{"id":3046,"date":"2024-03-28T12:11:27","date_gmt":"2024-03-28T16:11:27","guid":{"rendered":"https:\/\/azurdeces.com\/additional-qpp-information\/"},"modified":"2026-10-23T07:21:54","modified_gmt":"2026-10-23T11:21:54","slug":"additional-qpp-information","status":"publish","type":"page","link":"https:\/\/azurdeces.com\/en\/additional-qpp-information\/","title":{"rendered":"Additional QPP information"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"3046\" class=\"elementor elementor-3046 elementor-2147\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-d04172f e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-column-slider-no wpr-equal-height-no e-con e-parent\" data-id=\"d04172f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-157e07f e-flex e-con-boxed wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-column-slider-no wpr-equal-height-no e-con e-parent\" data-id=\"157e07f\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-c28cbd8 e-con-full e-flex wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no wpr-column-slider-no wpr-equal-height-no e-con e-child\" data-id=\"c28cbd8\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-5843e6b elementor-widget elementor-widget-htwpform-addons\" data-id=\"5843e6b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"htwpform-addons.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t            <div class=\"htwpform_area\" >\n                <div class=\"wpforms-container wpforms-container-full\" id=\"wpforms-2127\"><form id=\"wpforms-form-2127\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"2127\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/en\/wp-json\/wp\/v2\/pages\/3046\" autocomplete=\"nope\" data-token=\"696ac7b2e60269c672272d9b5257de72\" data-token-time=\"1792857493\"><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div class=\"wpforms-page-indicator progress\" data-indicator=\"progress\" data-indicator-color=\"#58a8de\" data-scroll=\"1\"><span class=\"wpforms-page-indicator-page-title\" ><\/span><span class=\"wpforms-page-indicator-page-title-sep\" style=\"display:none;\"> - <\/span><span class=\"wpforms-page-indicator-steps\">\u00c9tape <span class=\"wpforms-page-indicator-steps-current\">1<\/span> de 5<\/span><div class=\"wpforms-page-indicator-page-progress-wrap\"><div class=\"wpforms-page-indicator-page-progress\" style=\"width:20%;background-color:#58a8de\"><\/div><\/div><\/div><div class=\"wpforms-field-container\"><div class=\"wpforms-page wpforms-page-1 \" data-page=\"1\"><div id=\"wpforms-2127-field_160-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"160\"><\/div><div id=\"wpforms-2127-field_96-container\" class=\"wpforms-field wpforms-field-html\" data-field-type=\"html\" data-field-id=\"96\"><div id=\"wpforms-2127-field_96\">Additional QPP information<\/div><\/div><div id=\"wpforms-2127-field_51-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"51\"><div class=\"wpforms-field-description\">Funeral Director: Denis Lachance<\/div><\/div><div id=\"wpforms-2127-field_23-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"23\"><h3 id=\"wpforms-2127-field_23\">Deceased Person&#039;s Information<\/h3><\/div><div id=\"wpforms-2127-field_0-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half wpforms-first\" data-field-type=\"name\" data-field-id=\"0\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_0\">Family name at birth <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2127-field_0\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][0]\" placeholder=\"Family name at birth\" required><\/div><div id=\"wpforms-2127-field_86-container\" class=\"wpforms-field wpforms-field-name wpforms-one-half\" data-field-type=\"name\" data-field-id=\"86\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_86\">First name <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2127-field_86\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][86]\" placeholder=\"First name\" required><\/div><div id=\"wpforms-2127-field_71-container\" class=\"wpforms-field wpforms-field-date-time wpforms-one-half wpforms-first\" data-field-type=\"date-time\" data-field-id=\"71\"><label class=\"wpforms-field-label\">Date of birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][71][date][d]\" id=\"wpforms-2127-field_71-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>J<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][71][date][m]\" id=\"wpforms-2127-field_71-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>M<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][71][date][y]\" id=\"wpforms-2127-field_71-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>A<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><option value=\"1919\" >1919<\/option><option value=\"1918\" >1918<\/option><option value=\"1917\" >1917<\/option><option value=\"1916\" >1916<\/option><option value=\"1915\" >1915<\/option><option value=\"1914\" >1914<\/option><option value=\"1913\" >1913<\/option><option value=\"1912\" >1912<\/option><option value=\"1911\" >1911<\/option><option value=\"1910\" >1910<\/option><option value=\"1909\" >1909<\/option><option value=\"1908\" >1908<\/option><option value=\"1907\" >1907<\/option><option value=\"1906\" >1906<\/option><option value=\"1905\" >1905<\/option><option value=\"1904\" >1904<\/option><option value=\"1903\" >1903<\/option><option value=\"1902\" >1902<\/option><option value=\"1901\" >1901<\/option><option value=\"1900\" >1900<\/option><\/select><\/div><\/div><div id=\"wpforms-2127-field_110-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"110\"><label class=\"wpforms-field-label\">What was the marital status of the DECEASED at the time of death?  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_110\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_110_1\" name=\"wpforms[fields][110]\" value=\"Single\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_110_1\">Single<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_110_2\" name=\"wpforms[fields][110]\" value=\"Married\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_110_2\">Married<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_110_3\" name=\"wpforms[fields][110]\" value=\"Widower\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_110_3\">Widower<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_110_5\" name=\"wpforms[fields][110]\" value=\"Civil Union\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_110_5\">Civil Union<\/label><\/li><li class=\"choice-8 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_110_8\" name=\"wpforms[fields][110]\" value=\"Common-law Partner\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_110_8\">Common-law Partner<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_110_4\" name=\"wpforms[fields][110]\" value=\"Divorced\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_110_4\">Divorced<\/label><\/li><li class=\"choice-6 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_110_6\" name=\"wpforms[fields][110]\" value=\"Dissolved Union\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_110_6\">Dissolved Union<\/label><\/li><li class=\"choice-7 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_110_7\" name=\"wpforms[fields][110]\" value=\"Legally Separated\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_110_7\">Legally Separated<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_111-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"111\" style=\"display:none;\"><label class=\"wpforms-field-label\">Was the deceased person a common-law partner for more than three years? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_111\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_111_1\" name=\"wpforms[fields][111]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_111_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_111_2\" name=\"wpforms[fields][111]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_111_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_125-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-hide\" data-field-type=\"date-time\" data-field-id=\"125\"><label class=\"wpforms-field-label\">Since: (date of marriage, divorce, civil union, dissolved union, legal separation)<\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][125][date][d]\" id=\"wpforms-2127-field_125-day\" class=\"wpforms-field-date-time-date-day\" ><option value=\"\" class=\"placeholder\" selected disabled>J<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][125][date][m]\" id=\"wpforms-2127-field_125-month\" class=\"wpforms-field-date-time-date-month\" ><option value=\"\" class=\"placeholder\" selected disabled>M<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][125][date][y]\" id=\"wpforms-2127-field_125-year\" class=\"wpforms-field-date-time-date-year\" ><option value=\"\" class=\"placeholder\" selected disabled>A<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><option value=\"1919\" >1919<\/option><option value=\"1918\" >1918<\/option><option value=\"1917\" >1917<\/option><option value=\"1916\" >1916<\/option><option value=\"1915\" >1915<\/option><option value=\"1914\" >1914<\/option><option value=\"1913\" >1913<\/option><option value=\"1912\" >1912<\/option><option value=\"1911\" >1911<\/option><option value=\"1910\" >1910<\/option><option value=\"1909\" >1909<\/option><option value=\"1908\" >1908<\/option><option value=\"1907\" >1907<\/option><option value=\"1906\" >1906<\/option><option value=\"1905\" >1905<\/option><option value=\"1904\" >1904<\/option><option value=\"1903\" >1903<\/option><option value=\"1902\" >1902<\/option><option value=\"1901\" >1901<\/option><option value=\"1900\" >1900<\/option><\/select><\/div><\/div>\t\t<div id=\"wpforms-2127-field_1-container\"\n\t\t\tclass=\"wpforms-field wpforms-field-text\"\n\t\t\tdata-field-type=\"text\"\n\t\t\tdata-field-id=\"1\"\n\t\t\t>\n\t\t\t<label class=\"wpforms-field-label\" for=\"wpforms-2127-field_1\" >always the receive<\/label>\n\t\t\t<input type=\"text\" id=\"wpforms-2127-field_1\" class=\"wpforms-field-medium\" name=\"wpforms[fields][1]\" >\n\t\t<\/div>\n\t\t<div id=\"wpforms-2127-field_103-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"103\"><label class=\"wpforms-field-label\">Did the deceased person participate in a foreign social security scheme? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_103\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_103_1\" name=\"wpforms[fields][103]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_103_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_103_2\" name=\"wpforms[fields][103]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_103_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_104-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"104\"><label class=\"wpforms-field-label\">During their lifetime, did the deceased person have children (biological or adopted) born after 1958?  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_104\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_104_1\" name=\"wpforms[fields][104]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_104_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_104_2\" name=\"wpforms[fields][104]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_104_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_105-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"105\"><label class=\"wpforms-field-label\">During their lifetime, did the deceased person care for children born after 1958 (other than biological children)?  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_105\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_105_1\" name=\"wpforms[fields][105]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_105_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_105_2\" name=\"wpforms[fields][105]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_105_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_175-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"divider\" data-field-id=\"175\" style=\"display:none;\"><h3 id=\"wpforms-2127-field_175\">A deceased person who received family benefits from Quebec or Canada for a child may help someone become eligible for a pension or increase its amount. Therefore, it is important to provide, to your knowledge, the requested information about the deceased person&#039;s children. <\/h3><\/div><div id=\"wpforms-2127-field_169-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"169\" style=\"display:none;\"><label class=\"wpforms-field-label\">Which of these options describes the deceased person&#039;s situation regarding family benefits? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_169\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_169_1\" name=\"wpforms[fields][169]\" value=\"During their lifetime, the deceased person received family benefits in their name.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_169_1\">During their lifetime, the deceased person received family benefits in their name.<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_169_2\" name=\"wpforms[fields][169]\" value=\"During their lifetime, the deceased person did not receive family benefits in their name. They were paid to their spouse or common-law partner. \" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_169_2\">During their lifetime, the deceased person did not receive family benefits in their name. They were paid to their spouse or common-law partner.<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_169_3\" name=\"wpforms[fields][169]\" value=\"The deceased person was eligible for family benefits but never received them because their family income was too high.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_169_3\">The deceased person was eligible for family benefits but never received them because their family income was too high.<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_169_4\" name=\"wpforms[fields][169]\" value=\"The deceased person and their spouse or common-law partner never received family benefits.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_169_4\">The deceased person and their spouse or common-law partner never received family benefits.<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_169_5\" name=\"wpforms[fields][169]\" value=\"I do not know.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_169_5\">I do not know.<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_106-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"106\" style=\"display:none;\"><label class=\"wpforms-field-label\">From each child&#039;s birth until their 7th birthday, were there periods when the deceased person did not receive family benefits in their name? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_106\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_106_1\" name=\"wpforms[fields][106]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_106_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_106_2\" name=\"wpforms[fields][106]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_106_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_107-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"107\" style=\"display:none;\"><label class=\"wpforms-field-label\">From their birth or arrival in Canada until their 7th birthday, did each child always reside in Canada with the deceased person? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_107\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_107_1\" name=\"wpforms[fields][107]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_107_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_107_2\" name=\"wpforms[fields][107]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_107_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_108-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-2-columns\" data-field-type=\"radio\" data-field-id=\"108\"><label class=\"wpforms-field-label\">How would you like to receive the reimbursement? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_108\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_108_1\" name=\"wpforms[fields][108]\" value=\"&lt;b&gt;To the heirs:&lt;\/b&gt; A payment - a check for $2500 to the heirs.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_108_1\"><b>To the heirs:<\/b> A payment - a check for $2500 to the heirs.<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_108_2\" name=\"wpforms[fields][108]\" value=\"&lt;b&gt;To the person who paid for the funeral services:&lt;\/b&gt; A payment, to the person who paid for the funeral services, equal to the funeral services invoice, and a payment, equal to the difference, paid to the heirs.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_108_2\"><b>To the person who paid for the funeral services:<\/b> A payment, to the person who paid for the funeral services, equal to the funeral services invoice, and a payment, equal to the difference, paid to the heirs.<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_180-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"180\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"1\" data-formid=\"2127\" disabled>Next<\/button><img decoding=\"async\" src=\"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-2  \" data-page=\"2\" style=\"display:none;\"><div id=\"wpforms-2127-field_181-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"divider\" data-field-id=\"181\" style=\"display:none;\"><h3 id=\"wpforms-2127-field_181\">Information about children born after 1958<\/h3><\/div><div id=\"wpforms-2127-field_213-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"divider\" data-field-id=\"213\" style=\"display:none;\"><h3 id=\"wpforms-2127-field_213\">You have indicated no children born after 1958. Press NEXT <\/h3><\/div><div id=\"wpforms-2127-field_182-container\" class=\"wpforms-field wpforms-field-repeater wpforms-conditional-field wpforms-conditional-show wpforms-field-repeater-display-blocks\" data-rows-min=\"1\" data-rows-max=\"10\" data-clone-num=\"2\" data-field-type=\"repeater\" data-field-id=\"182\" style=\"display:none;\"><h3 class=\"wpforms-field-label\">\n\t\t\t\tChild\n\t\t\t<\/h3><div class=\"wpforms-field-description\">You can add up to 10 children<\/div><input type=\"hidden\" class=\"wpforms-field-repeater-clone-list\" name=\"wpforms[fields][182][clone_list]\" value=\"[]\"><script type=\"text\/html\" class=\"tmpl-wpforms-field-repeater-template-182-2127\"><div id=\"wpforms-2127-repeater-field_182-clone_{CLONE}\" class=\"wpforms-field-repeater-clone-wrap\" data-clone=\"{CLONE}\">\n\t\t\t\t<h3 class=\"wpforms-field-repeater-block-title\">\n\t\t\t\tChild <span class=\"wpforms-wpforms-field-repeater-block-num\">#{CLONE}<\/span>\n\t\t\t<\/h3><div class=\"wpforms-field-description\">You can add up to 10 children<\/div><div class=\"wpforms-field-layout-rows wpforms-field-large wpforms-field-repeater-display-blocks wpforms-field-repeater-preset-100\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_183_{CLONE}-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"183_{CLONE}\"><label class=\"wpforms-field-label\">Sex at Birth <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_183_{CLONE}\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_183_{CLONE}_1\" name=\"wpforms[fields][183_{CLONE}]\" value=\"Male\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_183_{CLONE}_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_183_{CLONE}_2\" name=\"wpforms[fields][183_{CLONE}]\" value=\"Female\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_183_{CLONE}_2\">Female<\/label><\/li><\/ul><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_186_{CLONE}-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"186_{CLONE}\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_186_{CLONE}\">Date of birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2127-field_186_{CLONE}\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"Y.m.d\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][186_{CLONE}][date]\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_184_{CLONE}-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"184_{CLONE}\"><label class=\"wpforms-field-label\">Child&#039;s Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_184_{CLONE}\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][184_{CLONE}][first]\" required><label for=\"wpforms-2127-field_184_{CLONE}\" class=\"wpforms-field-sublabel after\">First name<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_184_{CLONE}-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][184_{CLONE}][last]\" required><label for=\"wpforms-2127-field_184_{CLONE}-last\" class=\"wpforms-field-sublabel after\">Name<\/label><\/div><\/div><div class=\"wpforms-field-description\">Family name at birth<\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_187_{CLONE}-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"187_{CLONE}\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_187_{CLONE}\">Place of Birth (City, Province, Country) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2127-field_187_{CLONE}\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][187_{CLONE}]\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_188_{CLONE}-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"188_{CLONE}\"><label class=\"wpforms-field-label\">Mother&#039;s Last Name and First Name at Birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_188_{CLONE}\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][188_{CLONE}][first]\" required><label for=\"wpforms-2127-field_188_{CLONE}\" class=\"wpforms-field-sublabel after\">First name<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_188_{CLONE}-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][188_{CLONE}][last]\" required><label for=\"wpforms-2127-field_188_{CLONE}-last\" class=\"wpforms-field-sublabel after\">Name<\/label><\/div><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_189_{CLONE}-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"189_{CLONE}\"><label class=\"wpforms-field-label\">Father&#039;s Last Name and First Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_189_{CLONE}\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][189_{CLONE}][first]\" required><label for=\"wpforms-2127-field_189_{CLONE}\" class=\"wpforms-field-sublabel after\">First name<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_189_{CLONE}-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][189_{CLONE}][last]\" required><label for=\"wpforms-2127-field_189_{CLONE}-last\" class=\"wpforms-field-sublabel after\">Name<\/label><\/div><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_190_{CLONE}-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"190_{CLONE}\"><label class=\"wpforms-field-label\">Child&#039;s Current Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-2127-field_190_{CLONE}\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][190_{CLONE}][address1]\" required><label for=\"wpforms-2127-field_190_{CLONE}\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2127-field_190_{CLONE}-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][190_{CLONE}][city]\" required><label for=\"wpforms-2127-field_190_{CLONE}-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-2127-field_190_{CLONE}-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][190_{CLONE}][state]\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AB\" >Alberta<\/option><option value=\"BC\" >British Columbia<\/option><option value=\"MB\" >Manitoba<\/option><option value=\"NB\" >New Brunswick<\/option><option value=\"NL\" >Newfoundland and Labrador<\/option><option value=\"NS\" >Nova Scotia<\/option><option value=\"ON\" >Ontario<\/option><option value=\"PE\" >Prince Edward Island<\/option><option value=\"WQ\" >Quebec<\/option><option value=\"SK\" >Saskatchewan<\/option><\/select><label for=\"wpforms-2127-field_190_{CLONE}-state\" class=\"wpforms-field-sublabel after\">Province<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2127-field_190_{CLONE}-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][190_{CLONE}][postal]\" required><label for=\"wpforms-2127-field_190_{CLONE}-postal\" class=\"wpforms-field-sublabel after\">Code Postal<\/label><\/div><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_191_{CLONE}-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"191_{CLONE}\"><label class=\"wpforms-field-label\">Is this child the biological or adopted child of the deceased person? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_191_{CLONE}\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_191_{CLONE}_1\" name=\"wpforms[fields][191_{CLONE}]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_191_{CLONE}_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_191_{CLONE}_2\" name=\"wpforms[fields][191_{CLONE}]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_191_{CLONE}_2\">No<\/label><\/li><\/ul><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_192_{CLONE}-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"192_{CLONE}\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_192_{CLONE}\">If yes, for an adopted child, enter the adoption date:<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2127-field_192_{CLONE}\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"Y.m.d\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][192_{CLONE}][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_193_{CLONE}-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"193_{CLONE}\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_193_{CLONE}\">If no, if the child resided with the deceased person at the time of death, indicate since what date:<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2127-field_193_{CLONE}\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"Y.m.d\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][193_{CLONE}][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_194_{CLONE}-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"194_{CLONE}\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_194_{CLONE}\">If he did not reside with her, please specify the reason:<\/label><input type=\"text\" id=\"wpforms-2127-field_194_{CLONE}\" class=\"wpforms-field-medium\" name=\"wpforms[fields][194_{CLONE}]\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_195_{CLONE}-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"195_{CLONE}\"><label class=\"wpforms-field-label\">Do you receive financial assistance for this child as a foster parent or guardian? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_195_{CLONE}\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_195_{CLONE}_1\" name=\"wpforms[fields][195_{CLONE}]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_195_{CLONE}_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_195_{CLONE}_2\" name=\"wpforms[fields][195_{CLONE}]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_195_{CLONE}_2\">No<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div class=\"wpforms-field-repeater-display-blocks-buttons\" data-button-type=\"buttons_with_icons\">\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-add\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M12.129 7.984v1.032a.392.392 0 0 1-.387.387H8.903v2.839a.392.392 0 0 1-.387.387H7.484a.373.373 0 0 1-.387-.387V9.403H4.258a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h2.839V4.758c0-.193.161-.387.387-.387h1.032c.194 0 .387.194.387.387v2.839h2.839c.193 0 .387.193.387.387ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg><span>Ajouter un enfant<\/span>\n\t\t\t\t<\/button>\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-remove wpforms-disabled\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M4.258 9.403a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h7.484c.193 0 .387.193.387.387v1.032a.392.392 0 0 1-.387.387H4.258ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg><span>Retirer un enfant<\/span>\n\t\t\t\t<\/button>\n\t\t\t<\/div>\n\t\t\t<\/div><\/script><div class=\"wpforms-field-layout-rows wpforms-field-large wpforms-field-repeater-display-blocks wpforms-field-repeater-preset-100\"><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_183-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"183\"><label class=\"wpforms-field-label\">Sex at Birth <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_183\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_183_1\" name=\"wpforms[fields][183]\" value=\"Male\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_183_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_183_2\" name=\"wpforms[fields][183]\" value=\"Female\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_183_2\">Female<\/label><\/li><\/ul><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_186-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"186\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_186\">Date of birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2127-field_186\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-required wpforms-field-medium\" data-date-format=\"Y.m.d\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][186][date]\" required><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_184-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"184\"><label class=\"wpforms-field-label\">Child&#039;s Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_184\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][184][first]\" required><label for=\"wpforms-2127-field_184\" class=\"wpforms-field-sublabel after\">First name<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_184-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][184][last]\" required><label for=\"wpforms-2127-field_184-last\" class=\"wpforms-field-sublabel after\">Name<\/label><\/div><\/div><div class=\"wpforms-field-description\">Family name at birth<\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_187-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"187\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_187\">Place of Birth (City, Province, Country) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2127-field_187\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][187]\" required><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_188-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"188\"><label class=\"wpforms-field-label\">Mother&#039;s Last Name and First Name at Birth <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_188\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][188][first]\" required><label for=\"wpforms-2127-field_188\" class=\"wpforms-field-sublabel after\">First name<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_188-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][188][last]\" required><label for=\"wpforms-2127-field_188-last\" class=\"wpforms-field-sublabel after\">Name<\/label><\/div><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_189-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"189\"><label class=\"wpforms-field-label\">Father&#039;s Last Name and First Name <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_189\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][189][first]\" required><label for=\"wpforms-2127-field_189\" class=\"wpforms-field-sublabel after\">First name<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_189-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][189][last]\" required><label for=\"wpforms-2127-field_189-last\" class=\"wpforms-field-sublabel after\">Name<\/label><\/div><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_190-container\" class=\"wpforms-field wpforms-field-address\" data-field-type=\"address\" data-field-id=\"190\"><label class=\"wpforms-field-label\">Child&#039;s Current Address <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-2127-field_190\" class=\"wpforms-field-address-address1 wpforms-field-required\" name=\"wpforms[fields][190][address1]\" required><label for=\"wpforms-2127-field_190\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2127-field_190-city\" class=\"wpforms-field-address-city wpforms-field-required\" name=\"wpforms[fields][190][city]\" required><label for=\"wpforms-2127-field_190-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-2127-field_190-state\" class=\"wpforms-field-address-state wpforms-field-required\" name=\"wpforms[fields][190][state]\" required><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AB\" >Alberta<\/option><option value=\"BC\" >British Columbia<\/option><option value=\"MB\" >Manitoba<\/option><option value=\"NB\" >New Brunswick<\/option><option value=\"NL\" >Newfoundland and Labrador<\/option><option value=\"NS\" >Nova Scotia<\/option><option value=\"ON\" >Ontario<\/option><option value=\"PE\" >Prince Edward Island<\/option><option value=\"WQ\" >Quebec<\/option><option value=\"SK\" >Saskatchewan<\/option><\/select><label for=\"wpforms-2127-field_190-state\" class=\"wpforms-field-sublabel after\">Province<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2127-field_190-postal\" class=\"wpforms-field-address-postal wpforms-field-required\" name=\"wpforms[fields][190][postal]\" required><label for=\"wpforms-2127-field_190-postal\" class=\"wpforms-field-sublabel after\">Code Postal<\/label><\/div><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_191-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"191\"><label class=\"wpforms-field-label\">Is this child the biological or adopted child of the deceased person? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_191\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_191_1\" name=\"wpforms[fields][191]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_191_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_191_2\" name=\"wpforms[fields][191]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_191_2\">No<\/label><\/li><\/ul><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_192-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"192\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_192\">If yes, for an adopted child, enter the adoption date:<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2127-field_192\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"Y.m.d\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][192][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_193-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"193\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_193\">If no, if the child resided with the deceased person at the time of death, indicate since what date:<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2127-field_193\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-medium\" data-date-format=\"Y.m.d\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][193][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_194-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"194\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_194\">If he did not reside with her, please specify the reason:<\/label><input type=\"text\" id=\"wpforms-2127-field_194\" class=\"wpforms-field-medium\" name=\"wpforms[fields][194]\" ><\/div><\/div><\/div><div class=\"wpforms-layout-row\"><div class=\"wpforms-layout-column wpforms-layout-column-100\"><div id=\"wpforms-2127-field_195-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline\" data-field-type=\"radio\" data-field-id=\"195\"><label class=\"wpforms-field-label\">Do you receive financial assistance for this child as a foster parent or guardian? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_195\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_195_1\" name=\"wpforms[fields][195]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_195_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_195_2\" name=\"wpforms[fields][195]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_195_2\">No<\/label><\/li><\/ul><\/div><\/div><\/div><\/div><div class=\"wpforms-field-repeater-display-blocks-buttons\" data-button-type=\"buttons_with_icons\">\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-add\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M12.129 7.984v1.032a.392.392 0 0 1-.387.387H8.903v2.839a.392.392 0 0 1-.387.387H7.484a.373.373 0 0 1-.387-.387V9.403H4.258a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h2.839V4.758c0-.193.161-.387.387-.387h1.032c.194 0 .387.194.387.387v2.839h2.839c.193 0 .387.193.387.387ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg><span>Ajouter un enfant<\/span>\n\t\t\t\t<\/button>\n\t\t\t\t<button type=\"button\" class=\"wpforms-field-repeater-button-remove wpforms-disabled\">\n\t\t\t\t\t<svg width=\"16\" height=\"17\" fill=\"none\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\"><path d=\"M4.258 9.403a.373.373 0 0 1-.387-.387V7.984c0-.194.161-.387.387-.387h7.484c.193 0 .387.193.387.387v1.032a.392.392 0 0 1-.387.387H4.258ZM16 8.5c0 4.42-3.58 8-8 8s-8-3.58-8-8 3.58-8 8-8 8 3.58 8 8Zm-1.548 0c0-3.548-2.904-6.452-6.452-6.452A6.45 6.45 0 0 0 1.548 8.5 6.43 6.43 0 0 0 8 14.952 6.45 6.45 0 0 0 14.452 8.5Z\" fill=\"currentColor\"\/><\/svg><span>Retirer un enfant<\/span>\n\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"wpforms-2127-field_166-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"166\"><h3 id=\"wpforms-2127-field_166\">Orphan&#039;s Benefit<\/h3><div class=\"wpforms-field-description\">Renseignements sur l'identit\u00e9 de la personne qui subvient aux besoins des enfants<\/div><\/div><div id=\"wpforms-2127-field_112-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"112\"><label class=\"wpforms-field-label\">Did the deceased person have children under 18? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_112\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_112_1\" name=\"wpforms[fields][112]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_112_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_112_2\" name=\"wpforms[fields][112]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_112_2\">No<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_112_3\" name=\"wpforms[fields][112]\" value=\"Aucun enfant \u00e0 charge, mais je demande la rente de conjoint survivant\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_112_3\">Aucun enfant \u00e0 charge, mais je demande la rente de conjoint survivant<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_197-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-field wpforms-conditional-show wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"197\" style=\"display:none;\"><label class=\"wpforms-field-label\">Are you the spouse of the deceased person and are you also applying for a survivor&#039;s pension? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_197\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_197_1\" name=\"wpforms[fields][197]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_197_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_197_2\" name=\"wpforms[fields][197]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_197_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_198-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"divider\" data-field-id=\"198\" style=\"display:none;\"><div class=\"wpforms-field-description\">The information will be requested later in this form.<\/div><\/div><div id=\"wpforms-2127-field_199-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"divider\" data-field-id=\"199\" style=\"display:none;\"><h3 id=\"wpforms-2127-field_199\">Provide information about the person responsible for the children.<\/h3><div class=\"wpforms-field-description\">Indiquez l\u2019identit\u00e9 de la personne qui s\u2019occupe des enfants au quotidien et qui en a la responsabilit\u00e9 (garde). \u00c7a peut \u00eatre un parent, un tuteur ou toute autre personne qui a la garde.<br \/><br \/><b>En g\u00e9n\u00e9ral, c\u2019est le parent\/tuteur qui s\u2019occupe des enfants au quotidien \u2014 souvent la m\u00eame personne qui re\u00e7oit les allocations familiales.<\/b><\/div><\/div><div id=\"wpforms-2127-field_200-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"200\" style=\"display:none;\"><label class=\"wpforms-field-label\">Sex at Birth<\/label><ul id=\"wpforms-2127-field_200\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_200_1\" name=\"wpforms[fields][200]\" value=\"Male\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_200_1\">Male<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_200_2\" name=\"wpforms[fields][200]\" value=\"Female\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_200_2\">Female<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_201-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"name\" data-field-id=\"201\" style=\"display:none;\"><label class=\"wpforms-field-label\">Birth name<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_201\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][201][first]\" ><label for=\"wpforms-2127-field_201\" class=\"wpforms-field-sublabel after\">First name<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_201-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][201][last]\" ><label for=\"wpforms-2127-field_201-last\" class=\"wpforms-field-sublabel after\">Name<\/label><\/div><\/div><\/div><div id=\"wpforms-2127-field_202-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"name\" data-field-id=\"202\" style=\"display:none;\"><label class=\"wpforms-field-label\">Birth name, if different<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_202\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][202][first]\" ><label for=\"wpforms-2127-field_202\" class=\"wpforms-field-sublabel after\">First name<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_202-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][202][last]\" ><label for=\"wpforms-2127-field_202-last\" class=\"wpforms-field-sublabel after\">Name<\/label><\/div><\/div><\/div><div id=\"wpforms-2127-field_204-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"204\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_204\">Social Insurance Number<\/label><input type=\"text\" id=\"wpforms-2127-field_204\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"2127\" data-field-id=\"204\" data-text-limit=\"9\" name=\"wpforms[fields][204]\" maxlength=\"9\" ><\/div><div id=\"wpforms-2127-field_205-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"205\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_205\">Date of birth<\/label><div class=\"wpforms-datepicker-wrap\"><input type=\"text\" id=\"wpforms-2127-field_205\" class=\"wpforms-field-date-time-date wpforms-datepicker wpforms-field-small\" data-date-format=\"Y.m.d\" data-disable-past-dates=\"0\" data-input=\"true\" name=\"wpforms[fields][205][date]\" ><a title=\"Clear Date\" data-clear role=\"button\" tabindex=\"0\" class=\"wpforms-datepicker-clear\" aria-label=\"Clear Date\" style=\"display:none;\"><\/a><\/div><\/div><div id=\"wpforms-2127-field_206-container\" class=\"wpforms-field wpforms-field-radio wpforms-list-inline wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"206\" style=\"display:none;\"><label class=\"wpforms-field-label\">Correspondence language<\/label><ul id=\"wpforms-2127-field_206\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_206_1\" name=\"wpforms[fields][206]\" value=\"French\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_206_1\">French<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_206_2\" name=\"wpforms[fields][206]\" value=\"English\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_206_2\">English<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_207-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"name\" data-field-id=\"207\" style=\"display:none;\"><label class=\"wpforms-field-label\">Mother&#039;s Birth Name<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_207\" class=\"wpforms-field-name-first\" name=\"wpforms[fields][207][first]\" ><label for=\"wpforms-2127-field_207\" class=\"wpforms-field-sublabel after\">First name<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_207-last\" class=\"wpforms-field-name-last\" name=\"wpforms[fields][207][last]\" ><label for=\"wpforms-2127-field_207-last\" class=\"wpforms-field-sublabel after\">Name<\/label><\/div><\/div><\/div><div id=\"wpforms-2127-field_209-container\" class=\"wpforms-field wpforms-field-address wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"address\" data-field-id=\"209\" style=\"display:none;\"><label class=\"wpforms-field-label\">Address<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-2127-field_209\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][209][address1]\" ><label for=\"wpforms-2127-field_209\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2127-field_209-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][209][city]\" ><label for=\"wpforms-2127-field_209-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-2127-field_209-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][209][state]\" ><option class=\"placeholder\" value=\"\" selected disabled>--- Select state ---<\/option><option value=\"AB\" >Alberta<\/option><option value=\"BC\" >British Columbia<\/option><option value=\"MB\" >Manitoba<\/option><option value=\"NB\" >New Brunswick<\/option><option value=\"NL\" >Newfoundland and Labrador<\/option><option value=\"NS\" >Nova Scotia<\/option><option value=\"ON\" >Ontario<\/option><option value=\"PE\" >Prince Edward Island<\/option><option value=\"WQ\" >Quebec<\/option><option value=\"SK\" >Saskatchewan<\/option><\/select><label for=\"wpforms-2127-field_209-state\" class=\"wpforms-field-sublabel after\">Province<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2127-field_209-postal\" class=\"wpforms-field-address-postal\" name=\"wpforms[fields][209][postal]\" ><label for=\"wpforms-2127-field_209-postal\" class=\"wpforms-field-sublabel after\">Code Postal<\/label><\/div><\/div><\/div><div id=\"wpforms-2127-field_210-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"210\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_210\">Phone<\/label><input type=\"tel\" id=\"wpforms-2127-field_210\" class=\"wpforms-field-medium\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][210]\" aria-label=\"Phone\" ><\/div><div id=\"wpforms-2127-field_211-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"211\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_211\">Other Phone<\/label><input type=\"tel\" id=\"wpforms-2127-field_211\" class=\"wpforms-field-medium\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][211]\" aria-label=\"Other Phone\" ><\/div><div id=\"wpforms-2127-field_212-container\" class=\"wpforms-field wpforms-field-textarea wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"textarea\" data-field-id=\"212\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_212\">Other Children&#039;s Information<\/label><textarea id=\"wpforms-2127-field_212\" class=\"wpforms-field-medium\" name=\"wpforms[fields][212]\" ><\/textarea><div class=\"wpforms-field-description\">Use this space as needed. For each piece of information provided, indicate the corresponding question number. <\/div><\/div><div id=\"wpforms-2127-field_159-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"159\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"2\" data-formid=\"2127\" disabled>Pr\u00e9c\u00e9dent<\/button><\/span><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"2\" data-formid=\"2127\" disabled>Next<\/button><img decoding=\"async\" src=\"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-3  \" data-page=\"3\" style=\"display:none;\"><div id=\"wpforms-2127-field_162-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"162\"><h3 id=\"wpforms-2127-field_162\">Declarant Information<\/h3><\/div><div id=\"wpforms-2127-field_43-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-trigger\" data-field-type=\"radio\" data-field-id=\"43\"><label class=\"wpforms-field-label\">At the time of death, what was YOUR relationship to the deceased? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_43\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_43_1\" name=\"wpforms[fields][43]\" value=\"Married or in a Civil Union\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_43_1\">Married or in a Civil Union<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_43_2\" name=\"wpforms[fields][43]\" value=\"Common-law Partners\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_43_2\">Common-law Partners<\/label><\/li><li class=\"choice-4 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_43_4\" name=\"wpforms[fields][43]\" value=\"Divorced or our civil union was dissolved\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_43_4\">Divorced or our civil union was dissolved<\/label><\/li><li class=\"choice-3 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_43_3\" name=\"wpforms[fields][43]\" value=\"Legally Separated\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_43_3\">Legally Separated<\/label><\/li><li class=\"choice-5 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_43_5\" name=\"wpforms[fields][43]\" value=\"Relative or Friend (brother - sister - father - mother - cousin - child - friend)\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_43_5\">Relative or Friend (brother - sister - father - mother - cousin - child - friend)<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_178-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"178\" style=\"display:none;\"><label class=\"wpforms-field-label\">Since: (date of marriage, divorce, civil union, dissolved union, legal separation)<\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][178][date][d]\" id=\"wpforms-2127-field_178-day\" class=\"wpforms-field-date-time-date-day\" ><option value=\"\" class=\"placeholder\" selected disabled>J<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][178][date][m]\" id=\"wpforms-2127-field_178-month\" class=\"wpforms-field-date-time-date-month\" ><option value=\"\" class=\"placeholder\" selected disabled>M<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][178][date][y]\" id=\"wpforms-2127-field_178-year\" class=\"wpforms-field-date-time-date-year\" ><option value=\"\" class=\"placeholder\" selected disabled>A<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><option value=\"1919\" >1919<\/option><option value=\"1918\" >1918<\/option><option value=\"1917\" >1917<\/option><option value=\"1916\" >1916<\/option><option value=\"1915\" >1915<\/option><option value=\"1914\" >1914<\/option><option value=\"1913\" >1913<\/option><option value=\"1912\" >1912<\/option><option value=\"1911\" >1911<\/option><option value=\"1910\" >1910<\/option><option value=\"1909\" >1909<\/option><option value=\"1908\" >1908<\/option><option value=\"1907\" >1907<\/option><option value=\"1906\" >1906<\/option><option value=\"1905\" >1905<\/option><option value=\"1904\" >1904<\/option><option value=\"1903\" >1903<\/option><option value=\"1902\" >1902<\/option><option value=\"1901\" >1901<\/option><option value=\"1900\" >1900<\/option><\/select><\/div><\/div><div id=\"wpforms-2127-field_170-container\" class=\"wpforms-field wpforms-field-radio\" data-field-type=\"radio\" data-field-id=\"170\"><label class=\"wpforms-field-label\">Are you an heir? (declarant)  <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_170\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_170_1\" name=\"wpforms[fields][170]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_170_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_170_2\" name=\"wpforms[fields][170]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_170_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_214-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"214\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_214\">Num\u00e9ro d&#039;assurance sociale<\/label><input type=\"text\" id=\"wpforms-2127-field_214\" class=\"wpforms-field-medium wpforms-limit-characters-enabled\" data-form-id=\"2127\" data-field-id=\"214\" data-text-limit=\"9\" name=\"wpforms[fields][214]\" maxlength=\"9\" ><\/div><div id=\"wpforms-2127-field_115-container\" class=\"wpforms-field wpforms-field-date-time\" data-field-type=\"date-time\" data-field-id=\"115\"><label class=\"wpforms-field-label\">Date of Birth (declarant) <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][115][date][d]\" id=\"wpforms-2127-field_115-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>J<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][115][date][m]\" id=\"wpforms-2127-field_115-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>M<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][115][date][y]\" id=\"wpforms-2127-field_115-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>A<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><option value=\"1919\" >1919<\/option><option value=\"1918\" >1918<\/option><option value=\"1917\" >1917<\/option><option value=\"1916\" >1916<\/option><option value=\"1915\" >1915<\/option><option value=\"1914\" >1914<\/option><option value=\"1913\" >1913<\/option><option value=\"1912\" >1912<\/option><option value=\"1911\" >1911<\/option><option value=\"1910\" >1910<\/option><option value=\"1909\" >1909<\/option><option value=\"1908\" >1908<\/option><option value=\"1907\" >1907<\/option><option value=\"1906\" >1906<\/option><option value=\"1905\" >1905<\/option><option value=\"1904\" >1904<\/option><option value=\"1903\" >1903<\/option><option value=\"1902\" >1902<\/option><option value=\"1901\" >1901<\/option><option value=\"1900\" >1900<\/option><\/select><\/div><\/div><div id=\"wpforms-2127-field_116-container\" class=\"wpforms-field wpforms-field-text\" data-field-type=\"text\" data-field-id=\"116\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_116\">Place of Birth (City) (declarant) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2127-field_116\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][116]\" required><\/div><div id=\"wpforms-2127-field_114-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"114\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_114\">Mother&#039;s Name (declarant) <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_114\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][114][first]\" placeholder=\"First name\" required><label for=\"wpforms-2127-field_114\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First name<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_114-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][114][last]\" placeholder=\"Family name at birth\" required><label for=\"wpforms-2127-field_114-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Name<\/label><\/div><\/div><\/div><div id=\"wpforms-2127-field_118-container\" class=\"wpforms-field wpforms-field-name\" data-field-type=\"name\" data-field-id=\"118\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_118\">Father&#039;s Name (declarant) <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_118\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][118][first]\" placeholder=\"First name\" required><label for=\"wpforms-2127-field_118\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First name<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_118-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][118][last]\" placeholder=\"Last name\" required><label for=\"wpforms-2127-field_118-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Name<\/label><\/div><\/div><\/div><div id=\"wpforms-2127-field_163-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"163\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"3\" data-formid=\"2127\" disabled>Pr\u00e9c\u00e9dent<\/button><\/span><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"3\" data-formid=\"2127\" disabled>Next<\/button><img decoding=\"async\" src=\"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-4  \" data-page=\"4\" style=\"display:none;\"><div id=\"wpforms-2127-field_164-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"divider\" data-field-id=\"164\" style=\"display:none;\"><h3 id=\"wpforms-2127-field_164\">Survivor&#039;s Pension<\/h3><div class=\"wpforms-field-description\">Spouse's Information<\/div><\/div><div id=\"wpforms-2127-field_119-container\" class=\"wpforms-field wpforms-field-date-time wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"date-time\" data-field-id=\"119\" style=\"display:none;\"><label class=\"wpforms-field-label\">Date of Birth (spouse) <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-date-dropdown-wrap wpforms-field-medium\"><select name=\"wpforms[fields][119][date][d]\" id=\"wpforms-2127-field_119-day\" class=\"wpforms-field-date-time-date-day wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>J<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><option value=\"13\" >13<\/option><option value=\"14\" >14<\/option><option value=\"15\" >15<\/option><option value=\"16\" >16<\/option><option value=\"17\" >17<\/option><option value=\"18\" >18<\/option><option value=\"19\" >19<\/option><option value=\"20\" >20<\/option><option value=\"21\" >21<\/option><option value=\"22\" >22<\/option><option value=\"23\" >23<\/option><option value=\"24\" >24<\/option><option value=\"25\" >25<\/option><option value=\"26\" >26<\/option><option value=\"27\" >27<\/option><option value=\"28\" >28<\/option><option value=\"29\" >29<\/option><option value=\"30\" >30<\/option><option value=\"31\" >31<\/option><\/select><select name=\"wpforms[fields][119][date][m]\" id=\"wpforms-2127-field_119-month\" class=\"wpforms-field-date-time-date-month wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>M<\/option><option value=\"1\" >1<\/option><option value=\"2\" >2<\/option><option value=\"3\" >3<\/option><option value=\"4\" >4<\/option><option value=\"5\" >5<\/option><option value=\"6\" >6<\/option><option value=\"7\" >7<\/option><option value=\"8\" >8<\/option><option value=\"9\" >9<\/option><option value=\"10\" >10<\/option><option value=\"11\" >11<\/option><option value=\"12\" >12<\/option><\/select><select name=\"wpforms[fields][119][date][y]\" id=\"wpforms-2127-field_119-year\" class=\"wpforms-field-date-time-date-year wpforms-field-required\"  required><option value=\"\" class=\"placeholder\" selected disabled>A<\/option><option value=\"2026\" >2026<\/option><option value=\"2025\" >2025<\/option><option value=\"2024\" >2024<\/option><option value=\"2023\" >2023<\/option><option value=\"2022\" >2022<\/option><option value=\"2021\" >2021<\/option><option value=\"2020\" >2020<\/option><option value=\"2019\" >2019<\/option><option value=\"2018\" >2018<\/option><option value=\"2017\" >2017<\/option><option value=\"2016\" >2016<\/option><option value=\"2015\" >2015<\/option><option value=\"2014\" >2014<\/option><option value=\"2013\" >2013<\/option><option value=\"2012\" >2012<\/option><option value=\"2011\" >2011<\/option><option value=\"2010\" >2010<\/option><option value=\"2009\" >2009<\/option><option value=\"2008\" >2008<\/option><option value=\"2007\" >2007<\/option><option value=\"2006\" >2006<\/option><option value=\"2005\" >2005<\/option><option value=\"2004\" >2004<\/option><option value=\"2003\" >2003<\/option><option value=\"2002\" >2002<\/option><option value=\"2001\" >2001<\/option><option value=\"2000\" >2000<\/option><option value=\"1999\" >1999<\/option><option value=\"1998\" >1998<\/option><option value=\"1997\" >1997<\/option><option value=\"1996\" >1996<\/option><option value=\"1995\" >1995<\/option><option value=\"1994\" >1994<\/option><option value=\"1993\" >1993<\/option><option value=\"1992\" >1992<\/option><option value=\"1991\" >1991<\/option><option value=\"1990\" >1990<\/option><option value=\"1989\" >1989<\/option><option value=\"1988\" >1988<\/option><option value=\"1987\" >1987<\/option><option value=\"1986\" >1986<\/option><option value=\"1985\" >1985<\/option><option value=\"1984\" >1984<\/option><option value=\"1983\" >1983<\/option><option value=\"1982\" >1982<\/option><option value=\"1981\" >1981<\/option><option value=\"1980\" >1980<\/option><option value=\"1979\" >1979<\/option><option value=\"1978\" >1978<\/option><option value=\"1977\" >1977<\/option><option value=\"1976\" >1976<\/option><option value=\"1975\" >1975<\/option><option value=\"1974\" >1974<\/option><option value=\"1973\" >1973<\/option><option value=\"1972\" >1972<\/option><option value=\"1971\" >1971<\/option><option value=\"1970\" >1970<\/option><option value=\"1969\" >1969<\/option><option value=\"1968\" >1968<\/option><option value=\"1967\" >1967<\/option><option value=\"1966\" >1966<\/option><option value=\"1965\" >1965<\/option><option value=\"1964\" >1964<\/option><option value=\"1963\" >1963<\/option><option value=\"1962\" >1962<\/option><option value=\"1961\" >1961<\/option><option value=\"1960\" >1960<\/option><option value=\"1959\" >1959<\/option><option value=\"1958\" >1958<\/option><option value=\"1957\" >1957<\/option><option value=\"1956\" >1956<\/option><option value=\"1955\" >1955<\/option><option value=\"1954\" >1954<\/option><option value=\"1953\" >1953<\/option><option value=\"1952\" >1952<\/option><option value=\"1951\" >1951<\/option><option value=\"1950\" >1950<\/option><option value=\"1949\" >1949<\/option><option value=\"1948\" >1948<\/option><option value=\"1947\" >1947<\/option><option value=\"1946\" >1946<\/option><option value=\"1945\" >1945<\/option><option value=\"1944\" >1944<\/option><option value=\"1943\" >1943<\/option><option value=\"1942\" >1942<\/option><option value=\"1941\" >1941<\/option><option value=\"1940\" >1940<\/option><option value=\"1939\" >1939<\/option><option value=\"1938\" >1938<\/option><option value=\"1937\" >1937<\/option><option value=\"1936\" >1936<\/option><option value=\"1935\" >1935<\/option><option value=\"1934\" >1934<\/option><option value=\"1933\" >1933<\/option><option value=\"1932\" >1932<\/option><option value=\"1931\" >1931<\/option><option value=\"1930\" >1930<\/option><option value=\"1929\" >1929<\/option><option value=\"1928\" >1928<\/option><option value=\"1927\" >1927<\/option><option value=\"1926\" >1926<\/option><option value=\"1925\" >1925<\/option><option value=\"1924\" >1924<\/option><option value=\"1923\" >1923<\/option><option value=\"1922\" >1922<\/option><option value=\"1921\" >1921<\/option><option value=\"1920\" >1920<\/option><option value=\"1919\" >1919<\/option><option value=\"1918\" >1918<\/option><option value=\"1917\" >1917<\/option><option value=\"1916\" >1916<\/option><option value=\"1915\" >1915<\/option><option value=\"1914\" >1914<\/option><option value=\"1913\" >1913<\/option><option value=\"1912\" >1912<\/option><option value=\"1911\" >1911<\/option><option value=\"1910\" >1910<\/option><option value=\"1909\" >1909<\/option><option value=\"1908\" >1908<\/option><option value=\"1907\" >1907<\/option><option value=\"1906\" >1906<\/option><option value=\"1905\" >1905<\/option><option value=\"1904\" >1904<\/option><option value=\"1903\" >1903<\/option><option value=\"1902\" >1902<\/option><option value=\"1901\" >1901<\/option><option value=\"1900\" >1900<\/option><\/select><\/div><\/div><div id=\"wpforms-2127-field_168-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"168\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_168\">Place of Birth (City) (spouse) <span class=\"wpforms-required-label\">*<\/span><\/label><input type=\"text\" id=\"wpforms-2127-field_168\" class=\"wpforms-field-medium wpforms-field-required\" name=\"wpforms[fields][168]\" required><\/div><div id=\"wpforms-2127-field_120-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"name\" data-field-id=\"120\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_120\">Mother&#039;s Name (spouse) <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_120\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][120][first]\" placeholder=\"First name\" required><label for=\"wpforms-2127-field_120\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First name<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_120-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][120][last]\" placeholder=\"Family name at birth\" required><label for=\"wpforms-2127-field_120-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Name<\/label><\/div><\/div><\/div><div id=\"wpforms-2127-field_121-container\" class=\"wpforms-field wpforms-field-name wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"name\" data-field-id=\"121\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_121\">Father&#039;s Name (spouse) <span class=\"wpforms-required-label\">*<\/span><\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_121\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][121][first]\" placeholder=\"First name\" required><label for=\"wpforms-2127-field_121\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">First name<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_121-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][121][last]\" placeholder=\"Last name\" required><label for=\"wpforms-2127-field_121-last\" class=\"wpforms-field-sublabel after wpforms-sublabel-hide\">Name<\/label><\/div><\/div><\/div><div id=\"wpforms-2127-field_122-container\" class=\"wpforms-field wpforms-field-address wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"address\" data-field-id=\"122\" style=\"display:none;\"><label class=\"wpforms-field-label\">Address (spouse)<\/label><div class=\"wpforms-field-row wpforms-field-medium\"><div ><input type=\"text\" id=\"wpforms-2127-field_122\" class=\"wpforms-field-address-address1\" name=\"wpforms[fields][122][address1]\" ><label for=\"wpforms-2127-field_122\" class=\"wpforms-field-sublabel after\">Address Line 1<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2127-field_122-city\" class=\"wpforms-field-address-city\" name=\"wpforms[fields][122][city]\" ><label for=\"wpforms-2127-field_122-city\" class=\"wpforms-field-sublabel after\">City<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-2127-field_122-state\" class=\"wpforms-field-address-state\" name=\"wpforms[fields][122][state]\" value=\"Qu\u00e9bec\" ><label for=\"wpforms-2127-field_122-state\" class=\"wpforms-field-sublabel after\">State \/ Province \/ Region<\/label><\/div><\/div><div class=\"wpforms-field-row wpforms-field-medium\"><div class=\"wpforms-field-row-block wpforms-one-half wpforms-first\"><input type=\"text\" id=\"wpforms-2127-field_122-postal\" class=\"wpforms-field-address-postal\" name=\"wpforms[fields][122][postal]\" ><label for=\"wpforms-2127-field_122-postal\" class=\"wpforms-field-sublabel after\">Postal Code<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><select id=\"wpforms-2127-field_122-country\" class=\"wpforms-field-address-country\" name=\"wpforms[fields][122][country]\" value=\"CA\" ><option value=\"AF\" >Afghanistan<\/option><option value=\"AL\" >Albania<\/option><option value=\"DZ\" >Algeria<\/option><option value=\"AS\" >American Samoa<\/option><option value=\"AD\" >Andorra<\/option><option value=\"AO\" >Angola<\/option><option value=\"AI\" >Anguilla<\/option><option value=\"AQ\" >Antarctica<\/option><option value=\"AG\" >Antigua and Barbuda<\/option><option value=\"AR\" >Argentina<\/option><option value=\"AM\" >Armenia<\/option><option value=\"AW\" >Aruba<\/option><option value=\"AU\" >Australia<\/option><option value=\"AT\" >Austria<\/option><option value=\"AZ\" >Azerbaijan<\/option><option value=\"BS\" >Bahamas<\/option><option value=\"BH\" >Bahrain<\/option><option value=\"BD\" >Bangladesh<\/option><option value=\"BB\" >Barbados<\/option><option value=\"BY\" >Belarus<\/option><option value=\"BE\" >Belgium<\/option><option value=\"BZ\" >Belize<\/option><option value=\"BJ\" >Benin<\/option><option value=\"BM\" >Bermuda<\/option><option value=\"BT\" >Bhutan<\/option><option value=\"BO\" >Bolivia (Plurinational State of)<\/option><option value=\"BQ\" >Bonaire, Saint Eustatius and Saba<\/option><option value=\"BA\" >Bosnia and Herzegovina<\/option><option value=\"BW\" >Botswana<\/option><option value=\"BV\" >Bouvet Island<\/option><option value=\"BR\" >Brazil<\/option><option value=\"IO\" >British Indian Ocean Territory<\/option><option value=\"BN\" >Brunei Darussalam<\/option><option value=\"BG\" >Bulgaria<\/option><option value=\"BF\" >Burkina Faso<\/option><option value=\"BI\" >Burundi<\/option><option value=\"CV\" >Cabo Verde<\/option><option value=\"KH\" >Cambodia<\/option><option value=\"CM\" >Cameroon<\/option><option value=\"CA\"  selected='selected'>Canada<\/option><option value=\"KY\" >Cayman Islands<\/option><option value=\"CF\" >Central African Republic<\/option><option value=\"TD\" >Chad<\/option><option value=\"CL\" >Chile<\/option><option value=\"CN\" >China<\/option><option value=\"CX\" >Christmas Island<\/option><option value=\"CC\" >Cocos (Keeling) Islands<\/option><option value=\"CO\" >Colombia<\/option><option value=\"KM\" >Comoros<\/option><option value=\"CG\" >Congo<\/option><option value=\"CD\" >Congo (Democratic Republic of the)<\/option><option value=\"CK\" >Cook Islands<\/option><option value=\"CR\" >Costa Rica<\/option><option value=\"HR\" >Croatia<\/option><option value=\"CU\" >Cuba<\/option><option value=\"CW\" >Cura\u00e7ao<\/option><option value=\"CY\" >Cyprus<\/option><option value=\"CZ\" >Czech Republic<\/option><option value=\"CI\" >C\u00f4te d&#039;Ivoire<\/option><option value=\"DK\" >Denmark<\/option><option value=\"DJ\" >Djibouti<\/option><option value=\"DM\" >Dominica<\/option><option value=\"DO\" >Dominican Republic<\/option><option value=\"EC\" >Ecuador<\/option><option value=\"EG\" >Egypt<\/option><option value=\"SV\" >El Salvador<\/option><option value=\"GQ\" >Equatorial Guinea<\/option><option value=\"ER\" >Eritrea<\/option><option value=\"EE\" >Estonia<\/option><option value=\"SZ\" >Eswatini (Kingdom of)<\/option><option value=\"ET\" >Ethiopia<\/option><option value=\"FK\" >Falkland Islands (Malvinas)<\/option><option value=\"FO\" >Faroe Islands<\/option><option value=\"FJ\" >Fiji<\/option><option value=\"FI\" >Finland<\/option><option value=\"FR\" >France<\/option><option value=\"GF\" >French Guiana<\/option><option value=\"PF\" >French Polynesia<\/option><option value=\"TF\" >French Southern Territories<\/option><option value=\"GA\" >Gabon<\/option><option value=\"GM\" >Gambia<\/option><option value=\"GE\" >Georgia<\/option><option value=\"DE\" >Germany<\/option><option value=\"GH\" >Ghana<\/option><option value=\"GI\" >Gibraltar<\/option><option value=\"GR\" >Greece<\/option><option value=\"GL\" >Greenland<\/option><option value=\"GD\" >Grenada<\/option><option value=\"GP\" >Guadeloupe<\/option><option value=\"GU\" >Guam<\/option><option value=\"GT\" >Guatemala<\/option><option value=\"GG\" >Guernsey<\/option><option value=\"GN\" >Guinea<\/option><option value=\"GW\" >Guinea-Bissau<\/option><option value=\"GY\" >Guyana<\/option><option value=\"HT\" >Haiti<\/option><option value=\"HM\" >Heard Island and McDonald Islands<\/option><option value=\"HN\" >Honduras<\/option><option value=\"HK\" >Hong Kong<\/option><option value=\"HU\" >Hungary<\/option><option value=\"IS\" >Iceland<\/option><option value=\"IN\" >India<\/option><option value=\"ID\" >Indonesia<\/option><option value=\"IR\" >Iran (Islamic Republic of)<\/option><option value=\"IQ\" >Iraq<\/option><option value=\"IE\" >Ireland (Republic of)<\/option><option value=\"IM\" >Isle of Man<\/option><option value=\"IL\" >Israel<\/option><option value=\"IT\" >Italy<\/option><option value=\"JM\" >Jamaica<\/option><option value=\"JP\" >Japan<\/option><option value=\"JE\" >Jersey<\/option><option value=\"JO\" >Jordan<\/option><option value=\"KZ\" >Kazakhstan<\/option><option value=\"KE\" >Kenya<\/option><option value=\"KI\" >Kiribati<\/option><option value=\"KP\" >Korea (Democratic People&#039;s Republic of)<\/option><option value=\"KR\" >Korea (Republic of)<\/option><option value=\"XK\" >Kosovo<\/option><option value=\"KW\" >Kuwait<\/option><option value=\"KG\" >Kyrgyzstan<\/option><option value=\"LA\" >Lao People&#039;s Democratic Republic<\/option><option value=\"LV\" >Latvia<\/option><option value=\"LB\" >Lebanon<\/option><option value=\"LS\" >Lesotho<\/option><option value=\"LR\" >Liberia<\/option><option value=\"LY\" >Libya<\/option><option value=\"LI\" >Liechtenstein<\/option><option value=\"LT\" >Lithuania<\/option><option value=\"LU\" >Luxembourg<\/option><option value=\"MO\" >Macao<\/option><option value=\"MG\" >Madagascar<\/option><option value=\"MW\" >Malawi<\/option><option value=\"MY\" >Malaysia<\/option><option value=\"MV\" >Maldives<\/option><option value=\"ML\" >Mali<\/option><option value=\"MT\" >Malta<\/option><option value=\"MH\" >Marshall Islands<\/option><option value=\"MQ\" >Martinique<\/option><option value=\"MR\" >Mauritania<\/option><option value=\"MU\" >Mauritius<\/option><option value=\"YT\" >Mayotte<\/option><option value=\"MX\" >Mexico<\/option><option value=\"FM\" >Micronesia (Federated States of)<\/option><option value=\"MD\" >Moldova (Republic of)<\/option><option value=\"MC\" >Monaco<\/option><option value=\"MN\" >Mongolia<\/option><option value=\"ME\" >Montenegro<\/option><option value=\"MS\" >Montserrat<\/option><option value=\"MA\" >Morocco<\/option><option value=\"MZ\" >Mozambique<\/option><option value=\"MM\" >Myanmar<\/option><option value=\"NA\" >Namibia<\/option><option value=\"NR\" >Nauru<\/option><option value=\"NP\" >Nepal<\/option><option value=\"NL\" >Netherlands<\/option><option value=\"NC\" >New Caledonia<\/option><option value=\"NZ\" >New Zealand<\/option><option value=\"NI\" >Nicaragua<\/option><option value=\"NE\" >Niger<\/option><option value=\"NG\" >Nigeria<\/option><option value=\"NU\" >Niue<\/option><option value=\"NF\" >Norfolk Island<\/option><option value=\"MK\" >North Macedonia (Republic of)<\/option><option value=\"MP\" >Northern Mariana Islands<\/option><option value=\"NO\" >Norway<\/option><option value=\"OM\" >Oman<\/option><option value=\"PK\" >Pakistan<\/option><option value=\"PW\" >Palau<\/option><option value=\"PS\" >Palestine (State of)<\/option><option value=\"PA\" >Panama<\/option><option value=\"PG\" >Papua New Guinea<\/option><option value=\"PY\" >Paraguay<\/option><option value=\"PE\" >Peru<\/option><option value=\"PH\" >Philippines<\/option><option value=\"PN\" >Pitcairn<\/option><option value=\"PL\" >Poland<\/option><option value=\"PT\" >Portugal<\/option><option value=\"PR\" >Puerto Rico<\/option><option value=\"QA\" >Qatar<\/option><option value=\"RO\" >Romania<\/option><option value=\"RU\" >Russian Federation<\/option><option value=\"RW\" >Rwanda<\/option><option value=\"RE\" >R\u00e9union<\/option><option value=\"BL\" >Saint Barth\u00e9lemy<\/option><option value=\"SH\" >Saint Helena, Ascension and Tristan da Cunha<\/option><option value=\"KN\" >Saint Kitts and Nevis<\/option><option value=\"LC\" >Saint Lucia<\/option><option value=\"MF\" >Saint Martin (French part)<\/option><option value=\"PM\" >Saint Pierre and Miquelon<\/option><option value=\"VC\" >Saint Vincent and the Grenadines<\/option><option value=\"WS\" >Samoa<\/option><option value=\"SM\" >San Marino<\/option><option value=\"ST\" >Sao Tome and Principe<\/option><option value=\"SA\" >Saudi Arabia<\/option><option value=\"SN\" >Senegal<\/option><option value=\"RS\" >Serbia<\/option><option value=\"SC\" >Seychelles<\/option><option value=\"SL\" >Sierra Leone<\/option><option value=\"SG\" >Singapore<\/option><option value=\"SX\" >Sint Maarten (Dutch part)<\/option><option value=\"SK\" >Slovakia<\/option><option value=\"SI\" >Slovenia<\/option><option value=\"SB\" >Solomon Islands<\/option><option value=\"SO\" >Somalia<\/option><option value=\"ZA\" >South Africa<\/option><option value=\"GS\" >South Georgia and the South Sandwich Islands<\/option><option value=\"SS\" >South Sudan<\/option><option value=\"ES\" >Spain<\/option><option value=\"LK\" >Sri Lanka<\/option><option value=\"SD\" >Sudan<\/option><option value=\"SR\" >Suriname<\/option><option value=\"SJ\" >Svalbard and Jan Mayen<\/option><option value=\"SE\" >Sweden<\/option><option value=\"CH\" >Switzerland<\/option><option value=\"SY\" >Syrian Arab Republic<\/option><option value=\"TW\" >Taiwan, Republic of China<\/option><option value=\"TJ\" >Tajikistan<\/option><option value=\"TZ\" >Tanzania (United Republic of)<\/option><option value=\"TH\" >Thailand<\/option><option value=\"TL\" >Timor-Leste<\/option><option value=\"TG\" >Togo<\/option><option value=\"TK\" >Tokelau<\/option><option value=\"TO\" >Tonga<\/option><option value=\"TT\" >Trinidad and Tobago<\/option><option value=\"TN\" >Tunisia<\/option><option value=\"TM\" >Turkmenistan<\/option><option value=\"TC\" >Turks and Caicos Islands<\/option><option value=\"TV\" >Tuvalu<\/option><option value=\"TR\" >T\u00fcrkiye<\/option><option value=\"UG\" >Uganda<\/option><option value=\"UA\" >Ukraine<\/option><option value=\"AE\" >United Arab Emirates<\/option><option value=\"GB\" >United Kingdom of Great Britain and Northern Ireland<\/option><option value=\"UM\" >United States Minor Outlying Islands<\/option><option value=\"US\" >United States of America<\/option><option value=\"UY\" >Uruguay<\/option><option value=\"UZ\" >Uzbekistan<\/option><option value=\"VU\" >Vanuatu<\/option><option value=\"VA\" >Vatican City State<\/option><option value=\"VE\" >Venezuela (Bolivarian Republic of)<\/option><option value=\"VN\" >Vietnam<\/option><option value=\"VG\" >Virgin Islands (British)<\/option><option value=\"VI\" >Virgin Islands (U.S.)<\/option><option value=\"WF\" >Wallis and Futuna<\/option><option value=\"EH\" >Western Sahara<\/option><option value=\"YE\" >Yemen<\/option><option value=\"ZM\" >Zambia<\/option><option value=\"ZW\" >Zimbabwe<\/option><option value=\"AX\" >\u00c5land Islands<\/option><\/select><label for=\"wpforms-2127-field_122-country\" class=\"wpforms-field-sublabel after\">Country<\/label><\/div><\/div><\/div><div id=\"wpforms-2127-field_123-container\" class=\"wpforms-field wpforms-field-phone wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"phone\" data-field-id=\"123\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_123\">Phone (spouse)<\/label><input type=\"tel\" id=\"wpforms-2127-field_123\" class=\"wpforms-field-medium\" data-rule-int-phone-field=\"true\" name=\"wpforms[fields][123]\" aria-label=\"Phone (spouse)\" ><\/div><div id=\"wpforms-2127-field_215-container\" class=\"wpforms-field wpforms-field-text wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"text\" data-field-id=\"215\" style=\"display:none;\"><label class=\"wpforms-field-label\" for=\"wpforms-2127-field_215\">Num\u00e9ro d&#039;assurance sociale<\/label><input type=\"text\" id=\"wpforms-2127-field_215\" class=\"wpforms-field-medium\" name=\"wpforms[fields][215]\" ><\/div><div id=\"wpforms-2127-field_127-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"127\" style=\"display:none;\"><label class=\"wpforms-field-label\">Have you had or are you expecting a child with the deceased person? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_127\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_127_1\" name=\"wpforms[fields][127]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_127_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_127_2\" name=\"wpforms[fields][127]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_127_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_129-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"129\" style=\"display:none;\"><label class=\"wpforms-field-label\">Did one of you adopt a child of the other, or did you adopt a child together? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_129\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_129_1\" name=\"wpforms[fields][129]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_129_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_129_2\" name=\"wpforms[fields][129]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_129_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_130-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"130\" style=\"display:none;\"><label class=\"wpforms-field-label\">Are you disabled or do you consider yourself disabled? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_130\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_130_1\" name=\"wpforms[fields][130]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_130_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_130_2\" name=\"wpforms[fields][130]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_130_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_128-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"divider\" data-field-id=\"128\" style=\"display:none;\"><h3 id=\"wpforms-2127-field_128\">As of the date of your spouse&#039;s death:<\/h3><\/div><div id=\"wpforms-2127-field_133-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"133\" style=\"display:none;\"><label class=\"wpforms-field-label\">did you have a disabled child in your care? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_133\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_133_1\" name=\"wpforms[fields][133]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_133_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_133_2\" name=\"wpforms[fields][133]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_133_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_135-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"135\" style=\"display:none;\"><label class=\"wpforms-field-label\">did you have a child under 18 in your care? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_135\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_135_1\" name=\"wpforms[fields][135]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_135_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_135_2\" name=\"wpforms[fields][135]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_135_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_136-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"divider\" data-field-id=\"136\" style=\"display:none;\"><h3 id=\"wpforms-2127-field_136\">Since your spouse&#039;s death:<\/h3><\/div><div id=\"wpforms-2127-field_137-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"137\" style=\"display:none;\"><label class=\"wpforms-field-label\">have you taken a disabled child into your care? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_137\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_137_1\" name=\"wpforms[fields][137]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_137_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_137_2\" name=\"wpforms[fields][137]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_137_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_138-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"138\" style=\"display:none;\"><label class=\"wpforms-field-label\">Have you taken a child under 18 into your care? <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_138\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_138_1\" name=\"wpforms[fields][138]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_138_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_138_2\" name=\"wpforms[fields][138]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_138_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_172-container\" class=\"wpforms-field wpforms-field-divider wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"divider\" data-field-id=\"172\" style=\"display:none;\"><h3 id=\"wpforms-2127-field_172\">Excluding the Old Age Security pension, do you receive a Canada Pension Plan (CPP) benefit?<\/h3><\/div><div id=\"wpforms-2127-field_140-container\" class=\"wpforms-field wpforms-field-radio wpforms-conditional-field wpforms-conditional-show\" data-field-type=\"radio\" data-field-id=\"140\" style=\"display:none;\"><label class=\"wpforms-field-label\">Retirement pension, survivor&#039;s benefits, or disability benefits <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_140\" class=\"wpforms-field-required\"><li class=\"choice-1 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_140_1\" name=\"wpforms[fields][140]\" value=\"Yes\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_140_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"radio\" id=\"wpforms-2127-field_140_2\" name=\"wpforms[fields][140]\" value=\"No\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_140_2\">No<\/label><\/li><\/ul><\/div><div id=\"wpforms-2127-field_165-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"165\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-prev\" data-action=\"prev\" data-page=\"4\" data-formid=\"2127\" disabled>Pr\u00e9c\u00e9dent<\/button><\/span><span class=\"wpforms-page-button-group\"><button class=\"wpforms-page-button wpforms-page-next\" data-action=\"next\" data-page=\"4\" data-formid=\"2127\" disabled>Next<\/button><img decoding=\"async\" src=\"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-page-button-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/span><\/div><\/div><\/div><div class=\"wpforms-page wpforms-page-5 last \" data-page=\"5\" style=\"display:none;\"><div id=\"wpforms-2127-field_99-container\" class=\"wpforms-field wpforms-field-divider\" data-field-type=\"divider\" data-field-id=\"99\"><h3 id=\"wpforms-2127-field_99\">Authorizations<\/h3><\/div><div id=\"wpforms-2127-field_102-container\" class=\"wpforms-field wpforms-field-gdpr-checkbox\" data-field-type=\"gdpr-checkbox\" data-field-id=\"102\"><label class=\"wpforms-field-label\">By pressing the &quot;Submit&quot; button, I authorize Services fun\u00e9raire Azur incin\u00e9ration inc. to transmit and use all necessary information in accordance with the Privacy Policy and Confidentiality Policy.    <span class=\"wpforms-required-label\">*<\/span><\/label><ul id=\"wpforms-2127-field_102\" class=\"wpforms-field-required\"><li class=\"choice-1\"><input type=\"checkbox\" id=\"wpforms-2127-field_102_1\" name=\"wpforms[fields][102][]\" value=\"I agree.\" required ><label class=\"wpforms-field-label-inline\" for=\"wpforms-2127-field_102_1\">I agree.<\/label><\/li><\/ul><div class=\"wpforms-field-description\"><a href=\"https:\/\/www.azurformulaire.com\/politique-de-confidentialite\/\">  Personal Information Protection Policy and Privacy Policy<\/a><\/div><\/div><div id=\"wpforms-2127-field_70-container\" class=\"wpforms-field wpforms-field-divider wpforms-one-half wpforms-first\" data-field-type=\"divider\" data-field-id=\"70\"><h3 id=\"wpforms-2127-field_70\">Caution!<\/h3><div class=\"wpforms-field-description\">By clicking on the submit button below, I declare that I have carefully completed this questionnaire.<\/div><\/div><div id=\"wpforms-2127-field_161-container\" class=\"wpforms-field wpforms-field-pagebreak\" data-field-type=\"pagebreak\" data-field-id=\"161\"><div class=\"wpforms-clear wpforms-pagebreak-left\"><\/div><\/div><\/div><script>\n\t\t\t\t( function() {\n\t\t\t\t\tconst style = document.createElement( 'style' );\n\t\t\t\t\tstyle.appendChild( document.createTextNode( '#wpforms-2127-field_1-container { position: absolute !important; overflow: hidden !important; display: inline !important; height: 1px !important; width: 1px !important; z-index: -1000 !important; padding: 0 !important; } #wpforms-2127-field_1-container input { visibility: hidden; } #wpforms-conversational-form-page #wpforms-2127-field_1-container label { counter-increment: none; }' ) );\n\t\t\t\t\tdocument.head.appendChild( style );\n\t\t\t\t\tdocument.currentScript?.remove();\n\t\t\t\t} )();\n\t\t\t<\/script><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" style=\"display:none;\"><input type=\"hidden\" name=\"wpforms[id]\" value=\"2127\"><input type=\"hidden\" name=\"wpforms[time_token]\" value=\"1792857493.8ed2c0e54902108b00855c1e5a524ef53e9a626ffe4f01bd8fab45a65998cdd2\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/azurdeces.com\/en\/wp-json\/wp\/v2\/pages\/3046\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-2127\" class=\"wpforms-submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><\/form><\/div>  <!-- .wpforms-container -->            <\/div>\n\n        \t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire. &#8211; \u00c9tape 1 sur 4Compl\u00e9ment d&#8217;informations RRQDirecteur fun\u00e9raire : Denis Lachance Renseignements sur la personne d\u00e9c\u00e9d\u00e9e Nom de famille \u00e0 la naissance *Pr\u00e9nom *Date de naissance *J12345678910111213141516171819202122232425262728293031M123456789101112A202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900La personne d\u00e9c\u00e9d\u00e9 a-t-elle particip\u00e9 \u00e0 un r\u00e9gime de s\u00e9curit\u00e9 social \u00e0 l&#039;\u00e9tranger? * Oui Non Au cours de sa vie, la personne d\u00e9c\u00e9d\u00e9 a-t-elle eu des enfants (biologiques ou adoptifs) n\u00e9s apr\u00e8s 1958? * Oui Non Au cours de sa vie, la personne d\u00e9c\u00e9d\u00e9 a-t-elle pris en charge des enfants n\u00e9s apr\u00e8s 1958? * Oui Non Une personne d\u00e9c\u00e9d\u00e9e ayant re\u00e7u des prestations familiales du Qu\u00e9bec ou du Canada pour un enfant peut aider une personne \u00e0 devenir admissible \u00e0 une rente ou \u00e0 faire augmenter son montant. Il est donc important de fournir, \u00e0 votre connaissance, les renseignements demand\u00e9s sur les enfants de la personne d\u00e9c\u00e9d\u00e9e. Laquelle de ces options d\u00e9crit la situation de la personne d\u00e9c\u00e9d\u00e9e, \u00e0 l&#039;\u00e9gard des prestations familiales? * Au cours de sa vie, la personne d\u00e9c\u00e9d\u00e9e a re\u00e7u \u00e0 son nom des prestations familiales. Au cours de sa vie, la personne d\u00e9c\u00e9d\u00e9e n&#8217;a pas re\u00e7u \u00e0 son nom des prestations familiales. Elles ont \u00e9t\u00e9 vers\u00e9es \u00e0 sa conjointe ou son conjoint. La personne d\u00e9c\u00e9d\u00e9e \u00e9tait admissible \u00e0 des prestations familiales, mais n&#8217;en a jamais re\u00e7u parce que son revenu familial \u00e9tait trop \u00e9lev\u00e9. La personne d\u00e9c\u00e9d\u00e9e et sa conjointe ou son conjoint n&#8217;ont jamais re\u00e7u de prestations familiales. Je ne sais pas. De la naissance de chaque enfant jusqu&#039;\u00e0 son 7e anniversaire, y a-t-il eu des p\u00e9riodes o\u00f9 la personne d\u00e9c\u00e9d\u00e9e ne recevait pas de prestations familiales \u00e0 son nom? * Oui Non Depuis sa naissance ou son arriv\u00e9e au Canada jusqu&#039;\u00e0 son 7e anniversaire, chaque enfant a-t-il toujours r\u00e9sid\u00e9 au Canada avec la personne d\u00e9c\u00e9d\u00e9e? * Oui Non De quel fa\u00e7on voulez-vous recevoir le remboursement? * Aux h\u00e9ritiers: Un versement &#8211; un ch\u00e8que de 2500$ aux h\u00e9ritiers. \u00c0 la personne qui a payer les services fun\u00e9raires: Un versement, \u00e0 la personne qui a pay\u00e9 les services fun\u00e9raires, \u00e9gal \u00e0 la facture des services fun\u00e9raires et un versement, \u00e9gal \u00e0 la diff\u00e9rence, vers\u00e9 aux h\u00e9ritiers. Suivant Informations sur le d\u00e9clarant Est-ce que le d\u00e9clarant est l&#039;\u00e9poux\/\u00e9pouse ou conjoint(e) de fait? * \u00c9poux \/ \u00c9pouse \/ Conjoint de fait Parent ou ami Nous \u00e9tions: * Mari\u00e9 Conjoint de fait S\u00e9par\u00e9 l\u00e9galement Divorc\u00e9 \u00cates-vous un h\u00e9ritier? (d\u00e9clarant) * Oui Non Vous devrez fournir le num\u00e9ro d\u2019assurance sociale \u00e0 notre conseiller par t\u00e9l\u00e9phone.Date de naissance (d\u00e9clarant) *J12345678910111213141516171819202122232425262728293031M123456789101112A202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Lieu de naissance (Ville) (d\u00e9clarant) *Nom de la m\u00e8re (d\u00e9clarant) *Pr\u00e9nomNomNom du p\u00e8re (d\u00e9clarant) *Pr\u00e9nomNomSuivant Rente de conjoint survivant Informations sur le conjoint ou la conjointeQuel \u00e9tait la situation matrimoniale du d\u00e9funt lors de son d\u00e9c\u00e8s? * C\u00e9libataire Mari\u00e9 Veuf Union civil Conjoint de fait Divorc\u00e9 Union dissoute S\u00e9par\u00e9 l\u00e9galement Est-ce que la personne d\u00e9c\u00e9d\u00e9 \u00e9tais conjoint de fait depuis plus de trois ans? * Oui Non Date de naissance *J12345678910111213141516171819202122232425262728293031M123456789101112A202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Lieu de naissance (Ville) *Nom de la m\u00e8re *Pr\u00e9nomNomNom du p\u00e8re *Pr\u00e9nomNomAdresseAdresse ligne\u00a01Ville\u00c9tat \/ Province \/ R\u00e9gionCode postalAfghanistanAfrique du SudAlbanieAlg\u00e9rieAllemagneAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArabie SaouditeArgentineArm\u00e9nieArubaAustralieAutricheAzerba\u00efdjanBahamasBahre\u00efnBangladeshBarbadeBelgiqueBelizeBermudesBhoutanBi\u00e9lorussieBolivie (\u00c9tat plurinational de)Bonaire, Saint Eustatius and SabaBosnie-Herz\u00e9govineBotswanaBr\u00e9silBulgarieBurkina FasoBurundiB\u00e9ninCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresCongoCongo (R\u00e9publique d\u00e9mocratique du)Cor\u00e9e (R\u00e9publique de)Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)Costa RicaCroatieCubaCura\u00e7aoC\u00f4te d\u2019IvoireDanemarkDjiboutiDominiqueEspagneEstonieEswatini (Royaume de)FidjiFinlandeFranceF\u00e9d\u00e9ration RusseGabonGambieGhanaGibraltarGrenadeGroenlandGr\u00e8ceGuadeloupeGuamGuatemalaGuerneseyGuin\u00e9eGuin\u00e9e \u00e9quatorialeGuin\u00e9e-BissauGuyaneGuyaneG\u00e9orgieG\u00e9orgie du Sud et \u00eeles Sandwich du SudHa\u00eftiHondurasHong KongHongrieIndeIndon\u00e9sieIrakIran (R\u00e9publique islamique d\u2019)Irlande (R\u00e9publique d\u2019)IslandeIsra\u00eblItalieJama\u00efqueJaponJerseyJordanieKazakhstanKenyaKirghizistanKiribatiKosovoKowe\u00eftLa R\u00e9unionLesothoLettonieLibanLiberiaLibyeLiechtensteinLituanieLuxembourgMacaoMac\u00e9doine du Nord (R\u00e9publique de)MadagascarMalaisieMalawiMaldivesMaliMalteMarocMartiniqueMauritanieMayotteMexiqueMicron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)Moldova (R\u00e9publique de)MonacoMongolieMontserratMont\u00e9n\u00e9groMozambiqueMyanmarNamibieNauruNegara Brunei DarussalamNicaraguaNigerNig\u00e9riaNiueNorv\u00e8geNouvelle-Cal\u00e9donieNouvelle-Z\u00e9landeN\u00e9palOmanOugandaOuzb\u00e9kistanPakistanPalauPalestine (\u00c9tat de)PanamaPapouasie-Nouvelle-Guin\u00e9eParaguayPays-BasPhilippinesPolognePolyn\u00e9sie fran\u00e7aisePorto RicoPortugalP\u00e9rouQatarRoumanieRoyaume-Uni de Grande-Bretagne et d\u2019Irlande du NordRwandaR\u00e9publique arabe syrienneR\u00e9publique centrafricaineR\u00e9publique dominicaineR\u00e9publique d\u00e9mocratique populaire du LaosR\u00e9publique tch\u00e8queSahara occidentalSaint Barth\u00e9lemySaint Pierre et MiquelonSaint-Christophe-et-NevisSaint-MarinSaint-Martin (partie fran\u00e7aise)Saint-Vincent-et-les GrenadinesSainte-H\u00e9l\u00e8ne, Ascension et Tristan da CunhaSainte-LucieSalvadorSamoaSamoa am\u00e9ricainesSao Tom\u00e9 et PrincipeSerbieSeychellesSierra LeoneSingapourSint Maarten (partie hollandaise)SlovaquieSlov\u00e9nieSomalieSoudanSoudan du SudSri LankaSuisseSurinamSu\u00e8deS\u00e9n\u00e9galTadjikistanTaiwan, R\u00e9publique de ChineTanzanie (R\u00e9publique-Unie de)TchadTerres Australes Fran\u00e7aisesTerritoire britannique de l\u2019oc\u00e9an IndienTha\u00eflandeTimor orientalTogoTokelauTongaTrinit\u00e9 et TobagoTunisieTurkm\u00e9nistanTurquieTuvaluUkraineUruguayVanuatuVenezuela (R\u00e9publique bolivarienne du)VietnamWallis et FutunaY\u00e9menZambieZimbabwe\u00c9gypte\u00c9mirats arabes unis\u00c9quateur\u00c9rythr\u00e9e\u00c9tat de la cit\u00e9 du Vatican\u00c9tats-Unis d\u2019Am\u00e9rique\u00c9thiopie\u00cele Bouvet\u00cele Christmas\u00cele Maurice\u00cele Norfolk\u00cele de Man\u00celes Ca\u00efmans\u00celes Cocos (Keeling)\u00celes Cook\u00celes Falkland (Malvinas)\u00celes F\u00e9ro\u00e9\u00celes Heard et McDonald\u00celes Mariannes du Nord\u00celes Marshall\u00celes Pitcairn\u00celes Salomon\u00celes Turques et Ca\u00efques\u00celes Vierges (Am\u00e9ricaines)\u00celes Vierges (Britanniques)\u00celes de Svalbard et Jan Mayen\u00celes mineures am\u00e9ricaines\u00celes \u00c5landPaysT\u00e9l\u00e9phone Depuis: (date)J12345678910111213141516171819202122232425262728293031M123456789101112A202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Avez-vous eu ou attendez-vous un enfant de la personne d\u00e9c\u00e9d\u00e9e? * Oui Non L\u2019un de vous a-t-il adopt\u00e9 un enfant de l\u2019autre ou avez-vous adopt\u00e9 un enfant ensemble? * Oui Non \u00cates-vous invalide ou vous consid\u00e9rez-vous comme invalide? * Oui Non \u00c0 la date du d\u00e9c\u00e8s de votre conjointe ou conjoint : aviez-vous un enfant invalide \u00e0 votre charge? * Oui Non aviez-vous un enfant de moins de 18 ans \u00e0 votre charge? * Oui Non Depuis le d\u00e9c\u00e8s de votre conjointe ou conjoint : avez-vous pris un enfant invalide \u00e0 votre charge? * Oui Non Avez-vous pris un enfant de moins de 18 ans \u00e0 votre charge? * Oui Non Sans tenir compte de la pension de la S\u00e9curit\u00e9 de la vieillesse, recevez-vous une rente du R\u00e9gime de pensions du Canada (RPC)? Rente de retraite du RPC * Oui Non Rente de conjoint survivant du RPC * Oui Non Rente d&#039;invalidit\u00e9 du RPC * Oui Non Si oui, vous devrez fournir le num\u00e9ro d\u2019assurance sociale \u00e0 notre conseiller par t\u00e9l\u00e9phone. Rente d&#039;orphelin Est-ce que la personne d\u00e9c\u00e9d\u00e9 avait des enfants de moins de 18 ans * Oui Non Suivant Autorisations En appuyant sur le bouton &quot;Soumettre&quot; J\u2019autorise Services fun\u00e9raire Azur incin\u00e9ration inc. \u00e0 transmettre et utiliser l\u2019ensemble des renseignements n\u00e9cessaires en conformit\u00e9 avec la Politique de protection des renseignements personnels et politique de confidentialit\u00e9. * D&#8217;accord Politique de protection des renseignements personnels et politique de confidentialit\u00e9 Attention! En appuyant sur le bouton soumettre ci-dessous, je d\u00e9clare avoir rempli consciencieusement le pr\u00e9sent questionnaire.Email Soumettre<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_templately_pack_id":"","_templately_imported_at":"","_templately_source":"","_templately_import_session_id":"","footnotes":""},"categories":[],"class_list":["post-3046","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.7 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Additional QPP information - Services fun\u00e9raires Azur incin\u00e9ration<\/title>\n<meta name=\"robots\" content=\"noindex, follow\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Additional QPP information - Services fun\u00e9raires Azur incin\u00e9ration\" \/>\n<meta property=\"og:description\" content=\"Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire. &#8211; \u00c9tape 1 sur 4Compl\u00e9ment d&#8217;informations RRQDirecteur fun\u00e9raire : Denis Lachance Renseignements sur la personne d\u00e9c\u00e9d\u00e9e Nom de famille \u00e0 la naissance *Pr\u00e9nom *Date de naissance *J12345678910111213141516171819202122232425262728293031M123456789101112A202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900La personne d\u00e9c\u00e9d\u00e9 a-t-elle particip\u00e9 \u00e0 un r\u00e9gime de s\u00e9curit\u00e9 social \u00e0 l&#039;\u00e9tranger? * Oui Non Au cours de sa vie, la personne d\u00e9c\u00e9d\u00e9 a-t-elle eu des enfants (biologiques ou adoptifs) n\u00e9s apr\u00e8s 1958? * Oui Non Au cours de sa vie, la personne d\u00e9c\u00e9d\u00e9 a-t-elle pris en charge des enfants n\u00e9s apr\u00e8s 1958? * Oui Non Une personne d\u00e9c\u00e9d\u00e9e ayant re\u00e7u des prestations familiales du Qu\u00e9bec ou du Canada pour un enfant peut aider une personne \u00e0 devenir admissible \u00e0 une rente ou \u00e0 faire augmenter son montant. Il est donc important de fournir, \u00e0 votre connaissance, les renseignements demand\u00e9s sur les enfants de la personne d\u00e9c\u00e9d\u00e9e. Laquelle de ces options d\u00e9crit la situation de la personne d\u00e9c\u00e9d\u00e9e, \u00e0 l&#039;\u00e9gard des prestations familiales? * Au cours de sa vie, la personne d\u00e9c\u00e9d\u00e9e a re\u00e7u \u00e0 son nom des prestations familiales. Au cours de sa vie, la personne d\u00e9c\u00e9d\u00e9e n&#8217;a pas re\u00e7u \u00e0 son nom des prestations familiales. Elles ont \u00e9t\u00e9 vers\u00e9es \u00e0 sa conjointe ou son conjoint. La personne d\u00e9c\u00e9d\u00e9e \u00e9tait admissible \u00e0 des prestations familiales, mais n&#8217;en a jamais re\u00e7u parce que son revenu familial \u00e9tait trop \u00e9lev\u00e9. La personne d\u00e9c\u00e9d\u00e9e et sa conjointe ou son conjoint n&#8217;ont jamais re\u00e7u de prestations familiales. Je ne sais pas. De la naissance de chaque enfant jusqu&#039;\u00e0 son 7e anniversaire, y a-t-il eu des p\u00e9riodes o\u00f9 la personne d\u00e9c\u00e9d\u00e9e ne recevait pas de prestations familiales \u00e0 son nom? * Oui Non Depuis sa naissance ou son arriv\u00e9e au Canada jusqu&#039;\u00e0 son 7e anniversaire, chaque enfant a-t-il toujours r\u00e9sid\u00e9 au Canada avec la personne d\u00e9c\u00e9d\u00e9e? * Oui Non De quel fa\u00e7on voulez-vous recevoir le remboursement? * Aux h\u00e9ritiers: Un versement &#8211; un ch\u00e8que de 2500$ aux h\u00e9ritiers. \u00c0 la personne qui a payer les services fun\u00e9raires: Un versement, \u00e0 la personne qui a pay\u00e9 les services fun\u00e9raires, \u00e9gal \u00e0 la facture des services fun\u00e9raires et un versement, \u00e9gal \u00e0 la diff\u00e9rence, vers\u00e9 aux h\u00e9ritiers. Suivant Informations sur le d\u00e9clarant Est-ce que le d\u00e9clarant est l&#039;\u00e9poux\/\u00e9pouse ou conjoint(e) de fait? * \u00c9poux \/ \u00c9pouse \/ Conjoint de fait Parent ou ami Nous \u00e9tions: * Mari\u00e9 Conjoint de fait S\u00e9par\u00e9 l\u00e9galement Divorc\u00e9 \u00cates-vous un h\u00e9ritier? (d\u00e9clarant) * Oui Non Vous devrez fournir le num\u00e9ro d\u2019assurance sociale \u00e0 notre conseiller par t\u00e9l\u00e9phone.Date de naissance (d\u00e9clarant) *J12345678910111213141516171819202122232425262728293031M123456789101112A202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Lieu de naissance (Ville) (d\u00e9clarant) *Nom de la m\u00e8re (d\u00e9clarant) *Pr\u00e9nomNomNom du p\u00e8re (d\u00e9clarant) *Pr\u00e9nomNomSuivant Rente de conjoint survivant Informations sur le conjoint ou la conjointeQuel \u00e9tait la situation matrimoniale du d\u00e9funt lors de son d\u00e9c\u00e8s? * C\u00e9libataire Mari\u00e9 Veuf Union civil Conjoint de fait Divorc\u00e9 Union dissoute S\u00e9par\u00e9 l\u00e9galement Est-ce que la personne d\u00e9c\u00e9d\u00e9 \u00e9tais conjoint de fait depuis plus de trois ans? * Oui Non Date de naissance *J12345678910111213141516171819202122232425262728293031M123456789101112A202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Lieu de naissance (Ville) *Nom de la m\u00e8re *Pr\u00e9nomNomNom du p\u00e8re *Pr\u00e9nomNomAdresseAdresse ligne\u00a01Ville\u00c9tat \/ Province \/ R\u00e9gionCode postalAfghanistanAfrique du SudAlbanieAlg\u00e9rieAllemagneAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArabie SaouditeArgentineArm\u00e9nieArubaAustralieAutricheAzerba\u00efdjanBahamasBahre\u00efnBangladeshBarbadeBelgiqueBelizeBermudesBhoutanBi\u00e9lorussieBolivie (\u00c9tat plurinational de)Bonaire, Saint Eustatius and SabaBosnie-Herz\u00e9govineBotswanaBr\u00e9silBulgarieBurkina FasoBurundiB\u00e9ninCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresCongoCongo (R\u00e9publique d\u00e9mocratique du)Cor\u00e9e (R\u00e9publique de)Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)Costa RicaCroatieCubaCura\u00e7aoC\u00f4te d\u2019IvoireDanemarkDjiboutiDominiqueEspagneEstonieEswatini (Royaume de)FidjiFinlandeFranceF\u00e9d\u00e9ration RusseGabonGambieGhanaGibraltarGrenadeGroenlandGr\u00e8ceGuadeloupeGuamGuatemalaGuerneseyGuin\u00e9eGuin\u00e9e \u00e9quatorialeGuin\u00e9e-BissauGuyaneGuyaneG\u00e9orgieG\u00e9orgie du Sud et \u00eeles Sandwich du SudHa\u00eftiHondurasHong KongHongrieIndeIndon\u00e9sieIrakIran (R\u00e9publique islamique d\u2019)Irlande (R\u00e9publique d\u2019)IslandeIsra\u00eblItalieJama\u00efqueJaponJerseyJordanieKazakhstanKenyaKirghizistanKiribatiKosovoKowe\u00eftLa R\u00e9unionLesothoLettonieLibanLiberiaLibyeLiechtensteinLituanieLuxembourgMacaoMac\u00e9doine du Nord (R\u00e9publique de)MadagascarMalaisieMalawiMaldivesMaliMalteMarocMartiniqueMauritanieMayotteMexiqueMicron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)Moldova (R\u00e9publique de)MonacoMongolieMontserratMont\u00e9n\u00e9groMozambiqueMyanmarNamibieNauruNegara Brunei DarussalamNicaraguaNigerNig\u00e9riaNiueNorv\u00e8geNouvelle-Cal\u00e9donieNouvelle-Z\u00e9landeN\u00e9palOmanOugandaOuzb\u00e9kistanPakistanPalauPalestine (\u00c9tat de)PanamaPapouasie-Nouvelle-Guin\u00e9eParaguayPays-BasPhilippinesPolognePolyn\u00e9sie fran\u00e7aisePorto RicoPortugalP\u00e9rouQatarRoumanieRoyaume-Uni de Grande-Bretagne et d\u2019Irlande du NordRwandaR\u00e9publique arabe syrienneR\u00e9publique centrafricaineR\u00e9publique dominicaineR\u00e9publique d\u00e9mocratique populaire du LaosR\u00e9publique tch\u00e8queSahara occidentalSaint Barth\u00e9lemySaint Pierre et MiquelonSaint-Christophe-et-NevisSaint-MarinSaint-Martin (partie fran\u00e7aise)Saint-Vincent-et-les GrenadinesSainte-H\u00e9l\u00e8ne, Ascension et Tristan da CunhaSainte-LucieSalvadorSamoaSamoa am\u00e9ricainesSao Tom\u00e9 et PrincipeSerbieSeychellesSierra LeoneSingapourSint Maarten (partie hollandaise)SlovaquieSlov\u00e9nieSomalieSoudanSoudan du SudSri LankaSuisseSurinamSu\u00e8deS\u00e9n\u00e9galTadjikistanTaiwan, R\u00e9publique de ChineTanzanie (R\u00e9publique-Unie de)TchadTerres Australes Fran\u00e7aisesTerritoire britannique de l\u2019oc\u00e9an IndienTha\u00eflandeTimor orientalTogoTokelauTongaTrinit\u00e9 et TobagoTunisieTurkm\u00e9nistanTurquieTuvaluUkraineUruguayVanuatuVenezuela (R\u00e9publique bolivarienne du)VietnamWallis et FutunaY\u00e9menZambieZimbabwe\u00c9gypte\u00c9mirats arabes unis\u00c9quateur\u00c9rythr\u00e9e\u00c9tat de la cit\u00e9 du Vatican\u00c9tats-Unis d\u2019Am\u00e9rique\u00c9thiopie\u00cele Bouvet\u00cele Christmas\u00cele Maurice\u00cele Norfolk\u00cele de Man\u00celes Ca\u00efmans\u00celes Cocos (Keeling)\u00celes Cook\u00celes Falkland (Malvinas)\u00celes F\u00e9ro\u00e9\u00celes Heard et McDonald\u00celes Mariannes du Nord\u00celes Marshall\u00celes Pitcairn\u00celes Salomon\u00celes Turques et Ca\u00efques\u00celes Vierges (Am\u00e9ricaines)\u00celes Vierges (Britanniques)\u00celes de Svalbard et Jan Mayen\u00celes mineures am\u00e9ricaines\u00celes \u00c5landPaysT\u00e9l\u00e9phone Depuis: (date)J12345678910111213141516171819202122232425262728293031M123456789101112A202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Avez-vous eu ou attendez-vous un enfant de la personne d\u00e9c\u00e9d\u00e9e? * Oui Non L\u2019un de vous a-t-il adopt\u00e9 un enfant de l\u2019autre ou avez-vous adopt\u00e9 un enfant ensemble? * Oui Non \u00cates-vous invalide ou vous consid\u00e9rez-vous comme invalide? * Oui Non \u00c0 la date du d\u00e9c\u00e8s de votre conjointe ou conjoint : aviez-vous un enfant invalide \u00e0 votre charge? * Oui Non aviez-vous un enfant de moins de 18 ans \u00e0 votre charge? * Oui Non Depuis le d\u00e9c\u00e8s de votre conjointe ou conjoint : avez-vous pris un enfant invalide \u00e0 votre charge? * Oui Non Avez-vous pris un enfant de moins de 18 ans \u00e0 votre charge? * Oui Non Sans tenir compte de la pension de la S\u00e9curit\u00e9 de la vieillesse, recevez-vous une rente du R\u00e9gime de pensions du Canada (RPC)? Rente de retraite du RPC * Oui Non Rente de conjoint survivant du RPC * Oui Non Rente d&#039;invalidit\u00e9 du RPC * Oui Non Si oui, vous devrez fournir le num\u00e9ro d\u2019assurance sociale \u00e0 notre conseiller par t\u00e9l\u00e9phone. Rente d&#039;orphelin Est-ce que la personne d\u00e9c\u00e9d\u00e9 avait des enfants de moins de 18 ans * Oui Non Suivant Autorisations En appuyant sur le bouton &quot;Soumettre&quot; J\u2019autorise Services fun\u00e9raire Azur incin\u00e9ration inc. \u00e0 transmettre et utiliser l\u2019ensemble des renseignements n\u00e9cessaires en conformit\u00e9 avec la Politique de protection des renseignements personnels et politique de confidentialit\u00e9. * D&#8217;accord Politique de protection des renseignements personnels et politique de confidentialit\u00e9 Attention! En appuyant sur le bouton soumettre ci-dessous, je d\u00e9clare avoir rempli consciencieusement le pr\u00e9sent questionnaire.Email Soumettre\" \/>\n<meta property=\"og:url\" content=\"https:\/\/azurdeces.com\/en\/additional-qpp-information\/\" \/>\n<meta property=\"og:site_name\" content=\"Services fun\u00e9raires Azur incin\u00e9ration\" \/>\n<meta property=\"article:modified_time\" content=\"2026-10-23T11:21:54+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/azurdeces.com\/wp-content\/plugins\/wpforms\/assets\/images\/submit-spin.svg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"5 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/additional-qpp-information\\\/\",\"url\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/additional-qpp-information\\\/\",\"name\":\"Additional QPP information - Services fun\u00e9raires Azur incin\u00e9ration\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/additional-qpp-information\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/additional-qpp-information\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/azurdeces.com\\\/wp-content\\\/plugins\\\/wpforms\\\/assets\\\/images\\\/submit-spin.svg\",\"datePublished\":\"2024-03-28T16:11:27+00:00\",\"dateModified\":\"2026-10-23T11:21:54+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/additional-qpp-information\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/azurdeces.com\\\/en\\\/additional-qpp-information\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/additional-qpp-information\\\/#primaryimage\",\"url\":\"https:\\\/\\\/azurdeces.com\\\/wp-content\\\/plugins\\\/wpforms\\\/assets\\\/images\\\/submit-spin.svg\",\"contentUrl\":\"https:\\\/\\\/azurdeces.com\\\/wp-content\\\/plugins\\\/wpforms\\\/assets\\\/images\\\/submit-spin.svg\"},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/additional-qpp-information\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Accueil\",\"item\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/menu-en\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Additional QPP information\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/#website\",\"url\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/\",\"name\":\"Services fun\u00e9raires Azur - Transmission d'informations pour un d\u00e9c\u00e8s\",\"description\":\"Information Submission Form for a Death\",\"publisher\":{\"@id\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/#organization\",\"name\":\"Services fun\u00e9raires Azur - Transmission d'informations pour un d\u00e9c\u00e8s\",\"url\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/azurdeces.com\\\/wp-content\\\/uploads\\\/2025\\\/04\\\/Service-Funeraire-Azur_2024_Couleur-siteicon.png\",\"contentUrl\":\"https:\\\/\\\/azurdeces.com\\\/wp-content\\\/uploads\\\/2025\\\/04\\\/Service-Funeraire-Azur_2024_Couleur-siteicon.png\",\"width\":769,\"height\":769,\"caption\":\"Services fun\u00e9raires Azur - Transmission d'informations pour un d\u00e9c\u00e8s\"},\"image\":{\"@id\":\"https:\\\/\\\/azurdeces.com\\\/en\\\/#\\\/schema\\\/logo\\\/image\\\/\"}}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Additional QPP information - Services fun\u00e9raires Azur incin\u00e9ration","robots":{"index":"noindex","follow":"follow"},"og_locale":"en_US","og_type":"article","og_title":"Additional QPP information - Services fun\u00e9raires Azur incin\u00e9ration","og_description":"Veuillez activer JavaScript dans votre navigateur pour remplir ce formulaire. &#8211; \u00c9tape 1 sur 4Compl\u00e9ment d&#8217;informations RRQDirecteur fun\u00e9raire : Denis Lachance Renseignements sur la personne d\u00e9c\u00e9d\u00e9e Nom de famille \u00e0 la naissance *Pr\u00e9nom *Date de naissance *J12345678910111213141516171819202122232425262728293031M123456789101112A202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900La personne d\u00e9c\u00e9d\u00e9 a-t-elle particip\u00e9 \u00e0 un r\u00e9gime de s\u00e9curit\u00e9 social \u00e0 l&#039;\u00e9tranger? * Oui Non Au cours de sa vie, la personne d\u00e9c\u00e9d\u00e9 a-t-elle eu des enfants (biologiques ou adoptifs) n\u00e9s apr\u00e8s 1958? * Oui Non Au cours de sa vie, la personne d\u00e9c\u00e9d\u00e9 a-t-elle pris en charge des enfants n\u00e9s apr\u00e8s 1958? * Oui Non Une personne d\u00e9c\u00e9d\u00e9e ayant re\u00e7u des prestations familiales du Qu\u00e9bec ou du Canada pour un enfant peut aider une personne \u00e0 devenir admissible \u00e0 une rente ou \u00e0 faire augmenter son montant. Il est donc important de fournir, \u00e0 votre connaissance, les renseignements demand\u00e9s sur les enfants de la personne d\u00e9c\u00e9d\u00e9e. Laquelle de ces options d\u00e9crit la situation de la personne d\u00e9c\u00e9d\u00e9e, \u00e0 l&#039;\u00e9gard des prestations familiales? * Au cours de sa vie, la personne d\u00e9c\u00e9d\u00e9e a re\u00e7u \u00e0 son nom des prestations familiales. Au cours de sa vie, la personne d\u00e9c\u00e9d\u00e9e n&#8217;a pas re\u00e7u \u00e0 son nom des prestations familiales. Elles ont \u00e9t\u00e9 vers\u00e9es \u00e0 sa conjointe ou son conjoint. La personne d\u00e9c\u00e9d\u00e9e \u00e9tait admissible \u00e0 des prestations familiales, mais n&#8217;en a jamais re\u00e7u parce que son revenu familial \u00e9tait trop \u00e9lev\u00e9. La personne d\u00e9c\u00e9d\u00e9e et sa conjointe ou son conjoint n&#8217;ont jamais re\u00e7u de prestations familiales. Je ne sais pas. De la naissance de chaque enfant jusqu&#039;\u00e0 son 7e anniversaire, y a-t-il eu des p\u00e9riodes o\u00f9 la personne d\u00e9c\u00e9d\u00e9e ne recevait pas de prestations familiales \u00e0 son nom? * Oui Non Depuis sa naissance ou son arriv\u00e9e au Canada jusqu&#039;\u00e0 son 7e anniversaire, chaque enfant a-t-il toujours r\u00e9sid\u00e9 au Canada avec la personne d\u00e9c\u00e9d\u00e9e? * Oui Non De quel fa\u00e7on voulez-vous recevoir le remboursement? * Aux h\u00e9ritiers: Un versement &#8211; un ch\u00e8que de 2500$ aux h\u00e9ritiers. \u00c0 la personne qui a payer les services fun\u00e9raires: Un versement, \u00e0 la personne qui a pay\u00e9 les services fun\u00e9raires, \u00e9gal \u00e0 la facture des services fun\u00e9raires et un versement, \u00e9gal \u00e0 la diff\u00e9rence, vers\u00e9 aux h\u00e9ritiers. Suivant Informations sur le d\u00e9clarant Est-ce que le d\u00e9clarant est l&#039;\u00e9poux\/\u00e9pouse ou conjoint(e) de fait? * \u00c9poux \/ \u00c9pouse \/ Conjoint de fait Parent ou ami Nous \u00e9tions: * Mari\u00e9 Conjoint de fait S\u00e9par\u00e9 l\u00e9galement Divorc\u00e9 \u00cates-vous un h\u00e9ritier? (d\u00e9clarant) * Oui Non Vous devrez fournir le num\u00e9ro d\u2019assurance sociale \u00e0 notre conseiller par t\u00e9l\u00e9phone.Date de naissance (d\u00e9clarant) *J12345678910111213141516171819202122232425262728293031M123456789101112A202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Lieu de naissance (Ville) (d\u00e9clarant) *Nom de la m\u00e8re (d\u00e9clarant) *Pr\u00e9nomNomNom du p\u00e8re (d\u00e9clarant) *Pr\u00e9nomNomSuivant Rente de conjoint survivant Informations sur le conjoint ou la conjointeQuel \u00e9tait la situation matrimoniale du d\u00e9funt lors de son d\u00e9c\u00e8s? * C\u00e9libataire Mari\u00e9 Veuf Union civil Conjoint de fait Divorc\u00e9 Union dissoute S\u00e9par\u00e9 l\u00e9galement Est-ce que la personne d\u00e9c\u00e9d\u00e9 \u00e9tais conjoint de fait depuis plus de trois ans? * Oui Non Date de naissance *J12345678910111213141516171819202122232425262728293031M123456789101112A202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Lieu de naissance (Ville) *Nom de la m\u00e8re *Pr\u00e9nomNomNom du p\u00e8re *Pr\u00e9nomNomAdresseAdresse ligne\u00a01Ville\u00c9tat \/ Province \/ R\u00e9gionCode postalAfghanistanAfrique du SudAlbanieAlg\u00e9rieAllemagneAndorreAngolaAnguillaAntarctiqueAntigua-et-BarbudaArabie SaouditeArgentineArm\u00e9nieArubaAustralieAutricheAzerba\u00efdjanBahamasBahre\u00efnBangladeshBarbadeBelgiqueBelizeBermudesBhoutanBi\u00e9lorussieBolivie (\u00c9tat plurinational de)Bonaire, Saint Eustatius and SabaBosnie-Herz\u00e9govineBotswanaBr\u00e9silBulgarieBurkina FasoBurundiB\u00e9ninCambodgeCamerounCanadaCap-VertChiliChineChypreColombieComoresCongoCongo (R\u00e9publique d\u00e9mocratique du)Cor\u00e9e (R\u00e9publique de)Cor\u00e9e (R\u00e9publique populaire d\u00e9mocratique de)Costa RicaCroatieCubaCura\u00e7aoC\u00f4te d\u2019IvoireDanemarkDjiboutiDominiqueEspagneEstonieEswatini (Royaume de)FidjiFinlandeFranceF\u00e9d\u00e9ration RusseGabonGambieGhanaGibraltarGrenadeGroenlandGr\u00e8ceGuadeloupeGuamGuatemalaGuerneseyGuin\u00e9eGuin\u00e9e \u00e9quatorialeGuin\u00e9e-BissauGuyaneGuyaneG\u00e9orgieG\u00e9orgie du Sud et \u00eeles Sandwich du SudHa\u00eftiHondurasHong KongHongrieIndeIndon\u00e9sieIrakIran (R\u00e9publique islamique d\u2019)Irlande (R\u00e9publique d\u2019)IslandeIsra\u00eblItalieJama\u00efqueJaponJerseyJordanieKazakhstanKenyaKirghizistanKiribatiKosovoKowe\u00eftLa R\u00e9unionLesothoLettonieLibanLiberiaLibyeLiechtensteinLituanieLuxembourgMacaoMac\u00e9doine du Nord (R\u00e9publique de)MadagascarMalaisieMalawiMaldivesMaliMalteMarocMartiniqueMauritanieMayotteMexiqueMicron\u00e9sie (\u00c9tats f\u00e9d\u00e9r\u00e9s de)Moldova (R\u00e9publique de)MonacoMongolieMontserratMont\u00e9n\u00e9groMozambiqueMyanmarNamibieNauruNegara Brunei DarussalamNicaraguaNigerNig\u00e9riaNiueNorv\u00e8geNouvelle-Cal\u00e9donieNouvelle-Z\u00e9landeN\u00e9palOmanOugandaOuzb\u00e9kistanPakistanPalauPalestine (\u00c9tat de)PanamaPapouasie-Nouvelle-Guin\u00e9eParaguayPays-BasPhilippinesPolognePolyn\u00e9sie fran\u00e7aisePorto 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(date)J12345678910111213141516171819202122232425262728293031M123456789101112A202520242023202220212020201920182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900Avez-vous eu ou attendez-vous un enfant de la personne d\u00e9c\u00e9d\u00e9e? * Oui Non L\u2019un de vous a-t-il adopt\u00e9 un enfant de l\u2019autre ou avez-vous adopt\u00e9 un enfant ensemble? * Oui Non \u00cates-vous invalide ou vous consid\u00e9rez-vous comme invalide? * Oui Non \u00c0 la date du d\u00e9c\u00e8s de votre conjointe ou conjoint : aviez-vous un enfant invalide \u00e0 votre charge? * Oui Non 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