0.0', version: '1.0.0' },
  name: 'new_form',
  properties: {},
  items: [{
    name: 'panel-1',
    fieldType: 'panel',
    label: { value: 'Your Contact Information' },
    required: false,
    items: [{
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Your Name', fieldType: 'text-input', required: true, label: { value: 'Your Name' }, maxLength: 3, minLength: 2,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Your Address', fieldType: 'text-input', required: true, label: { value: 'Your Address' },
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Your City', fieldType: 'text-input', required: true, label: { value: 'Your City' },
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Your State', fieldType: 'drop-down', enum: ['', 'AL', 'AK', 'AZ', 'AR', 'CA', 'CO', 'CT', 'DE', 'DC', 'FL', 'GA', 'GU', 'HI', 'ID', 'IL', 'IN', 'IA', 'KS', 'KY', 'LA', 'ME', 'MD', 'MA', 'MI', 'MN', 'MS', 'MO', 'MT', 'NE', 'NV', 'NH', 'NJ', 'NM', 'NY', 'NC', 'ND', 'OH', 'OK', 'OR', 'PA', 'PR', 'RI', 'MP', 'SC', 'SD', 'TN', 'TX', 'UT', 'VT', 'VI', 'VA', 'WA', 'WV', 'WI', 'WY'], enumNames: ['Select a State', 'Alabama', 'Alaska', 'Arizona', 'Arkansas', 'California', 'Colorado', 'Connecticut', 'Delaware', 'District of Columbia', 'Florida', 'Georgia', 'Guam', 'Hawaii', 'Idaho', 'Illinois', 'Indiana', 'Iowa', 'Kansas', 'Kentucky', 'Louisiana', 'Maine', 'Maryland', 'Massachusetts', 'Michigan', 'Minnesota', 'Mississippi', 'Missouri', 'Montana', 'Nebraska', 'Nevada', 'New Hampshire', 'New Jersey', 'New Mexico', 'New York', 'North Carolina', 'North Dakota', 'Ohio', 'Oklahoma', 'Oregon', 'Pennsylvania', 'Puerto Rico', 'Rhode Island', 'Saipan', 'South Carolina', 'South Dakota', 'Tennessee', 'Texas', 'Utah', 'Vermont', 'Virgin Islands', 'Virginia', 'Washington', 'West Virginia', 'Wisconsin', 'Wyoming'], label: { value: 'Your State' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Your Zip/Postal Code', fieldType: 'number-input', required: true, label: { value: 'Your Zip/Postal Code' }, maxLength: '99999', minLength: '90000',
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Your Province/Region', fieldType: 'text-input', label: { value: 'Your Province/Region (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Your Country', fieldType: 'text-input', required: true, label: { value: 'Your Country' },
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Your Phone Number', fieldType: 'tel', required: true, label: { value: 'Your Phone Number' },
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Your Fax Number', fieldType: 'tel', label: { value: 'Your Fax Number (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Your E-mail Address', fieldType: 'email', required: true, label: { value: 'Your E-mail Address' },
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Insured Property Address', fieldType: 'text-input', label: { value: 'Insured Property Address (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Insured Property City', fieldType: 'text-input', label: { value: 'City (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Insured Property State', fieldType: 'drop-down', enum: ['', 'AL', 'AK', 'AZ', 'AR', 'CA', 'CO', 'CT', 'DE', 'DC', 'FL', 'GA', 'GU', 'HI', 'ID', 'IL', 'IN', 'IA', 'KS', 'KY', 'LA', 'ME', 'MD', 'MA', 'MI', 'MN', 'MS', 'MO', 'MT', 'NE', 'NV', 'NH', 'NJ', 'NM', 'NY', 'NC', 'ND', 'OH', 'OK', 'OR', 'PA', 'PR', 'RI', 'MP', 'SC', 'SD', 'TN', 'TX', 'UT', 'VT', 'VI', 'VA', 'WA', 'WV', 'WI', 'WY'], enumNames: ['Select a State', 'Alabama', 'Alaska', 'Arizona', 'Arkansas', 'California', 'Colorado', 'Connecticut', 'Delaware', 'District of Columbia', 'Florida', 'Georgia', 'Guam', 'Hawaii', 'Idaho', 'Illinois', 'Indiana', 'Iowa', 'Kansas', 'Kentucky', 'Louisiana', 'Maine', 'Maryland', 'Massachusetts', 'Michigan', 'Minnesota', 'Mississippi', 'Missouri', 'Montana', 'Nebraska', 'Nevada', 'New Hampshire', 'New Jersey', 'New Mexico', 'New York', 'North Carolina', 'North Dakota', 'Ohio', 'Oklahoma', 'Oregon', 'Pennsylvania', 'Puerto Rico', 'Rhode Island', 'Saipan', 'South Carolina', 'South Dakota', 'Tennessee', 'Texas', 'Utah', 'Vermont', 'Virgin Islands', 'Virginia', 'Washington', 'West Virginia', 'Wisconsin', 'Wyoming'], label: { value: 'Your State' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Insured Property Zip/Postal Code', fieldType: 'number-input', label: { value: 'Zip/Postal Code (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Insured Property Province/Region', fieldType: 'text-input', label: { value: 'Province/Region (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Insured Property Country', fieldType: 'text-input', label: { value: 'Country (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Alt. Contact Name', fieldType: 'text-input', label: { value: 'Name (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Alt. Contact Address', fieldType: 'text-input', label: { value: 'Address (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Alt. Contact City', fieldType: 'text-input', label: { value: 'City (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Alt. Contact State', fieldType: 'drop-down', enum: ['', 'AL', 'AK', 'AZ', 'AR', 'CA', 'CO', 'CT', 'DE', 'DC', 'FL', 'GA', 'GU', 'HI', 'ID', 'IL', 'IN', 'IA', 'KS', 'KY', 'LA', 'ME', 'MD', 'MA', 'MI', 'MN', 'MS', 'MO', 'MT', 'NE', 'NV', 'NH', 'NJ', 'NM', 'NY', 'NC', 'ND', 'OH', 'OK', 'OR', 'PA', 'PR', 'RI', 'MP', 'SC', 'SD', 'TN', 'TX', 'UT', 'VT', 'VI', 'VA', 'WA', 'WV', 'WI', 'WY'], enumNames: ['Select a State', 'Alabama', 'Alaska', 'Arizona', 'Arkansas', 'California', 'Colorado', 'Connecticut', 'Delaware', 'District of Columbia', 'Florida', 'Georgia', 'Guam', 'Hawaii', 'Idaho', 'Illinois', 'Indiana', 'Iowa', 'Kansas', 'Kentucky', 'Louisiana', 'Maine', 'Maryland', 'Massachusetts', 'Michigan', 'Minnesota', 'Mississippi', 'Missouri', 'Montana', 'Nebraska', 'Nevada', 'New Hampshire', 'New Jersey', 'New Mexico', 'New York', 'North Carolina', 'North Dakota', 'Ohio', 'Oklahoma', 'Oregon', 'Pennsylvania', 'Puerto Rico', 'Rhode Island', 'Saipan', 'South Carolina', 'South Dakota', 'Tennessee', 'Texas', 'Utah', 'Vermont', 'Virgin Islands', 'Virginia', 'Washington', 'West Virginia', 'Wisconsin', 'Wyoming'], label: { value: 'State' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Alt. Contact Zip/Postal Code', fieldType: 'number-input', label: { value: 'Zip/Postal Code (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Alt. Contact Province/Region', fieldType: 'text-input', label: { value: 'Province/Region (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Alt. Contact Country', fieldType: 'text-input', label: { value: 'Country (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Alt. Contact Phone Number', fieldType: 'tel', label: { value: 'Phone Number (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Policy Date', fieldType: 'date', label: { value: 'Policy Date (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Policy Number', fieldType: 'text-input', label: { value: 'Policy Number (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Name of Issuing Agent', fieldType: 'text-input', label: { value: 'Name of Issuing Agent (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: "Agent's File Number/GF #", fieldType: 'text-input', label: { value: "Agent's File Number/GF # (Optional)" }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Name of Insured or Borrower', fieldType: 'text-input', label: { value: 'Name of Insured or Borrower (Optional)' }, required: false,
    }, {
      Fieldset: 'panel-1', constraintMessages: { required: 'Please fill in this field.' }, name: 'Briefly Describe Your Concern', fieldType: 'multiline-input', label: { value: 'Briefly Describe Your Concern (Optional)' }, required: false,
    }],
  }, {
    name: 'panel-2', fieldType: 'panel', label: { value: 'After you have filled in all required information, click on the “Review” button. This will open an email in your default email tool set to email to the proper Stewart contact address. Review the information and attach all pertinent documents to the email. Be sure to attach a copy of your policy.' }, required: false,
  }, {
    name: 'panel-3',
    fieldType: 'panel',
    required: false,
    items: [{
      Fieldset: 'panel-3',
      constraintMessages: { required: 'Please fill in this field.' },
      name: 'form-button-498615320',
      fieldType: 'button',
      label: { value: 'Review' },
      required: false,
      buttonType: 'submit',
      properties: {
        'fd:buttonType': 'submit',
      },
    }],
  }],
};
