{"id":23136,"date":"2020-01-07T15:43:18","date_gmt":"2020-01-07T07:43:18","guid":{"rendered":"https:\/\/www.health-way.org\/isys\/?page_id=23136"},"modified":"2025-04-09T20:05:39","modified_gmt":"2025-04-09T12:05:39","slug":"hkcuapp","status":"publish","type":"page","link":"https:\/\/www.health-way.org\/isys\/hkcuapp\/","title":{"rendered":"ApplicationForm-HKCOU"},"content":{"rendered":"<script>\n var applicant = '';\n var members = '';\n var formAction  =  'New';\n var activeorderamount = 0;\n console.log(applicant);\n jQuery(document).ready(function($){\n    \n    if (typeof applicant !== 'undefined') {\n       update_applicant_cards(applicant);\n       update_applicant_personal_info(applicant);\n \n    } \/\/ end applicant check\n    if (typeof members !== 'undefined') {   \n      update_members_info(members);\n    }\n    if ($(\".PaidAmt\").val() > activeorderamount) {\n      $(\".PaidAmt\").val(activeorderamount);\n    }\n\n   initalize_member_number_counter();\n   \/\/initlize on change event for members_number to control the display of the Membership No section \n   initalize_membership_no_info();\n \n   function initalize_member_number_counter(){\n      if (typeof members !== 'undefined') {   \n          number_count = members.length;\n          if(number_count > 0){\n            for(i = 0 ; i <number_count ; i++){\n              if(i == 0){\n                $(\".members_number option[value='']\").remove();\n              }else{\n                $(\".members_number option[value='\"+i+\"']\").remove();\n              }\n            }\n          \n          }\n      }\n   }\n \n   function initalize_membership_no_info(){\n        $(\"[class$=-memberid]\").each(function() {\n                 if($(this).val() == '') {\n                    $(this).closest('.quform-element-row').hide();\n                 }\n        });\n   \n   }\n \n   function update_members_info(members){\n      count = members.length;\n      $(\".members_number\").val(count);\n      if(count <= 0){\n        return;\n      }\n      for(i = 0; i < members.length; i++) { \n         no = i+1;\n         $(\".m\"+no+\"-memberid\").val(members[i].member_no);\n\t       $(\".m\"+no+\"-sname\").val(members[i].last_name);\n         $(\".m\"+no+\"-gname\").val(members[i].first_name);\n         $(\".m\"+no+\"-rel\").val(members[i].relationship);      \n         $(\".m\"+no+\"-sex\").val(members[i].sex); \n         $(\".m\"+no+\"-idtype\").val(members[i].identity_type);\n         $(\".m\"+no+\"-idno\").val(members[i].identity_no);\n         $(\".m\"+no+\"-dob\").val(members[i].dob);\n         $(\".m\"+no+\"-tel\").val(members[i].contact_no);\n         update_members_cards(members[i],no);\n         labeltext = $(\"#m\"+no+\"-label\").text();\n         labeltext = labeltext + \" \" + members[i].last_name + \" \"+members[i].first_name;\n         $(\"#m\"+no+\"-label\").text(labeltext);\n         if (members[i].dentalsure == \"Y\") {\n          var dnum = parseInt(members[i].dentalplanPrice) || 0; \n          activeorderamount = activeorderamount + dnum;\n         }\n         if (members[i].medicard == \"Y\") {\n          var mnum = parseInt(members[i].medicalplanPrice) || 0;\n          activeorderamount = activeorderamount + mnum;\n         }\n         if (members[i].medical_checkup == \"Y\") {\n          var cnum = parseInt(members[i].checkupplanPrice) || 0;\n          activeorderamount = activeorderamount + cnum;\n         }\n      }\n      \n     \n   }\n     function update_members_cards(member, i){\n       $(\".m\"+i+\"-addcard\").each(function () {\n        if(member.medicard == 'Y'){\n          if($(this).val() == 'gold'+i){\n            $(this).attr('checked', true);\n            $(this).attr('data-gold'+i, 'Y');\n            if(formAction == 'Edit'){\n              $(this).click(function(){\n                 alert('\u5df3\u7d93\u9078\u5b9a\u7684\u8a08\u5283\u4e0d\u53ef\u6539\u8b8a');\n                 return false;\n             });\n            }\n          }\n        }\n       if(member.dentalsure == 'Y'){\n          if($(this).val() == 'dental'+i){\n            $(this).attr('checked', true);\n            $(this).attr('data-dental'+i, 'Y');\n            if(formAction == 'Edit'){\n              $(this).click(function(){\n                 alert('\u5df3\u7d93\u9078\u5b9a\u7684\u8a08\u5283\u4e0d\u53ef\u6539\u8b8a');\n                 return false;\n             });\n            }          \n          }\n        }\n       if(member.medical_checkup == 'Y'){\n          if($(this).val() == 'checkup'+i){\n            $(this).attr('checked', true);\n            $(this).attr('data-checkup'+i, 'Y');\n            if(formAction == 'Edit'){\n              $(this).click(function(){\n                 alert('\u5df3\u7d93\u9078\u5b9a\u7684\u8a08\u5283\u4e0d\u53ef\u6539\u8b8a');\n                 return false;\n             });\n            }          \n          }\n        }\n    });\n   } \/\/ end update_applicant_cards function\n \n  function update_applicant_personal_info(applicant){\n    $(\".a-sname\").val(applicant.last_name);\n    $(\".a-gname\").val(applicant.first_name);\n    $(\".a-sex\").val(applicant.sex);\n    $(\".a-mno\").val(applicant.applicant_member_no);\n    $(\".a-mtype\").val(applicant.applicant_type);\n    $(\".a-hkid\").val(applicant.identity_no);\n    $(\".a-dob\").val(applicant.dob);\n    $(\".a-add\").val(applicant.address);\n    $(\".a-tel\").val(applicant.contact_no);\n    $(\".a-email\").val(applicant.email);\n    if (applicant.discountcode == \"DISC30\") {\n      activeorderamount = activeorderamount + 30;\n    } else if (applicant.discountcode == \"DISC80\") {\n      activeorderamount = activeorderamount + 80;\n    }else if (applicant.discountcode == \"GCDIS50\") {\n      activeorderamount = activeorderamount + 150;\n    }else if (applicant.discountcode == \"GCDIS10\") {\n      activeorderamount = activeorderamount + 100;\n    }\n    if (applicant.dentalsure == \"Y\") {\n      var dnum = parseInt(applicant.dentalplanPrice) || 0;\n      activeorderamount = activeorderamount + dnum;\n    }\n    if (applicant.medicard == \"Y\") {\n      var mnum = parseInt(applicant.medicalplanPrice) || 0;\n      activeorderamount = activeorderamount + mnum;\n    }\n    if (applicant.medical_checkup == \"Y\") {\n      var cnum = parseInt(applicant.checkupplanPrice) || 0;\n      activeorderamount = activeorderamount + cnum;\n    }\n    if(applicant.paid  === null || applicant.paid == ''){\n        $(\".PaidAmt\").val(0);\n       }else{\n          if(formAction == 'Renew'){\n             $(\".PaidAmt\").val(0);\n          }else{\n            $(\".PaidAmt\").val(applicant.paid);\n          }\n       }\n       \n   }\n \n   function update_applicant_cards(applicant){\n       $(\".a-addcard\").each(function () {\n        if(applicant.medicard == 'Y'){\n          if($(this).val() == 'gold'){\n            $(this).attr('checked', true);\n            $(this).attr('data-gold', 'Y');\n            if(formAction == 'Edit'){\n              $(this).click(function(){\n                 alert('\u5df3\u7d93\u9078\u5b9a\u7684\u8a08\u5283\u4e0d\u53ef\u6539\u8b8a');\n                 return false;\n             });\n            }          \n          }\n        }\n       \/* $expireDentalsure = date_create_from_format('Y-m-d',applicant.dentalsure_expire');\n        $today = date('Y-m-d') ;\n        $todayDateTime = date_create_from_format('Y-m-d', $today); \n        $diff = $todayDateTime->diff($expireDateTime);\n        if( $diff->invert >= 1){ \n*\/\n\n      if(applicant.dentalsure == 'Y'){\n          if($(this).val() == 'dental'){\n            $(this).attr('checked', true);\n            $(this).attr('data-dental', 'Y');\n            if(formAction == 'Edit'){\n              $(this).click(function(){\n                 alert('\u5df3\u7d93\u9078\u5b9a\u7684\u8a08\u5283\u4e0d\u53ef\u6539\u8b8a');\n                 return false;\n             });\n            }          \n          }\n        }\n       if(applicant.medical_checkup == 'Y'){\n          if($(this).val() == 'checkup'){\n            $(this).attr('checked', true);\n            $(this).attr('data-checkup', 'Y');\n            if(formAction == 'Edit'){\n              $(this).click(function(){\n                 alert('\u5df3\u7d93\u9078\u5b9a\u7684\u8a08\u5283\u4e0d\u53ef\u6539\u8b8a');\n                 return false;\n             });\n            }          \n          }\n        }\n    });\n   } \/\/ end update_applicant_cards function\n \n});  \/\/ end document ready\n\n\n<\/script>\n\n<div id=\"quform-6e1cb0\" class=\"quform quform-97 quform-theme-light quform-support-page-caching quform-is-first-page\"><form id=\"quform-form-6e1cb0\" class=\"quform-form quform-form-97\" action=\"\/isys\/wp-json\/wp\/v2\/pages\/23136#quform-6e1cb0\" method=\"post\" enctype=\"multipart\/form-data\" novalidate=\"novalidate\" 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match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;576&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;any&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;4&quot;,&quot;value&quot;:&quot;hwed&quot;},{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;17&quot;,&quot;value&quot;:&quot;gced&quot;},{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;19&quot;,&quot;value&quot;:&quot;mped&quot;},{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;21&quot;,&quot;value&quot;:&quot;pcac&quot;}]},&quot;3697&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;any&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;21&quot;,&quot;value&quot;:&quot;pcac&quot;}]},&quot;592&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;any&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;4&quot;,&quot;value&quot;:&quot;hwed&quot;},{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;17&quot;,&quot;value&quot;:&quot;gced&quot;},{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;19&quot;,&quot;value&quot;:&quot;mped&quot;},{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;21&quot;,&quot;value&quot;:&quot;pcac&quot;}]},&quot;3695&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;any&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;21&quot;,&quot;value&quot;:&quot;pcac&quot;}]},&quot;578&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;any&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;jpoa&quot;},{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;2&quot;,&quot;value&quot;:&quot;fsda&quot;},{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;5&quot;,&quot;value&quot;:&quot;csoa&quot;}]},&quot;3663&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;16&quot;,&quot;value&quot;:&quot;4pro&quot;}]},&quot;3662&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;any&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;16&quot;,&quot;value&quot;:&quot;4pro&quot;}]},&quot;637&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;any&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;2&quot;,&quot;value&quot;:&quot;fsda&quot;}]},&quot;640&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;any&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;2&quot;,&quot;value&quot;:&quot;fsda&quot;}]},&quot;3582&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;any&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;4&quot;,&quot;value&quot;:&quot;hwed&quot;},{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;17&quot;,&quot;value&quot;:&quot;gced&quot;},{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;19&quot;,&quot;value&quot;:&quot;mped&quot;},{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;23&quot;,&quot;value&quot;:&quot;ntma&quot;}]},&quot;3569&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;19&quot;,&quot;value&quot;:&quot;mped&quot;}]},&quot;3700&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;19&quot;,&quot;value&quot;:&quot;mped&quot;}]},&quot;3573&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;23&quot;,&quot;value&quot;:&quot;ntma&quot;}]},&quot;3707&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;23&quot;,&quot;value&quot;:&quot;ntma&quot;}]},&quot;3691&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;19&quot;,&quot;value&quot;:&quot;mped&quot;}]},&quot;5&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;0&quot;},{&quot;elementId&quot;:&quot;1731&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;edit&quot;}]},&quot;1967&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;1969&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;1974&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;1975&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1974&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Delete&quot;}]},&quot;74&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;19&quot;,&quot;value&quot;:&quot;mped&quot;}]},&quot;1723&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;0&quot;},{&quot;elementId&quot;:&quot;1731&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;2&quot;,&quot;value&quot;:&quot;save&quot;}]},&quot;1737&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;0&quot;}]},&quot;1731&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;0&quot;}]},&quot;670&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;1&quot;},{&quot;elementId&quot;:&quot;1736&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;edit&quot;}]},&quot;1981&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;1983&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;1985&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;1987&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1985&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Delete&quot;}]},&quot;705&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;19&quot;,&quot;value&quot;:&quot;mped&quot;}]},&quot;1734&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;1&quot;},{&quot;elementId&quot;:&quot;1736&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;2&quot;,&quot;value&quot;:&quot;save&quot;}]},&quot;1738&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;0&quot;}]},&quot;1736&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;1&quot;}]},&quot;850&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;2&quot;},{&quot;elementId&quot;:&quot;1744&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;edit&quot;}]},&quot;1994&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;1996&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;1998&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;2000&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1998&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Delete&quot;}]},&quot;885&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;19&quot;,&quot;value&quot;:&quot;mped&quot;}]},&quot;1741&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;2&quot;},{&quot;elementId&quot;:&quot;1744&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;2&quot;,&quot;value&quot;:&quot;save&quot;}]},&quot;1744&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;2&quot;}]},&quot;814&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;3&quot;},{&quot;elementId&quot;:&quot;1750&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;edit&quot;}]},&quot;2003&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;2005&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;2007&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;2009&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;2007&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Delete&quot;}]},&quot;849&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;19&quot;,&quot;value&quot;:&quot;mped&quot;}]},&quot;1747&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;3&quot;},{&quot;elementId&quot;:&quot;1750&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;2&quot;,&quot;value&quot;:&quot;save&quot;}]},&quot;1750&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;3&quot;}]},&quot;778&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;4&quot;},{&quot;elementId&quot;:&quot;1756&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;edit&quot;}]},&quot;2012&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;2014&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;2016&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;2018&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;2016&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Delete&quot;}]},&quot;813&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;19&quot;,&quot;value&quot;:&quot;mped&quot;}]},&quot;1753&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;4&quot;},{&quot;elementId&quot;:&quot;1756&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;2&quot;,&quot;value&quot;:&quot;save&quot;}]},&quot;1756&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;4&quot;}]},&quot;742&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;5&quot;},{&quot;elementId&quot;:&quot;1762&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;edit&quot;}]},&quot;2021&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;2023&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;2025&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;2027&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;2025&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;Delete&quot;}]},&quot;777&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;3558&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;19&quot;,&quot;value&quot;:&quot;mped&quot;}]},&quot;1759&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;5&quot;},{&quot;elementId&quot;:&quot;1762&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;2&quot;,&quot;value&quot;:&quot;save&quot;}]},&quot;1762&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;5&quot;}]},&quot;706&quot;:{&quot;action&quot;:true,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;4&quot;,&quot;operator&quot;:&quot;gt&quot;,&quot;optionId&quot;:null,&quot;value&quot;:&quot;6&quot;},{&quot;elementId&quot;:&quot;1768&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;edit&quot;}]},&quot;2030&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&quot;:&quot;New&quot;}]},&quot;2032&quot;:{&quot;action&quot;:false,&quot;match&quot;:&quot;all&quot;,&quot;rules&quot;:[{&quot;elementId&quot;:&quot;1972&quot;,&quot;operator&quot;:&quot;eq&quot;,&quot;optionId&quot;:&quot;1&quot;,&quot;value&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\/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u586b\u5beb\u8868\u683c<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3557 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center; color:#9d9d9d\">\u9999\u6e2f\u6d88\u9632\u8655\u6551\u8b77\u54e1\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u586b\u5beb\u8868\u683c<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3559 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center; color:#9d9d9d\">\u9999\u6e2f\u7ae5\u8ecd\u7e3d\u6703\u65b0\u754c\u6771\u5730\u57df<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u586b\u5beb\u8868\u683c<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3685 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center; color:#9d9d9d\">\u9999\u6e2f\u7ae5\u8ecd\u7e3d\u6703\u65b0\u754c\u5730\u57df<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u586b\u5beb\u8868\u683c<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3560 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center; color:#9d9d9d\">\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u586b\u5beb\u8868\u683c<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3625 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center; color:#9d9d9d\">\u6e2f\u4e5d\u52de\u5de5\u793e\u5718\u806f\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u586b\u5beb\u8868\u683c<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3626 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center; color:#9d9d9d\">\u9999\u6e2f\u8b66\u52d9\u7763\u5bdf\u5354\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u586b\u5beb\u8868\u683c<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3629 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center; color:#9d9d9d\">\u9999\u6e2f\u7279\u5340\u653f\u5e9c\u516c\u52d9\u4eba\u54e1\u806f\u6703\/\u570b\u5bb6\u884c\u653f\u5b78\u9662\u9999\u6e2f\u540c\u5b78\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u586b\u5beb\u8868\u683c<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3628 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center; color:#9d9d9d\">\u9999\u6e2f\u5165\u5883\u4e8b\u52d9\u52a9\u7406\u54e1\u5de5\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u586b\u5beb\u8868\u683c<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3627 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center; color:#9d9d9d\">\u9999\u6e2f\u6d88\u9632\u8655\u8077\u5de5\u7e3d\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u586b\u5beb\u8868\u683c<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3641 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center; color:#9d9d9d\">\u9999\u6e2f\u6d77\u95dc\u5b98\u54e1\u5354\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u586b\u5beb\u8868\u683c<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3717 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center; color:#9d9d9d\">\u9999\u6e2f\u61f2\u6559\u7f72\u61f2\u6559\u52a9\u7406\u7e3d\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u586b\u5beb\u8868\u683c<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3645 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center; color:#9d9d9d\">\u9999\u6e2f\u6d77\u95dc\u95dc\u54e1\u5de5\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u586b\u5beb\u8868\u683c<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3648 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center; color:#9d9d9d\">\u9999\u6e2f\u8b66\u5bdf\u968a\u54e1\u4f50\u7d1a\u5354\u6703\u5275\u5efa\u4eba\u9000\u5f79\u540c\u50da\u806f\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u586b\u5beb\u8868\u683c<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3649 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center; color:#9d9d9d\">\u9999\u6e2f\u6d88\u9632\u63a7\u5236\u7d44\u7e54\u54e1\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u586b\u5beb\u8868\u683c<\/h1><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_3611 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_3611\"><label class=\"quform-label-text\" for=\"quform_97_3611_6e1cb0\">xcount<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_3611\"><div class=\"quform-input quform-input-text quform-input-97_3611 quform-cf\"><input type=\"text\" id=\"quform_97_3611_6e1cb0\" name=\"quform_97_3611\" class=\"quform-field quform-field-text quform-field-97_3611 xcount\" value=\"0\" readonly \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_3679 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_3679\"><label class=\"quform-label-text\" for=\"quform_97_3679_6e1cb0\">isValidForEdit<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_3679\"><div class=\"quform-input quform-input-text quform-input-97_3679 quform-cf\"><input type=\"text\" id=\"quform_97_3679_6e1cb0\" name=\"quform_97_3679\" class=\"quform-field quform-field-text quform-field-97_3679 isValidForEdit\" value=\"0\" readonly \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_3561 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_3561\"><label class=\"quform-label-text\" for=\"quform_97_3561_6e1cb0\">HealthCareAmt<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_3561\"><div class=\"quform-input quform-input-text quform-input-97_3561 quform-cf\"><input type=\"text\" id=\"quform_97_3561_6e1cb0\" name=\"quform_97_3561\" class=\"quform-field quform-field-text quform-field-97_3561 HealthCareAmt\" value=\"0\" readonly \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_3564 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_3564\"><label class=\"quform-label-text\" for=\"quform_97_3564_6e1cb0\">MediCardAmt<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_3564\"><div class=\"quform-input quform-input-text quform-input-97_3564 quform-cf\"><input type=\"text\" id=\"quform_97_3564_6e1cb0\" name=\"quform_97_3564\" class=\"quform-field quform-field-text quform-field-97_3564 MediCardAmt\" value=\"1840\" readonly \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_3562 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_3562\"><label class=\"quform-label-text\" for=\"quform_97_3562_6e1cb0\">DentalSureAmt<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_3562\"><div class=\"quform-input quform-input-text quform-input-97_3562 quform-cf\"><input type=\"text\" id=\"quform_97_3562_6e1cb0\" name=\"quform_97_3562\" class=\"quform-field quform-field-text quform-field-97_3562 DentalSureAmt\" value=\"450\" readonly \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_3563 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_3563\"><label class=\"quform-label-text\" for=\"quform_97_3563_6e1cb0\">CheckUpAmt<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_3563\"><div class=\"quform-input quform-input-text quform-input-97_3563 quform-cf\"><input type=\"text\" id=\"quform_97_3563_6e1cb0\" name=\"quform_97_3563\" class=\"quform-field quform-field-text quform-field-97_3563 CheckUpAmt\" value=\"390\" readonly \/><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_3601 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_3601\"><label class=\"quform-label-text\" for=\"quform_97_3601_6e1cb0\">PaidAmt<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_3601\"><div class=\"quform-input quform-input-text quform-input-97_3601 quform-cf\"><input type=\"text\" id=\"quform_97_3601_6e1cb0\" name=\"quform_97_3601\" class=\"quform-field quform-field-text quform-field-97_3601 PaidAmt\" value=\"0\" readonly \/><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_558 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\"><span><div style=\"text-align: center;\"><span>\u7533\u8acb\u985e\u5225 Type of Cover<\/span><\/div><\/span><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_608 quform-1-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_609\"><div class=\"quform-element quform-element-row quform-element-row-97_648 quform-2-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_649\"><div class=\"quform-element quform-element-html quform-element-97_647 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/jpoa-blue.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3693 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2021\/04\/pc-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3635 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/2019\/07\/piag-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3620 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/csoa-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3703 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2021\/05\/hkap-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3637 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/2019\/07\/csgu-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3721 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2024\/03\/fcs-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3639 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/2019\/07\/csgu-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3583 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/fsda-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3585 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/nter-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3686 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2021\/02\/ntr-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3587 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/hwed-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3642 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/2019\/12\/aceso-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3718 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2023\/03\/aoga-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3646 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/2020\/01\/hkcuo-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3650 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2020\/07\/hkia-green-1.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3652 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2020\/07\/fscs-green-2.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3654 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2020\/07\/fvjp-green-2.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3659 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2020\/08\/4prof-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3673 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2020\/08\/GC-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3709 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2021\/05\/ntma-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3714 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2021\/06\/mhc-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3681 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2021\/01\/mp-green.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4572\" \/><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_612 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_612\"><label class=\"quform-label-text\" id=\"quform_97_612_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_612\"><div class=\"quform-input quform-input-radio quform-input-97_612 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_612_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_612\" id=\"quform_97_612_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_612 quform-field-97_612_1 type_of_cover\" value=\"main\" checked \/><label for=\"quform_97_612_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_612_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_650\"><div class=\"quform-element quform-element-html quform-element-97_651 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/jpoa-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3694 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2021\/04\/pc-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3636 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/2019\/07\/piag-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3621 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/csoa-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3704 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2021\/05\/hkap-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3638 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/2019\/07\/csgu-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3722 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2024\/03\/fcs-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3640 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/2019\/07\/csgu-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3584 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/fsda-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3586 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/nter-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3687 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2021\/02\/ntr-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3588 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/hwed-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3643 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/2019\/12\/aceso-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3719 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2023\/03\/aoga-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3647 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/2020\/01\/hkcuo-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3651 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2020\/07\/hkia-gold-1.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3653 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2020\/07\/fscs-gold-2.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3655 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2020\/07\/fvjp-gold-2.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3660 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2020\/08\/4prof-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3674 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2020\/08\/GC-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3710 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2021\/05\/ntma-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3715 quform-cf\"><div class=\"quform-spacer\"><img decoding=\"async\" src=\"https:\/\/www.health-way.org\/isys\/wp-content\/uploads\/2021\/06\/mhc-gold.jpeg\" alt=\"\" width=\"50%\"  class=\"alignnone size-medium wp-image-4575\" \/><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_613 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_613\"><label class=\"quform-label-text\" id=\"quform_97_613_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_613\"><div class=\"quform-input quform-input-checkbox quform-input-97_613 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_613_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_613[]\" id=\"quform_97_613_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_613 quform-field-97_613_1 a-addcard\" value=\"gold\" \/><label for=\"quform_97_613_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_613_1\"><span class=\"quform-option-text\">Medicard(\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_613[]\" id=\"quform_97_613_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_613 quform-field-97_613_2 a-addcard\" value=\"dental\" \/><label for=\"quform_97_613_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_613_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_613[]\" id=\"quform_97_613_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_613 quform-field-97_613_3 a-addcard\" value=\"checkup\" \/><label for=\"quform_97_613_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_613_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_3689 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_3689\"><label class=\"quform-label-text\" id=\"quform_97_3689_6e1cb0_label\">\u5982\u9078\u7528HKD680.-\/\u5e74\u8a08\u5283\uff0c\u8acb\u9078\u4ee5\u4e0b\u5176\u4e2d\u4e00\u9805\u3002<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_3689\"><div class=\"quform-input quform-input-radio quform-input-97_3689 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_3689_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_3689\" id=\"quform_97_3689_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_3689 quform-field-97_3689_1 a-addcard\" value=\"dental\" \/><label for=\"quform_97_3689_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_3689_1\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_3689\" id=\"quform_97_3689_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_3689 quform-field-97_3689_2 a-addcard\" value=\"checkup\" \/><label for=\"quform_97_3689_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_3689_2\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3566 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: #0000ff;\"><strong>HealthCare \u884c\u653f\u8cbb - \u514d\u6536<br \/>\nMediCard (\u91d1\u54ad) - HKD1840\/\u5e74\uff1b DentalSure - HKD450\/\u5e74\uff1b Medical Checkup - HKD370\/\u5e74<\/strong><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3567 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: #0000ff;\"><strong>HealthCare \u884c\u653f\u8cbb - \u6bcf\u5bb6\u5eadHKD200\/\u5e74\uff1b\u82e5\u6709\u4efb\u4f55\u6210\u54e1\u53c3\u52a0\u4e0b\u5217\u4efb\u4f55\u9805\u76ee\uff0c\u53ef\u8c41\u514d\u884c\u653f\u8cbb\u3002<br \/>\nMediCard (\u91d1\u54ad) - HKD2043\/\u5e74\uff1b DentalSure - HKD550\/\u5e74\uff1b Medical Checkup - HKD480\/\u5e74<\/strong><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3661 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: #0000ff;\"><strong>HealthCare \u884c\u653f\u8cbb - \u6bcf\u5bb6\u5eadHKD150\/\u5e74\uff1b\u82e5\u6709\u4efb\u4f55\u6210\u54e1\u53c3\u52a0\u4e0b\u5217\u4efb\u4f55\u9805\u76ee\uff0c\u53ef\u8c41\u514d\u884c\u653f\u8cbb\u3002<br \/>\nMediCard (\u91d1\u54ad) - HKD1840\/\u5e74\uff1b DentalSure - HKD550\/\u5e74\uff1b Medical Checkup - HKD400\/\u5e74<\/strong><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3675 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: #0000ff;\"><strong>HealthCare \u884c\u653f\u8cbb - HKD240\/\u5e74<\/strong><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3615 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.4rem; color: #0000ff;\"><strong><br \/>\u672c\u6703\u5c07\u4ee5 PayPal \u6536\u53d6\u76f8\u95dc\u8cbb\u7528\uff0c\u5982\u6c92\u6709 PayPal \u6236\u53e3\uff0c\u8acb\u6309\u6b64\u7533\u8acb... <\/strong><a href=\"https:\/\/www.paypal.com\/hk\/home?locale.x=zh_HK\" rel=\"noopener\" target=\"_blank\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/health-way.org\/isys\/wp-content\/uploads\/paypal-300x82.jpg\" alt=\"\" width=\"100\" height=\"33\" class=\"alignnone size-medium wp-image-22849\" \/><\/a><\/div><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1972 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1972\"><label class=\"quform-label-text\" id=\"quform_97_1972_6e1cb0_label\">new-edit-renew<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1972\"><div class=\"quform-input quform-input-radio quform-input-97_1972 quform-cf\"><div class=\"quform-options quform-cf quform-options-inline quform-options-style-button quform-button-icon-left\" role=\"radiogroup\" aria-labelledby=\"quform_97_1972_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1972\" id=\"quform_97_1972_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1972 quform-field-97_1972_1 new-edit\" value=\"New\" checked \/><label for=\"quform_97_1972_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1972_1\"><span class=\"quform-option-text\">New<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1972\" id=\"quform_97_1972_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1972 quform-field-97_1972_2 new-edit\" value=\"Edit\" \/><label for=\"quform_97_1972_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1972_2\"><span class=\"quform-option-text\">Edit<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1972\" id=\"quform_97_1972_6e1cb0_4\" class=\"quform-field quform-field-radio quform-field-97_1972 quform-field-97_1972_4 new-edit\" value=\"Renew\" \/><label for=\"quform_97_1972_6e1cb0_4\" class=\"quform-option-label quform-option-label-97_1972_4\"><span class=\"quform-option-text\">Renew<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_560 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\"><span><div style=\"text-align: center;\"><span>\u7533\u8acb\u4eba\u8cc7\u6599 Applicant detail<\/span><\/div><\/span><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_561 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_1957 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1958\"><div class=\"quform-element quform-element-html quform-element-97_1964 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1960\"><div class=\"quform-element quform-element-text quform-element-97_1956 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1956\"><label class=\"quform-label-text\" for=\"quform_97_1956_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1956\"><div class=\"quform-input quform-input-text quform-input-97_1956 quform-cf\"><input type=\"text\" id=\"quform_97_1956_6e1cb0\" name=\"quform_97_1956\" class=\"quform-field quform-field-text quform-field-97_1956 a-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1962\"><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_562 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_563\"><div class=\"quform-element quform-element-html quform-element-97_564 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u59d3\u540d Name<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_565\"><div class=\"quform-element quform-element-text quform-element-97_1955 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1955\"><label class=\"quform-label-text\" for=\"quform_97_1955_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1955\"><div class=\"quform-input quform-input-text quform-input-97_1955 quform-cf\"><input type=\"text\" id=\"quform_97_1955_6e1cb0\" name=\"quform_97_1955\" class=\"quform-field quform-field-text quform-field-97_1955 a-sname\" placeholder=\"\u59d3 Surname\" maxlength=\"40\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_567\"><div class=\"quform-element quform-element-text quform-element-97_568 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_568\"><label class=\"quform-label-text\" for=\"quform_97_568_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_568\"><div class=\"quform-input quform-input-text quform-input-97_568 quform-cf\"><input type=\"text\" id=\"quform_97_568_6e1cb0\" name=\"quform_97_568\" class=\"quform-field quform-field-text quform-field-97_568 a-gname\" placeholder=\"\u540d Given Name\" maxlength=\"40\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_603 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_604\"><div class=\"quform-element quform-element-html quform-element-97_605 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6027\u5225 Sex<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_606\"><div class=\"quform-element quform-element-select quform-element-97_607 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_607\"><label class=\"quform-label-text\" for=\"quform_97_607_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_607\"><div class=\"quform-input quform-input-select quform-input-97_607 quform-cf\"><select id=\"quform_97_607_6e1cb0\" name=\"quform_97_607\" class=\"quform-field quform-field-select quform-field-97_607 quform-field-select-enhanced a-sex\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"\" selected=\"selected\"> \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_574 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_575\"><div class=\"quform-element quform-element-html quform-element-97_576 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f <\/label><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3697 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u8eab\u4efd <\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_577\"><div class=\"quform-element quform-element-text quform-element-97_592 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_592\"><label class=\"quform-label-text\" for=\"quform_97_592_6e1cb0\">\u6703\u54e1\u7de8\u865f<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_592\"><div class=\"quform-input quform-input-text quform-input-97_592 quform-cf\"><input type=\"text\" id=\"quform_97_592_6e1cb0\" name=\"quform_97_592\" class=\"quform-field quform-field-text quform-field-97_592 a-mno\" placeholder=\"\u8acb\u8f38\u5165\u6703\u54e1\uff0f\u5de5\u4f5c\u8a3c\u7de8\u865f\" maxlength=\"50\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u4e0d\u80fd\u78ba\u8a8d\u7533\u8acb<\/p><\/div><\/div><\/div><div class=\"quform-element quform-element-select quform-element-97_3695 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_3695\"><label class=\"quform-label-text\" for=\"quform_97_3695_6e1cb0\">\u6703\u54e1\u8eab\u4efd<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_3695\"><div class=\"quform-input quform-input-select quform-input-97_3695 quform-cf\"><select id=\"quform_97_3695_6e1cb0\" name=\"quform_97_3695\" class=\"quform-field quform-field-select quform-field-97_3695 quform-field-select-enhanced a-mtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"\u6821\u65b9\u7ba1\u7406\u5c64\" selected=\"selected\">\u6821\u65b9\u7ba1\u7406\u5c64<\/option><option value=\"\u6559\u5e2b\u53ca\u8077\u54e1\">\u6559\u5e2b\u53ca\u8077\u54e1<\/option><option value=\"\u5b78\u751f\">\u5b78\u751f<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_579\"><div class=\"quform-element quform-element-select quform-element-97_578 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_578\"><label class=\"quform-label-text\" for=\"quform_97_578_6e1cb0\">\u6703\u54e1\u985e\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_578\"><div class=\"quform-input quform-input-select quform-input-97_578 quform-cf\"><select id=\"quform_97_578_6e1cb0\" name=\"quform_97_578\" class=\"quform-field quform-field-select quform-field-97_578 quform-field-select-enhanced a-mtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"\u73fe\u8077\u6703\u54e1\" selected=\"selected\">\u73fe\u8077\u6703\u54e1<\/option><option value=\"\u9000\u4f11\u6703\u54e1\">\u9000\u4f11\u6703\u54e1<\/option><\/select><\/div><label id=\"quform_97_578_6e1cb0_sub_label_below\" class=\"quform-sub-label quform-sub-label-below\">\u6703\u54e1\u985e\u5225<\/label><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3664 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_3665\"><div class=\"quform-element quform-element-html quform-element-97_3663 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u5c6c\u6703 <\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3668\"><div class=\"quform-element quform-element-select quform-element-97_3662 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_3662\"><label class=\"quform-label-text\" for=\"quform_97_3662_6e1cb0\">\u5c6c\u6703<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_3662\"><div class=\"quform-input quform-input-select quform-input-97_3662 quform-cf\"><select id=\"quform_97_3662_6e1cb0\" name=\"quform_97_3662\" class=\"quform-field quform-field-select quform-field-97_3662 quform-field-select-enhanced a-mtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"\u5168\u7403\u5927\u5b78\u6821\u53cb\u6703\u806f\u76df\" selected=\"selected\">\u5168\u7403\u5927\u5b78\u6821\u53cb\u6703\u806f\u76df<\/option><option value=\"\u7f8e\u570b\u7ba1\u7406\u79d1\u6280\u5927\u5b78\u9999\u6e2f\u6821\u53cb\u6703\">\u7f8e\u570b\u7ba1\u7406\u79d1\u6280\u5927\u5b78\u9999\u6e2f\u6821\u53cb\u6703<\/option><option value=\"\u9999\u6e2f\u5c4b\u5b87\u53ca\u8a2d\u5099\u5de5\u7a0b\u5e2b\u5b78\u6703\">\u9999\u6e2f\u5c4b\u5b87\u53ca\u8a2d\u5099\u5de5\u7a0b\u5e2b\u5b78\u6703<\/option><option value=\"\u9999\u6e2f\u570b\u969b\u590f\u5a01\u5937\u821e\u5354\u6703\">\u9999\u6e2f\u570b\u969b\u590f\u5a01\u5937\u821e\u5354\u6703<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3671\"><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_635 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_636\"><\/div><div class=\"quform-element quform-element-column quform-element-97_638\"><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_614 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_615\"><div class=\"quform-element quform-element-html quform-element-97_616 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u9999\u6e2f\u8eab\u4efd\u8b49 HKID<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_619\"><div class=\"quform-element quform-element-text quform-element-97_625 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_625\"><label class=\"quform-label-text\" for=\"quform_97_625_6e1cb0\">HKID<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_625\"><div class=\"quform-input quform-input-text quform-input-97_625 quform-cf\"><input type=\"text\" id=\"quform_97_625_6e1cb0\" name=\"quform_97_625\" class=\"quform-field quform-field-text quform-field-97_625 a-hkid\" placeholder=\"A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u8eab\u4efd\u8b49\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_593 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_594\"><div class=\"quform-element quform-element-html quform-element-97_595 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u51fa\u751f\u65e5\u671f Date of Birth <\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_596\"><div class=\"quform-element quform-element-date quform-element-97_597 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_597\"><label class=\"quform-label-text\" for=\"quform_97_597_6e1cb0\">\u51fa\u751f\u65e5\u671f<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_597\"><div class=\"quform-input quform-input-date quform-input-97_597 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_597_6e1cb0\" name=\"quform_97_597\" class=\"quform-field quform-field-date quform-field-97_597 a-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_597&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_598 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_599\"><div class=\"quform-element quform-element-html quform-element-97_600 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u901a\u8a0a\u5730\u5740<br\/>\nCorrespondence Address<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_601\"><div class=\"quform-element quform-element-text quform-element-97_602 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_602\"><label class=\"quform-label-text\" for=\"quform_97_602_6e1cb0\">\u901a\u8a0a\u5730\u5740 Correspondence Address<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_602\"><div class=\"quform-input quform-input-text quform-input-97_602 quform-cf\"><input type=\"text\" id=\"quform_97_602_6e1cb0\" name=\"quform_97_602\" class=\"quform-field quform-field-text quform-field-97_602 a-add\" placeholder=\"\u901a\u8a0a\u5730\u5740 Correspondence Address\" maxlength=\"300\" \/><\/div><p class=\"quform-description quform-description-below\">(\u53ea\u63a5\u53d7\u82f1\u6587\u901a\u8a0a\u5730\u5740)<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_665 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_666\"><div class=\"quform-element quform-element-html quform-element-97_667 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u806f\u7d61\u96fb\u8a71 Tel No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_668\"><div class=\"quform-element quform-element-text quform-element-97_669 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_669\"><label class=\"quform-label-text\" for=\"quform_97_669_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_669\"><div class=\"quform-input quform-input-text quform-input-97_669 quform-cf\"><input type=\"text\" id=\"quform_97_669_6e1cb0\" name=\"quform_97_669\" class=\"quform-field quform-field-text quform-field-97_669 a-tel\" maxlength=\"20\" \/><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_641 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_642\"><div class=\"quform-element quform-element-html quform-element-97_643 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u96fb\u90f5 Email<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_644\"><div class=\"quform-element quform-element-text quform-element-97_645 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_645\"><label class=\"quform-label-text\" for=\"quform_97_645_6e1cb0\">\u96fb\u90f5 Email<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_645\"><div class=\"quform-input quform-input-text quform-input-97_645 quform-cf\"><input type=\"text\" id=\"quform_97_645_6e1cb0\" name=\"quform_97_645\" class=\"quform-field quform-field-text quform-field-97_645 a-email\" maxlength=\"100\" \/><\/div><p class=\"quform-description quform-description-below\">** \u5fc5\u586b\u6b04 - \u7528\u4f5c\u6536\u53d6\u96fb\u5b50\u7248\u91ab\u7642\u54ad<\/p><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_3582 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_3571 quform-6-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_3572\"><div class=\"quform-element quform-element-html quform-element-97_3569 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u5730\u5340\u7de8\u865f<br\/>District Code<\/label><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3700 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">Company Code<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3575\"><div class=\"quform-element quform-element-text quform-element-97_3570 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_3570\"><label class=\"quform-label-text\" for=\"quform_97_3570_6e1cb0\">District Code<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_3570\"><div class=\"quform-input quform-input-text quform-input-97_3570 quform-cf\"><input type=\"text\" id=\"quform_97_3570_6e1cb0\" name=\"quform_97_3570\" class=\"quform-field quform-field-text quform-field-97_3570 a-district\" \/><\/div><p class=\"quform-description quform-description-below\">**\u5fc5\u9808\u586b\u5beb<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3578\"><div class=\"quform-element quform-element-html quform-element-97_3573 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u9867\u554f\u7de8\u865f<br\/>Agent Code<\/label><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3707 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">Order Code<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3579\"><div class=\"quform-element quform-element-text quform-element-97_3576 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_3576\"><label class=\"quform-label-text\" for=\"quform_97_3576_6e1cb0\">Agent Code<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_3576\"><div class=\"quform-input quform-input-text quform-input-97_3576 quform-cf\"><input type=\"text\" id=\"quform_97_3576_6e1cb0\" name=\"quform_97_3576\" class=\"quform-field quform-field-text quform-field-97_3576 a-agent\" \/><\/div><p class=\"quform-description quform-description-below\">**\u5fc5\u9808\u586b\u5beb<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3580\"><div class=\"quform-element quform-element-html quform-element-97_3574 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u512a\u60e0\u7de8\u865f<br\/>Discount Code<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3581\"><div class=\"quform-element quform-element-text quform-element-97_3577 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_3577\"><label class=\"quform-label-text\" for=\"quform_97_3577_6e1cb0\">Discount Code<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_3577\"><div class=\"quform-input quform-input-text quform-input-97_3577 quform-cf\"><input type=\"text\" id=\"quform_97_3577_6e1cb0\" name=\"quform_97_3577\" class=\"quform-field quform-field-text quform-field-97_3577 a-discount\" \/><\/div><p class=\"quform-description quform-description-below\">\uff08\u5982\u6709\uff09<\/p><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_559 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: center; font-family: kaiti; font-size: 1.4rem;\"><span>\u7533\u8acb\u4eba\u5bb6\u5c6c\u8cc7\u6599 Applicant families detail<\/span><\/div><\/div><\/div><div class=\"quform-element quform-element-select quform-element-97_4 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_4\"><label class=\"quform-label-text\" for=\"quform_97_4_6e1cb0\">\u5bb6\u5c6c\u4eba\u6578<\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_4\"><div class=\"quform-input quform-input-select quform-input-97_4 quform-cf\"><select id=\"quform_97_4_6e1cb0\" name=\"quform_97_4\" class=\"quform-field quform-field-select quform-field-97_4 quform-field-select-enhanced members_number\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"\" selected=\"selected\">\u5bb6\u5c6c\u4eba\u6578<\/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><\/select><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3691 quform-cf\"><div class=\"quform-spacer\"><span style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\">\u4eba\u6578\u4e00\u7d93\u78ba\u8a8d\u5f8c\uff0c\u6055\u4e0d\u4fee\u6539<\/span><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_5 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 1<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_1965 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1966\"><div class=\"quform-element quform-element-html quform-element-97_1967 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1968\"><div class=\"quform-element quform-element-text quform-element-97_1969 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1969\"><label class=\"quform-label-text\" for=\"quform_97_1969_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1969\"><div class=\"quform-input quform-input-text quform-input-97_1969 quform-cf\"><input type=\"text\" id=\"quform_97_1969_6e1cb0\" name=\"quform_97_1969\" class=\"quform-field quform-field-text quform-field-97_1969 m1-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1973\"><div class=\"quform-element quform-element-checkbox quform-element-97_1974 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1974\"><label class=\"quform-label-text\" id=\"quform_97_1974_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1974\"><div class=\"quform-input quform-input-checkbox quform-input-97_1974 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_1974_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1974[]\" id=\"quform_97_1974_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1974 quform-field-97_1974_1 m1-del\" value=\"Delete\" \/><label for=\"quform_97_1974_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1974_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1976\"><div class=\"quform-element quform-element-html quform-element-97_1975 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_6 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_7\"><div class=\"quform-element quform-element-text quform-element-97_11 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_11\"><label class=\"quform-label-text\" for=\"quform_97_11_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_11\"><div class=\"quform-input quform-input-text quform-input-97_11 quform-cf\"><input type=\"text\" id=\"quform_97_11_6e1cb0\" name=\"quform_97_11\" class=\"quform-field quform-field-text quform-field-97_11 m1-sname\" placeholder=\"\u59d3 Surname\" maxlength=\"40\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_8\"><div class=\"quform-element quform-element-text quform-element-97_12 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_12\"><label class=\"quform-label-text\" for=\"quform_97_12_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_12\"><div class=\"quform-input quform-input-text quform-input-97_12 quform-cf\"><input type=\"text\" id=\"quform_97_12_6e1cb0\" name=\"quform_97_12\" class=\"quform-field quform-field-text quform-field-97_12 m1-gname\" placeholder=\"\u540d Given Name\" maxlength=\"40\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_9\"><div class=\"quform-element quform-element-select quform-element-97_17 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_17\"><label class=\"quform-label-text\" for=\"quform_97_17_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_17\"><div class=\"quform-input quform-input-select quform-input-97_17 quform-cf\"><select id=\"quform_97_17_6e1cb0\" name=\"quform_97_17\" class=\"quform-field quform-field-select quform-field-97_17 m1-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_661\"><div class=\"quform-element quform-element-select quform-element-97_22 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_22\"><label class=\"quform-label-text\" for=\"quform_97_22_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_22\"><div class=\"quform-input quform-input-select quform-input-97_22 quform-cf\"><select id=\"quform_97_22_6e1cb0\" name=\"quform_97_22\" class=\"quform-field quform-field-select quform-field-97_22 m1-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_23 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_24\"><div class=\"quform-element quform-element-select quform-element-97_30 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_30\"><label class=\"quform-label-text\" for=\"quform_97_30_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_30\"><div class=\"quform-input quform-input-select quform-input-97_30 quform-cf\"><select id=\"quform_97_30_6e1cb0\" name=\"quform_97_30\" class=\"quform-field quform-field-select quform-field-97_30 quform-field-select-enhanced m1-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_26\"><div class=\"quform-element quform-element-text quform-element-97_29 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_29\"><label class=\"quform-label-text\" for=\"quform_97_29_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_29\"><div class=\"quform-input quform-input-text quform-input-97_29 quform-cf\"><input type=\"text\" id=\"quform_97_29_6e1cb0\" name=\"quform_97_29\" class=\"quform-field quform-field-text quform-field-97_29 m1-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" maxlength=\"50\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_53 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_54\"><div class=\"quform-element quform-element-date quform-element-97_61 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_61\"><label class=\"quform-label-text\" for=\"quform_97_61_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_61\"><div class=\"quform-input quform-input-date quform-input-97_61 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_61_6e1cb0\" name=\"quform_97_61\" class=\"quform-field quform-field-date quform-field-97_61 m1-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_61&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_67 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_67\"><label class=\"quform-label-text\" for=\"quform_97_67_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_67\"><div class=\"quform-input quform-input-text quform-input-97_67 quform-cf\"><input type=\"text\" id=\"quform_97_67_6e1cb0\" name=\"quform_97_67\" class=\"quform-field quform-field-text quform-field-97_67 m1-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_56\"><\/div><div class=\"quform-element quform-element-column quform-element-97_664\"><div class=\"quform-element quform-element-html quform-element-97_70 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_73 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_73\"><label class=\"quform-label-text\" id=\"quform_97_73_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_73\"><div class=\"quform-input quform-input-radio quform-input-97_73 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_73_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_73\" id=\"quform_97_73_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_73 quform-field-97_73_1 m1-toc\" value=\"main\" checked \/><label for=\"quform_97_73_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_73_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_74 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_74\"><label class=\"quform-label-text\" id=\"quform_97_74_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_74\"><div class=\"quform-input quform-input-checkbox quform-input-97_74 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_74_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_74[]\" id=\"quform_97_74_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_74 quform-field-97_74_1 m1-addcard\" value=\"gold1\" \/><label for=\"quform_97_74_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_74_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_74[]\" id=\"quform_97_74_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_74 quform-field-97_74_2 m1-addcard\" value=\"dental1\" \/><label for=\"quform_97_74_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_74_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_74[]\" id=\"quform_97_74_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_74 quform-field-97_74_3 m1-addcard\" value=\"checkup1\" \/><label for=\"quform_97_74_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_74_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1724 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1725\"><div class=\"quform-element quform-element-html quform-element-97_1723 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m1-label\";> \u5bb6\u5c6c - 1<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1737 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m1-sname').change(function() {\n        var applicant_sname = $('.m1-sname').val();\n        var applicant_gname = $('.m1-gname').val();\n\t\tif ($('.m1-del').is(':checked')) {\n\t\t\t$('#m1-label').html(\"\u5bb6\u5c6c - 1\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel1' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m1-label').html(\"\u5bb6\u5c6c - 1\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m1-gname').change(function() {\n        var applicant_sname = $('.m1-sname').val();\n        var applicant_gname = $('.m1-gname').val();\n\t\tif ($('.m1-del').is(':checked')) {\n\t\t\t$('#m1-label').html(\"\u5bb6\u5c6c - 1\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel1' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m1-label').html(\"\u5bb6\u5c6c - 1\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m1-del').click(function() {\n        var applicant_sname = $('.m1-sname').val();\n        var applicant_gname = $('.m1-gname').val();\n\t\tif ($('.m1-del').is(':checked')) {\n    \t\t$('#m1-label').html(\"\u5bb6\u5c6c - 1\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel1' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m1-label').html(\"\u5bb6\u5c6c - 1\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1727\"><div class=\"quform-element quform-element-radio quform-element-97_1731 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1731\"><label class=\"quform-label-text\" id=\"quform_97_1731_6e1cb0_label\">Member 1 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1731\"><div class=\"quform-input quform-input-radio quform-input-97_1731 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1731_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1731\" id=\"quform_97_1731_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1731 quform-field-97_1731_1 m1-edit\" value=\"edit\" \/><label for=\"quform_97_1731_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1731_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1731\" id=\"quform_97_1731_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1731 quform-field-97_1731_2 m1-edit\" value=\"save\" checked \/><label for=\"quform_97_1731_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1731_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_670 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 2<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_1979 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1980\"><div class=\"quform-element quform-element-html quform-element-97_1981 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1982\"><div class=\"quform-element quform-element-text quform-element-97_1983 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1983\"><label class=\"quform-label-text\" for=\"quform_97_1983_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1983\"><div class=\"quform-input quform-input-text quform-input-97_1983 quform-cf\"><input type=\"text\" id=\"quform_97_1983_6e1cb0\" name=\"quform_97_1983\" class=\"quform-field quform-field-text quform-field-97_1983 m2-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1984\"><div class=\"quform-element quform-element-checkbox quform-element-97_1985 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1985\"><label class=\"quform-label-text\" id=\"quform_97_1985_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1985\"><div class=\"quform-input quform-input-checkbox quform-input-97_1985 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_1985_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1985[]\" id=\"quform_97_1985_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1985 quform-field-97_1985_1 m2-del\" value=\"Delete\" \/><label for=\"quform_97_1985_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1985_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1986\"><div class=\"quform-element quform-element-html quform-element-97_1987 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_671 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_672\"><div class=\"quform-element quform-element-text quform-element-97_673 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_673\"><label class=\"quform-label-text\" for=\"quform_97_673_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_673\"><div class=\"quform-input quform-input-text quform-input-97_673 quform-cf\"><input type=\"text\" id=\"quform_97_673_6e1cb0\" name=\"quform_97_673\" class=\"quform-field quform-field-text quform-field-97_673 m2-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_674\"><div class=\"quform-element quform-element-text quform-element-97_675 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_675\"><label class=\"quform-label-text\" for=\"quform_97_675_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_675\"><div class=\"quform-input quform-input-text quform-input-97_675 quform-cf\"><input type=\"text\" id=\"quform_97_675_6e1cb0\" name=\"quform_97_675\" class=\"quform-field quform-field-text quform-field-97_675 m2-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_676\"><div class=\"quform-element quform-element-select quform-element-97_677 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_677\"><label class=\"quform-label-text\" for=\"quform_97_677_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_677\"><div class=\"quform-input quform-input-select quform-input-97_677 quform-cf\"><select id=\"quform_97_677_6e1cb0\" name=\"quform_97_677\" class=\"quform-field quform-field-select quform-field-97_677 m2-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_678\"><div class=\"quform-element quform-element-select quform-element-97_679 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_679\"><label class=\"quform-label-text\" for=\"quform_97_679_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_679\"><div class=\"quform-input quform-input-select quform-input-97_679 quform-cf\"><select id=\"quform_97_679_6e1cb0\" name=\"quform_97_679\" class=\"quform-field quform-field-select quform-field-97_679 m2-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_680 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_681\"><div class=\"quform-element quform-element-select quform-element-97_682 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_682\"><label class=\"quform-label-text\" for=\"quform_97_682_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_682\"><div class=\"quform-input quform-input-select quform-input-97_682 quform-cf\"><select id=\"quform_97_682_6e1cb0\" name=\"quform_97_682\" class=\"quform-field quform-field-select quform-field-97_682 quform-field-select-enhanced m2-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_683\"><div class=\"quform-element quform-element-text quform-element-97_696 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_696\"><label class=\"quform-label-text\" for=\"quform_97_696_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_696\"><div class=\"quform-input quform-input-text quform-input-97_696 quform-cf\"><input type=\"text\" id=\"quform_97_696_6e1cb0\" name=\"quform_97_696\" class=\"quform-field quform-field-text quform-field-97_696 m2-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_697 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_698\"><div class=\"quform-element quform-element-date quform-element-97_699 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_699\"><label class=\"quform-label-text\" for=\"quform_97_699_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_699\"><div class=\"quform-input quform-input-date quform-input-97_699 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_699_6e1cb0\" name=\"quform_97_699\" class=\"quform-field quform-field-date quform-field-97_699 m2-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_699&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_700 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_700\"><label class=\"quform-label-text\" for=\"quform_97_700_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_700\"><div class=\"quform-input quform-input-text quform-input-97_700 quform-cf\"><input type=\"text\" id=\"quform_97_700_6e1cb0\" name=\"quform_97_700\" class=\"quform-field quform-field-text quform-field-97_700 m2-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_701\"><\/div><div class=\"quform-element quform-element-column quform-element-97_702\"><div class=\"quform-element quform-element-html quform-element-97_703 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_704 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_704\"><label class=\"quform-label-text\" id=\"quform_97_704_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_704\"><div class=\"quform-input quform-input-radio quform-input-97_704 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_704_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_704\" id=\"quform_97_704_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_704 quform-field-97_704_1 m2-toc\" value=\"main\" checked \/><label for=\"quform_97_704_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_704_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_705 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_705\"><label class=\"quform-label-text\" id=\"quform_97_705_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_705\"><div class=\"quform-input quform-input-checkbox quform-input-97_705 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_705_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_705[]\" id=\"quform_97_705_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_705 quform-field-97_705_1 m2-addcard\" value=\"gold2\" \/><label for=\"quform_97_705_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_705_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_705[]\" id=\"quform_97_705_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_705 quform-field-97_705_2 m2-addcard\" value=\"dental2\" \/><label for=\"quform_97_705_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_705_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_705[]\" id=\"quform_97_705_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_705 quform-field-97_705_3 m2-addcard\" value=\"checkup2\" \/><label for=\"quform_97_705_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_705_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1732 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1733\"><div class=\"quform-element quform-element-html quform-element-97_1734 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m2-label\";>\u5bb6\u5c6c - 2<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1738 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m2-sname').change(function() {\n        var applicant_sname = $('.m2-sname').val();\n        var applicant_gname = $('.m2-gname').val();\n\t\tif ($('.m2-del').is(':checked')) {\n\t\t\t$('#m2-label').html(\"\u5bb6\u5c6c - 2\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel2' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m2-label').html(\"\u5bb6\u5c6c - 2\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m2-gname').change(function() {\n        var applicant_sname = $('.m2-sname').val();\n        var applicant_gname = $('.m2-gname').val();\n\t\tif ($('.m2-del').is(':checked')) {\n\t\t\t$('#m2-label').html(\"\u5bb6\u5c6c - 2\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel2' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m2-label').html(\"\u5bb6\u5c6c - 2\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m2-del').click(function() {\n        var applicant_sname = $('.m2-sname').val();\n        var applicant_gname = $('.m2-gname').val();\n\t\tif ($('.m2-del').is(':checked')) {\n    \t\t$('#m2-label').html(\"\u5bb6\u5c6c - 2\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel2' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m2-label').html(\"\u5bb6\u5c6c - 2\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1735\"><div class=\"quform-element quform-element-radio quform-element-97_1736 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1736\"><label class=\"quform-label-text\" id=\"quform_97_1736_6e1cb0_label\">Member 2 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1736\"><div class=\"quform-input quform-input-radio quform-input-97_1736 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1736_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1736\" id=\"quform_97_1736_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1736 quform-field-97_1736_1 m2-edit\" value=\"edit\" \/><label for=\"quform_97_1736_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1736_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1736\" id=\"quform_97_1736_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1736 quform-field-97_1736_2 m2-edit\" value=\"save\" checked \/><label for=\"quform_97_1736_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1736_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_850 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 3<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_1992 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1993\"><div class=\"quform-element quform-element-html quform-element-97_1994 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1995\"><div class=\"quform-element quform-element-text quform-element-97_1996 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1996\"><label class=\"quform-label-text\" for=\"quform_97_1996_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1996\"><div class=\"quform-input quform-input-text quform-input-97_1996 quform-cf\"><input type=\"text\" id=\"quform_97_1996_6e1cb0\" name=\"quform_97_1996\" class=\"quform-field quform-field-text quform-field-97_1996 m3-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1997\"><div class=\"quform-element quform-element-checkbox quform-element-97_1998 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1998\"><label class=\"quform-label-text\" id=\"quform_97_1998_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1998\"><div class=\"quform-input quform-input-checkbox quform-input-97_1998 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_1998_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1998[]\" id=\"quform_97_1998_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1998 quform-field-97_1998_1 m3-del\" value=\"Delete\" \/><label for=\"quform_97_1998_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1998_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1999\"><div class=\"quform-element quform-element-html quform-element-97_2000 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_851 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_852\"><div class=\"quform-element quform-element-text quform-element-97_853 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_853\"><label class=\"quform-label-text\" for=\"quform_97_853_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_853\"><div class=\"quform-input quform-input-text quform-input-97_853 quform-cf\"><input type=\"text\" id=\"quform_97_853_6e1cb0\" name=\"quform_97_853\" class=\"quform-field quform-field-text quform-field-97_853 m3-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_854\"><div class=\"quform-element quform-element-text quform-element-97_855 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_855\"><label class=\"quform-label-text\" for=\"quform_97_855_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_855\"><div class=\"quform-input quform-input-text quform-input-97_855 quform-cf\"><input type=\"text\" id=\"quform_97_855_6e1cb0\" name=\"quform_97_855\" class=\"quform-field quform-field-text quform-field-97_855 m3-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_856\"><div class=\"quform-element quform-element-select quform-element-97_857 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_857\"><label class=\"quform-label-text\" for=\"quform_97_857_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_857\"><div class=\"quform-input quform-input-select quform-input-97_857 quform-cf\"><select id=\"quform_97_857_6e1cb0\" name=\"quform_97_857\" class=\"quform-field quform-field-select quform-field-97_857 m3-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_858\"><div class=\"quform-element quform-element-select quform-element-97_859 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_859\"><label class=\"quform-label-text\" for=\"quform_97_859_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_859\"><div class=\"quform-input quform-input-select quform-input-97_859 quform-cf\"><select id=\"quform_97_859_6e1cb0\" name=\"quform_97_859\" class=\"quform-field quform-field-select quform-field-97_859 m3-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_860 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_861\"><div class=\"quform-element quform-element-select quform-element-97_862 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_862\"><label class=\"quform-label-text\" for=\"quform_97_862_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_862\"><div class=\"quform-input quform-input-select quform-input-97_862 quform-cf\"><select id=\"quform_97_862_6e1cb0\" name=\"quform_97_862\" class=\"quform-field quform-field-select quform-field-97_862 quform-field-select-enhanced m3-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_863\"><div class=\"quform-element quform-element-text quform-element-97_876 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_876\"><label class=\"quform-label-text\" for=\"quform_97_876_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_876\"><div class=\"quform-input quform-input-text quform-input-97_876 quform-cf\"><input type=\"text\" id=\"quform_97_876_6e1cb0\" name=\"quform_97_876\" class=\"quform-field quform-field-text quform-field-97_876 m3-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_877 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_878\"><div class=\"quform-element quform-element-date quform-element-97_879 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_879\"><label class=\"quform-label-text\" for=\"quform_97_879_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_879\"><div class=\"quform-input quform-input-date quform-input-97_879 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_879_6e1cb0\" name=\"quform_97_879\" class=\"quform-field quform-field-date quform-field-97_879 m3-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_879&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_880 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_880\"><label class=\"quform-label-text\" for=\"quform_97_880_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_880\"><div class=\"quform-input quform-input-text quform-input-97_880 quform-cf\"><input type=\"text\" id=\"quform_97_880_6e1cb0\" name=\"quform_97_880\" class=\"quform-field quform-field-text quform-field-97_880 m3-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_881\"><\/div><div class=\"quform-element quform-element-column quform-element-97_882\"><div class=\"quform-element quform-element-html quform-element-97_883 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_884 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_884\"><label class=\"quform-label-text\" id=\"quform_97_884_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_884\"><div class=\"quform-input quform-input-radio quform-input-97_884 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_884_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_884\" id=\"quform_97_884_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_884 quform-field-97_884_1 m3-toc\" value=\"main\" checked \/><label for=\"quform_97_884_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_884_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_885 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_885\"><label class=\"quform-label-text\" id=\"quform_97_885_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_885\"><div class=\"quform-input quform-input-checkbox quform-input-97_885 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_885_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_885[]\" id=\"quform_97_885_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_885 quform-field-97_885_1 m3-addcard\" value=\"gold3\" \/><label for=\"quform_97_885_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_885_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_885[]\" id=\"quform_97_885_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_885 quform-field-97_885_2 m3-addcard\" value=\"dental3\" \/><label for=\"quform_97_885_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_885_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_885[]\" id=\"quform_97_885_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_885 quform-field-97_885_3 m3-addcard\" value=\"checkup3\" \/><label for=\"quform_97_885_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_885_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1739 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1740\"><div class=\"quform-element quform-element-html quform-element-97_1741 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m3-label\"; >\u5bb6\u5c6c - 3<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1742 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m3-sname').change(function() {\n        var applicant_sname = $('.m3-sname').val();\n        var applicant_gname = $('.m3-gname').val();\n\t\tif ($('.m3-del').is(':checked')) {\n\t\t\t$('#m3-label').html(\"\u5bb6\u5c6c - 3\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel3' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m3-label').html(\"\u5bb6\u5c6c - 3\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m3-gname').change(function() {\n        var applicant_sname = $('.m3-sname').val();\n        var applicant_gname = $('.m3-gname').val();\n\t\tif ($('.m3-del').is(':checked')) {\n\t\t\t$('#m3-label').html(\"\u5bb6\u5c6c - 3\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel3' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m3-label').html(\"\u5bb6\u5c6c - 3\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m3-del').click(function() {\n        var applicant_sname = $('.m3-sname').val();\n        var applicant_gname = $('.m3-gname').val();\n\t\tif ($('.m3-del').is(':checked')) {\n    \t\t$('#m3-label').html(\"\u5bb6\u5c6c - 3\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel3' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m3-label').html(\"\u5bb6\u5c6c - 3\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1743\"><div class=\"quform-element quform-element-radio quform-element-97_1744 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1744\"><label class=\"quform-label-text\" id=\"quform_97_1744_6e1cb0_label\">Member 3 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1744\"><div class=\"quform-input quform-input-radio quform-input-97_1744 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1744_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1744\" id=\"quform_97_1744_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1744 quform-field-97_1744_1 m3-edit\" value=\"edit\" \/><label for=\"quform_97_1744_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1744_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1744\" id=\"quform_97_1744_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1744 quform-field-97_1744_2 m3-edit\" value=\"save\" checked \/><label for=\"quform_97_1744_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1744_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_814 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 4<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2001 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2002\"><div class=\"quform-element quform-element-html quform-element-97_2003 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2004\"><div class=\"quform-element quform-element-text quform-element-97_2005 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2005\"><label class=\"quform-label-text\" for=\"quform_97_2005_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2005\"><div class=\"quform-input quform-input-text quform-input-97_2005 quform-cf\"><input type=\"text\" id=\"quform_97_2005_6e1cb0\" name=\"quform_97_2005\" class=\"quform-field quform-field-text quform-field-97_2005 m4-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2006\"><div class=\"quform-element quform-element-checkbox quform-element-97_2007 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2007\"><label class=\"quform-label-text\" id=\"quform_97_2007_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2007\"><div class=\"quform-input quform-input-checkbox quform-input-97_2007 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2007_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2007[]\" id=\"quform_97_2007_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2007 quform-field-97_2007_1 m4-del\" value=\"Delete\" \/><label for=\"quform_97_2007_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2007_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2008\"><div class=\"quform-element quform-element-html quform-element-97_2009 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_815 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_816\"><div class=\"quform-element quform-element-text quform-element-97_817 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_817\"><label class=\"quform-label-text\" for=\"quform_97_817_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_817\"><div class=\"quform-input quform-input-text quform-input-97_817 quform-cf\"><input type=\"text\" id=\"quform_97_817_6e1cb0\" name=\"quform_97_817\" class=\"quform-field quform-field-text quform-field-97_817 m4-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_818\"><div class=\"quform-element quform-element-text quform-element-97_819 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_819\"><label class=\"quform-label-text\" for=\"quform_97_819_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_819\"><div class=\"quform-input quform-input-text quform-input-97_819 quform-cf\"><input type=\"text\" id=\"quform_97_819_6e1cb0\" name=\"quform_97_819\" class=\"quform-field quform-field-text quform-field-97_819 m4-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_820\"><div class=\"quform-element quform-element-select quform-element-97_821 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_821\"><label class=\"quform-label-text\" for=\"quform_97_821_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_821\"><div class=\"quform-input quform-input-select quform-input-97_821 quform-cf\"><select id=\"quform_97_821_6e1cb0\" name=\"quform_97_821\" class=\"quform-field quform-field-select quform-field-97_821 m4-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_822\"><div class=\"quform-element quform-element-select quform-element-97_823 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_823\"><label class=\"quform-label-text\" for=\"quform_97_823_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_823\"><div class=\"quform-input quform-input-select quform-input-97_823 quform-cf\"><select id=\"quform_97_823_6e1cb0\" name=\"quform_97_823\" class=\"quform-field quform-field-select quform-field-97_823 m4-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_824 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_825\"><div class=\"quform-element quform-element-select quform-element-97_826 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_826\"><label class=\"quform-label-text\" for=\"quform_97_826_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_826\"><div class=\"quform-input quform-input-select quform-input-97_826 quform-cf\"><select id=\"quform_97_826_6e1cb0\" name=\"quform_97_826\" class=\"quform-field quform-field-select quform-field-97_826 quform-field-select-enhanced m4-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_827\"><div class=\"quform-element quform-element-text quform-element-97_840 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_840\"><label class=\"quform-label-text\" for=\"quform_97_840_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_840\"><div class=\"quform-input quform-input-text quform-input-97_840 quform-cf\"><input type=\"text\" id=\"quform_97_840_6e1cb0\" name=\"quform_97_840\" class=\"quform-field quform-field-text quform-field-97_840 m4-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_841 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_842\"><div class=\"quform-element quform-element-date quform-element-97_843 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_843\"><label class=\"quform-label-text\" for=\"quform_97_843_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_843\"><div class=\"quform-input quform-input-date quform-input-97_843 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_843_6e1cb0\" name=\"quform_97_843\" class=\"quform-field quform-field-date quform-field-97_843 m4-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_843&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_844 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_844\"><label class=\"quform-label-text\" for=\"quform_97_844_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_844\"><div class=\"quform-input quform-input-text quform-input-97_844 quform-cf\"><input type=\"text\" id=\"quform_97_844_6e1cb0\" name=\"quform_97_844\" class=\"quform-field quform-field-text quform-field-97_844 m4-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_845\"><\/div><div class=\"quform-element quform-element-column quform-element-97_846\"><div class=\"quform-element quform-element-html quform-element-97_847 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_848 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_848\"><label class=\"quform-label-text\" id=\"quform_97_848_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_848\"><div class=\"quform-input quform-input-radio quform-input-97_848 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_848_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_848\" id=\"quform_97_848_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_848 quform-field-97_848_1 m4-toc\" value=\"main\" checked \/><label for=\"quform_97_848_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_848_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_849 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_849\"><label class=\"quform-label-text\" id=\"quform_97_849_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_849\"><div class=\"quform-input quform-input-checkbox quform-input-97_849 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_849_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_849[]\" id=\"quform_97_849_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_849 quform-field-97_849_1 m4-addcard\" value=\"gold4\" \/><label for=\"quform_97_849_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_849_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_849[]\" id=\"quform_97_849_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_849 quform-field-97_849_2 m4-addcard\" value=\"dental4\" \/><label for=\"quform_97_849_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_849_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_849[]\" id=\"quform_97_849_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_849 quform-field-97_849_3 m4-addcard\" value=\"checkup4\" \/><label for=\"quform_97_849_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_849_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1745 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1746\"><div class=\"quform-element quform-element-html quform-element-97_1747 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m4-label\"; >\u5bb6\u5c6c - 4<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1748 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m4-sname').change(function() {\n        var applicant_sname = $('.m4-sname').val();\n        var applicant_gname = $('.m4-gname').val();\n\t\tif ($('.m4-del').is(':checked')) {\n\t\t\t$('#m4-label').html(\"\u5bb6\u5c6c - 4\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel4' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m4-label').html(\"\u5bb6\u5c6c - 4\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m4-gname').change(function() {\n        var applicant_sname = $('.m4-sname').val();\n        var applicant_gname = $('.m4-gname').val();\n\t\tif ($('.m4-del').is(':checked')) {\n\t\t\t$('#m4-label').html(\"\u5bb6\u5c6c - 4\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel4' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m4-label').html(\"\u5bb6\u5c6c - 4\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m4-del').click(function() {\n        var applicant_sname = $('.m4-sname').val();\n        var applicant_gname = $('.m4-gname').val();\n\t\tif ($('.m4-del').is(':checked')) {\n    \t\t$('#m4-label').html(\"\u5bb6\u5c6c - 4\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel4' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m4-label').html(\"\u5bb6\u5c6c - 4\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1749\"><div class=\"quform-element quform-element-radio quform-element-97_1750 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1750\"><label class=\"quform-label-text\" id=\"quform_97_1750_6e1cb0_label\">Member 4 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1750\"><div class=\"quform-input quform-input-radio quform-input-97_1750 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1750_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1750\" id=\"quform_97_1750_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1750 quform-field-97_1750_1 m4-edit\" value=\"edit\" \/><label for=\"quform_97_1750_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1750_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1750\" id=\"quform_97_1750_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1750 quform-field-97_1750_2 m4-edit\" value=\"save\" checked \/><label for=\"quform_97_1750_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1750_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_778 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 5<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2010 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2011\"><div class=\"quform-element quform-element-html quform-element-97_2012 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2013\"><div class=\"quform-element quform-element-text quform-element-97_2014 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2014\"><label class=\"quform-label-text\" for=\"quform_97_2014_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2014\"><div class=\"quform-input quform-input-text quform-input-97_2014 quform-cf\"><input type=\"text\" id=\"quform_97_2014_6e1cb0\" name=\"quform_97_2014\" class=\"quform-field quform-field-text quform-field-97_2014 m5-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2015\"><div class=\"quform-element quform-element-checkbox quform-element-97_2016 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2016\"><label class=\"quform-label-text\" id=\"quform_97_2016_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2016\"><div class=\"quform-input quform-input-checkbox quform-input-97_2016 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2016_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2016[]\" id=\"quform_97_2016_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2016 quform-field-97_2016_1 m5-del\" value=\"Delete\" \/><label for=\"quform_97_2016_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2016_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2017\"><div class=\"quform-element quform-element-html quform-element-97_2018 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_779 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_780\"><div class=\"quform-element quform-element-text quform-element-97_781 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_781\"><label class=\"quform-label-text\" for=\"quform_97_781_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_781\"><div class=\"quform-input quform-input-text quform-input-97_781 quform-cf\"><input type=\"text\" id=\"quform_97_781_6e1cb0\" name=\"quform_97_781\" class=\"quform-field quform-field-text quform-field-97_781 m5-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_782\"><div class=\"quform-element quform-element-text quform-element-97_783 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_783\"><label class=\"quform-label-text\" for=\"quform_97_783_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_783\"><div class=\"quform-input quform-input-text quform-input-97_783 quform-cf\"><input type=\"text\" id=\"quform_97_783_6e1cb0\" name=\"quform_97_783\" class=\"quform-field quform-field-text quform-field-97_783 m5-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_784\"><div class=\"quform-element quform-element-select quform-element-97_785 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_785\"><label class=\"quform-label-text\" for=\"quform_97_785_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_785\"><div class=\"quform-input quform-input-select quform-input-97_785 quform-cf\"><select id=\"quform_97_785_6e1cb0\" name=\"quform_97_785\" class=\"quform-field quform-field-select quform-field-97_785 m5-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_786\"><div class=\"quform-element quform-element-select quform-element-97_787 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_787\"><label class=\"quform-label-text\" for=\"quform_97_787_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_787\"><div class=\"quform-input quform-input-select quform-input-97_787 quform-cf\"><select id=\"quform_97_787_6e1cb0\" name=\"quform_97_787\" class=\"quform-field quform-field-select quform-field-97_787 m5-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_788 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_789\"><div class=\"quform-element quform-element-select quform-element-97_790 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_790\"><label class=\"quform-label-text\" for=\"quform_97_790_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_790\"><div class=\"quform-input quform-input-select quform-input-97_790 quform-cf\"><select id=\"quform_97_790_6e1cb0\" name=\"quform_97_790\" class=\"quform-field quform-field-select quform-field-97_790 quform-field-select-enhanced m5-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_791\"><div class=\"quform-element quform-element-text quform-element-97_804 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_804\"><label class=\"quform-label-text\" for=\"quform_97_804_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_804\"><div class=\"quform-input quform-input-text quform-input-97_804 quform-cf\"><input type=\"text\" id=\"quform_97_804_6e1cb0\" name=\"quform_97_804\" class=\"quform-field quform-field-text quform-field-97_804 m5-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_805 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_806\"><div class=\"quform-element quform-element-date quform-element-97_807 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_807\"><label class=\"quform-label-text\" for=\"quform_97_807_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_807\"><div class=\"quform-input quform-input-date quform-input-97_807 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_807_6e1cb0\" name=\"quform_97_807\" class=\"quform-field quform-field-date quform-field-97_807 m5-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_807&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_808 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_808\"><label class=\"quform-label-text\" for=\"quform_97_808_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_808\"><div class=\"quform-input quform-input-text quform-input-97_808 quform-cf\"><input type=\"text\" id=\"quform_97_808_6e1cb0\" name=\"quform_97_808\" class=\"quform-field quform-field-text quform-field-97_808 m5-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_809\"><\/div><div class=\"quform-element quform-element-column quform-element-97_810\"><div class=\"quform-element quform-element-html quform-element-97_811 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_812 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_812\"><label class=\"quform-label-text\" id=\"quform_97_812_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_812\"><div class=\"quform-input quform-input-radio quform-input-97_812 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_812_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_812\" id=\"quform_97_812_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_812 quform-field-97_812_1 m5-toc\" value=\"main\" checked \/><label for=\"quform_97_812_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_812_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_813 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_813\"><label class=\"quform-label-text\" id=\"quform_97_813_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_813\"><div class=\"quform-input quform-input-checkbox quform-input-97_813 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_813_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_813[]\" id=\"quform_97_813_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_813 quform-field-97_813_1 m5-addcard\" value=\"gold5\" \/><label for=\"quform_97_813_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_813_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_813[]\" id=\"quform_97_813_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_813 quform-field-97_813_2 m5-addcard\" value=\"dental5\" \/><label for=\"quform_97_813_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_813_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_813[]\" id=\"quform_97_813_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_813 quform-field-97_813_3 m5-addcard\" value=\"checkup5\" \/><label for=\"quform_97_813_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_813_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1751 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1752\"><div class=\"quform-element quform-element-html quform-element-97_1753 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m5-label\"; >\u5bb6\u5c6c - 5<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1754 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m5-sname').change(function() {\n        var applicant_sname = $('.m5-sname').val();\n        var applicant_gname = $('.m5-gname').val();\n\t\tif ($('.m5-del').is(':checked')) {\n\t\t\t$('#m5-label').html(\"\u5bb6\u5c6c - 5\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel5' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m5-label').html(\"\u5bb6\u5c6c - 5\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m5-gname').change(function() {\n        var applicant_sname = $('.m5-sname').val();\n        var applicant_gname = $('.m5-gname').val();\n\t\tif ($('.m5-del').is(':checked')) {\n\t\t\t$('#m5-label').html(\"\u5bb6\u5c6c - 5\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel5' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m5-label').html(\"\u5bb6\u5c6c - 5\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m5-del').click(function() {\n        var applicant_sname = $('.m5-sname').val();\n        var applicant_gname = $('.m5-gname').val();\n\t\tif ($('.m5-del').is(':checked')) {\n    \t\t$('#m5-label').html(\"\u5bb6\u5c6c - 5\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel5' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m5-label').html(\"\u5bb6\u5c6c - 5\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1755\"><div class=\"quform-element quform-element-radio quform-element-97_1756 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1756\"><label class=\"quform-label-text\" id=\"quform_97_1756_6e1cb0_label\">Member 5 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1756\"><div class=\"quform-input quform-input-radio quform-input-97_1756 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1756_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1756\" id=\"quform_97_1756_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1756 quform-field-97_1756_1 m5-edit\" value=\"edit\" \/><label for=\"quform_97_1756_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1756_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1756\" id=\"quform_97_1756_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1756 quform-field-97_1756_2 m5-edit\" value=\"save\" checked \/><label for=\"quform_97_1756_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1756_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_742 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 6<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2019 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2020\"><div class=\"quform-element quform-element-html quform-element-97_2021 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2022\"><div class=\"quform-element quform-element-text quform-element-97_2023 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2023\"><label class=\"quform-label-text\" for=\"quform_97_2023_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2023\"><div class=\"quform-input quform-input-text quform-input-97_2023 quform-cf\"><input type=\"text\" id=\"quform_97_2023_6e1cb0\" name=\"quform_97_2023\" class=\"quform-field quform-field-text quform-field-97_2023 m6-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2024\"><div class=\"quform-element quform-element-checkbox quform-element-97_2025 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2025\"><label class=\"quform-label-text\" id=\"quform_97_2025_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2025\"><div class=\"quform-input quform-input-checkbox quform-input-97_2025 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2025_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2025[]\" id=\"quform_97_2025_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2025 quform-field-97_2025_1 m6-del\" value=\"Delete\" \/><label for=\"quform_97_2025_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2025_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2026\"><div class=\"quform-element quform-element-html quform-element-97_2027 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_743 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_744\"><div class=\"quform-element quform-element-text quform-element-97_745 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_745\"><label class=\"quform-label-text\" for=\"quform_97_745_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_745\"><div class=\"quform-input quform-input-text quform-input-97_745 quform-cf\"><input type=\"text\" id=\"quform_97_745_6e1cb0\" name=\"quform_97_745\" class=\"quform-field quform-field-text quform-field-97_745 m6-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_746\"><div class=\"quform-element quform-element-text quform-element-97_747 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_747\"><label class=\"quform-label-text\" for=\"quform_97_747_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_747\"><div class=\"quform-input quform-input-text quform-input-97_747 quform-cf\"><input type=\"text\" id=\"quform_97_747_6e1cb0\" name=\"quform_97_747\" class=\"quform-field quform-field-text quform-field-97_747 m6-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_748\"><div class=\"quform-element quform-element-select quform-element-97_749 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_749\"><label class=\"quform-label-text\" for=\"quform_97_749_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_749\"><div class=\"quform-input quform-input-select quform-input-97_749 quform-cf\"><select id=\"quform_97_749_6e1cb0\" name=\"quform_97_749\" class=\"quform-field quform-field-select quform-field-97_749 m6-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_750\"><div class=\"quform-element quform-element-select quform-element-97_751 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_751\"><label class=\"quform-label-text\" for=\"quform_97_751_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_751\"><div class=\"quform-input quform-input-select quform-input-97_751 quform-cf\"><select id=\"quform_97_751_6e1cb0\" name=\"quform_97_751\" class=\"quform-field quform-field-select quform-field-97_751 m6-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_752 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_753\"><div class=\"quform-element quform-element-select quform-element-97_754 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_754\"><label class=\"quform-label-text\" for=\"quform_97_754_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_754\"><div class=\"quform-input quform-input-select quform-input-97_754 quform-cf\"><select id=\"quform_97_754_6e1cb0\" name=\"quform_97_754\" class=\"quform-field quform-field-select quform-field-97_754 quform-field-select-enhanced m6-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_755\"><div class=\"quform-element quform-element-text quform-element-97_768 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_768\"><label class=\"quform-label-text\" for=\"quform_97_768_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_768\"><div class=\"quform-input quform-input-text quform-input-97_768 quform-cf\"><input type=\"text\" id=\"quform_97_768_6e1cb0\" name=\"quform_97_768\" class=\"quform-field quform-field-text quform-field-97_768 m6-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_769 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_770\"><div class=\"quform-element quform-element-date quform-element-97_771 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_771\"><label class=\"quform-label-text\" for=\"quform_97_771_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_771\"><div class=\"quform-input quform-input-date quform-input-97_771 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_771_6e1cb0\" name=\"quform_97_771\" class=\"quform-field quform-field-date quform-field-97_771 m6-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_771&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_772 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_772\"><label class=\"quform-label-text\" for=\"quform_97_772_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_772\"><div class=\"quform-input quform-input-text quform-input-97_772 quform-cf\"><input type=\"text\" id=\"quform_97_772_6e1cb0\" name=\"quform_97_772\" class=\"quform-field quform-field-text quform-field-97_772 m6-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_773\"><\/div><div class=\"quform-element quform-element-column quform-element-97_774\"><div class=\"quform-element quform-element-html quform-element-97_775 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_776 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_776\"><label class=\"quform-label-text\" id=\"quform_97_776_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_776\"><div class=\"quform-input quform-input-radio quform-input-97_776 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_776_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_776\" id=\"quform_97_776_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_776 quform-field-97_776_1 m6-toc\" value=\"main\" checked \/><label for=\"quform_97_776_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_776_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_777 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_777\"><label class=\"quform-label-text\" id=\"quform_97_777_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_777\"><div class=\"quform-input quform-input-checkbox quform-input-97_777 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_777_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_777[]\" id=\"quform_97_777_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_777 quform-field-97_777_1 m6-addcard\" value=\"gold6\" \/><label for=\"quform_97_777_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_777_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_777[]\" id=\"quform_97_777_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_777 quform-field-97_777_2 m6-addcard\" value=\"dental6\" \/><label for=\"quform_97_777_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_777_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_777[]\" id=\"quform_97_777_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_777 quform-field-97_777_3 m6-addcard\" value=\"checkup6\" \/><label for=\"quform_97_777_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_777_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1757 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1758\"><div class=\"quform-element quform-element-html quform-element-97_1759 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m6-label\"; >\u5bb6\u5c6c - 6<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1760 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m6-sname').change(function() {\n        var applicant_sname = $('.m6-sname').val();\n        var applicant_gname = $('.m6-gname').val();\n\t\tif ($('.m6-del').is(':checked')) {\n\t\t\t$('#m6-label').html(\"\u5bb6\u5c6c - 6\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel6' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m6-label').html(\"\u5bb6\u5c6c - 6\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m6-gname').change(function() {\n        var applicant_sname = $('.m6-sname').val();\n        var applicant_gname = $('.m6-gname').val();\n\t\tif ($('.m6-del').is(':checked')) {\n\t\t\t$('#m6-label').html(\"\u5bb6\u5c6c - 6\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel6' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m6-label').html(\"\u5bb6\u5c6c - 6\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m6-del').click(function() {\n        var applicant_sname = $('.m6-sname').val();\n        var applicant_gname = $('.m6-gname').val();\n\t\tif ($('.m6-del').is(':checked')) {\n    \t\t$('#m6-label').html(\"\u5bb6\u5c6c - 6\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel6' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m6-label').html(\"\u5bb6\u5c6c - 6\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1761\"><div class=\"quform-element quform-element-radio quform-element-97_1762 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1762\"><label class=\"quform-label-text\" id=\"quform_97_1762_6e1cb0_label\">Member 6 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1762\"><div class=\"quform-input quform-input-radio quform-input-97_1762 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1762_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1762\" id=\"quform_97_1762_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1762 quform-field-97_1762_1 m6-edit\" value=\"edit\" \/><label for=\"quform_97_1762_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1762_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1762\" id=\"quform_97_1762_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1762 quform-field-97_1762_2 m6-edit\" value=\"save\" checked \/><label for=\"quform_97_1762_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1762_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_706 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 7<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2028 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2029\"><div class=\"quform-element quform-element-html quform-element-97_2030 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2031\"><div class=\"quform-element quform-element-text quform-element-97_2032 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2032\"><label class=\"quform-label-text\" for=\"quform_97_2032_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2032\"><div class=\"quform-input quform-input-text quform-input-97_2032 quform-cf\"><input type=\"text\" id=\"quform_97_2032_6e1cb0\" name=\"quform_97_2032\" class=\"quform-field quform-field-text quform-field-97_2032 m7-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2033\"><div class=\"quform-element quform-element-checkbox quform-element-97_2034 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2034\"><label class=\"quform-label-text\" id=\"quform_97_2034_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2034\"><div class=\"quform-input quform-input-checkbox quform-input-97_2034 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2034_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2034[]\" id=\"quform_97_2034_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2034 quform-field-97_2034_1 m7-del\" value=\"Delete\" \/><label for=\"quform_97_2034_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2034_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2035\"><div class=\"quform-element quform-element-html quform-element-97_2036 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_707 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_708\"><div class=\"quform-element quform-element-text quform-element-97_709 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_709\"><label class=\"quform-label-text\" for=\"quform_97_709_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_709\"><div class=\"quform-input quform-input-text quform-input-97_709 quform-cf\"><input type=\"text\" id=\"quform_97_709_6e1cb0\" name=\"quform_97_709\" class=\"quform-field quform-field-text quform-field-97_709 m7-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_710\"><div class=\"quform-element quform-element-text quform-element-97_711 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_711\"><label class=\"quform-label-text\" for=\"quform_97_711_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_711\"><div class=\"quform-input quform-input-text quform-input-97_711 quform-cf\"><input type=\"text\" id=\"quform_97_711_6e1cb0\" name=\"quform_97_711\" class=\"quform-field quform-field-text quform-field-97_711 m7-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_712\"><div class=\"quform-element quform-element-select quform-element-97_713 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_713\"><label class=\"quform-label-text\" for=\"quform_97_713_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_713\"><div class=\"quform-input quform-input-select quform-input-97_713 quform-cf\"><select id=\"quform_97_713_6e1cb0\" name=\"quform_97_713\" class=\"quform-field quform-field-select quform-field-97_713 m7-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_714\"><div class=\"quform-element quform-element-select quform-element-97_715 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_715\"><label class=\"quform-label-text\" for=\"quform_97_715_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_715\"><div class=\"quform-input quform-input-select quform-input-97_715 quform-cf\"><select id=\"quform_97_715_6e1cb0\" name=\"quform_97_715\" class=\"quform-field quform-field-select quform-field-97_715 m7-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_716 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_717\"><div class=\"quform-element quform-element-select quform-element-97_718 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_718\"><label class=\"quform-label-text\" for=\"quform_97_718_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_718\"><div class=\"quform-input quform-input-select quform-input-97_718 quform-cf\"><select id=\"quform_97_718_6e1cb0\" name=\"quform_97_718\" class=\"quform-field quform-field-select quform-field-97_718 quform-field-select-enhanced m7-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_719\"><div class=\"quform-element quform-element-text quform-element-97_732 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_732\"><label class=\"quform-label-text\" for=\"quform_97_732_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_732\"><div class=\"quform-input quform-input-text quform-input-97_732 quform-cf\"><input type=\"text\" id=\"quform_97_732_6e1cb0\" name=\"quform_97_732\" class=\"quform-field quform-field-text quform-field-97_732 m7-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_733 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_734\"><div class=\"quform-element quform-element-date quform-element-97_735 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_735\"><label class=\"quform-label-text\" for=\"quform_97_735_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_735\"><div class=\"quform-input quform-input-date quform-input-97_735 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_735_6e1cb0\" name=\"quform_97_735\" class=\"quform-field quform-field-date quform-field-97_735 m7-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_735&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_736 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_736\"><label class=\"quform-label-text\" for=\"quform_97_736_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_736\"><div class=\"quform-input quform-input-text quform-input-97_736 quform-cf\"><input type=\"text\" id=\"quform_97_736_6e1cb0\" name=\"quform_97_736\" class=\"quform-field quform-field-text quform-field-97_736 m7-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_737\"><\/div><div class=\"quform-element quform-element-column quform-element-97_738\"><div class=\"quform-element quform-element-html quform-element-97_739 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_740 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_740\"><label class=\"quform-label-text\" id=\"quform_97_740_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_740\"><div class=\"quform-input quform-input-radio quform-input-97_740 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_740_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_740\" id=\"quform_97_740_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_740 quform-field-97_740_1 m7-toc\" value=\"main\" checked \/><label for=\"quform_97_740_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_740_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_741 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_741\"><label class=\"quform-label-text\" id=\"quform_97_741_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_741\"><div class=\"quform-input quform-input-checkbox quform-input-97_741 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_741_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_741[]\" id=\"quform_97_741_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_741 quform-field-97_741_1 m7-addcard\" value=\"gold7\" \/><label for=\"quform_97_741_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_741_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_741[]\" id=\"quform_97_741_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_741 quform-field-97_741_2 m7-addcard\" value=\"dental7\" \/><label for=\"quform_97_741_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_741_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_741[]\" id=\"quform_97_741_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_741 quform-field-97_741_3 m7-addcard\" value=\"checkup7\" \/><label for=\"quform_97_741_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_741_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1763 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1764\"><div class=\"quform-element quform-element-html quform-element-97_1765 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m7-label\"; >\u5bb6\u5c6c - 7<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1766 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m7-sname').change(function() {\n        var applicant_sname = $('.m7-sname').val();\n        var applicant_gname = $('.m7-gname').val();\n\t\tif ($('.m7-del').is(':checked')) {\n\t\t\t$('#m7-label').html(\"\u5bb6\u5c6c - 7\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel7' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m7-label').html(\"\u5bb6\u5c6c - 7\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m7-gname').change(function() {\n        var applicant_sname = $('.m7-sname').val();\n        var applicant_gname = $('.m7-gname').val();\n\t\tif ($('.m7-del').is(':checked')) {\n\t\t\t$('#m7-label').html(\"\u5bb6\u5c6c - 7\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel7' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m7-label').html(\"\u5bb6\u5c6c - 7\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m7-del').click(function() {\n        var applicant_sname = $('.m7-sname').val();\n        var applicant_gname = $('.m7-gname').val();\n\t\tif ($('.m7-del').is(':checked')) {\n    \t\t$('#m7-label').html(\"\u5bb6\u5c6c - 7\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel7' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m7-label').html(\"\u5bb6\u5c6c - 7\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1767\"><div class=\"quform-element quform-element-radio quform-element-97_1768 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1768\"><label class=\"quform-label-text\" id=\"quform_97_1768_6e1cb0_label\">Member 7 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1768\"><div class=\"quform-input quform-input-radio quform-input-97_1768 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1768_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1768\" id=\"quform_97_1768_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1768 quform-field-97_1768_1 m7-edit\" value=\"edit\" \/><label for=\"quform_97_1768_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1768_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1768\" id=\"quform_97_1768_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1768 quform-field-97_1768_2 m7-edit\" value=\"save\" checked \/><label for=\"quform_97_1768_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1768_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_958 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 8<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2037 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2038\"><div class=\"quform-element quform-element-html quform-element-97_2039 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2040\"><div class=\"quform-element quform-element-text quform-element-97_2041 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2041\"><label class=\"quform-label-text\" for=\"quform_97_2041_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2041\"><div class=\"quform-input quform-input-text quform-input-97_2041 quform-cf\"><input type=\"text\" id=\"quform_97_2041_6e1cb0\" name=\"quform_97_2041\" class=\"quform-field quform-field-text quform-field-97_2041 m8-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2042\"><div class=\"quform-element quform-element-checkbox quform-element-97_2043 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2043\"><label class=\"quform-label-text\" id=\"quform_97_2043_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2043\"><div class=\"quform-input quform-input-checkbox quform-input-97_2043 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2043_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2043[]\" id=\"quform_97_2043_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2043 quform-field-97_2043_1 m8-del\" value=\"Delete\" \/><label for=\"quform_97_2043_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2043_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2044\"><div class=\"quform-element quform-element-html quform-element-97_2045 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_959 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_960\"><div class=\"quform-element quform-element-text quform-element-97_961 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_961\"><label class=\"quform-label-text\" for=\"quform_97_961_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_961\"><div class=\"quform-input quform-input-text quform-input-97_961 quform-cf\"><input type=\"text\" id=\"quform_97_961_6e1cb0\" name=\"quform_97_961\" class=\"quform-field quform-field-text quform-field-97_961 m8-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_962\"><div class=\"quform-element quform-element-text quform-element-97_963 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_963\"><label class=\"quform-label-text\" for=\"quform_97_963_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_963\"><div class=\"quform-input quform-input-text quform-input-97_963 quform-cf\"><input type=\"text\" id=\"quform_97_963_6e1cb0\" name=\"quform_97_963\" class=\"quform-field quform-field-text quform-field-97_963 m8-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_964\"><div class=\"quform-element quform-element-select quform-element-97_965 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_965\"><label class=\"quform-label-text\" for=\"quform_97_965_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_965\"><div class=\"quform-input quform-input-select quform-input-97_965 quform-cf\"><select id=\"quform_97_965_6e1cb0\" name=\"quform_97_965\" class=\"quform-field quform-field-select quform-field-97_965 m8-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_966\"><div class=\"quform-element quform-element-select quform-element-97_967 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_967\"><label class=\"quform-label-text\" for=\"quform_97_967_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_967\"><div class=\"quform-input quform-input-select quform-input-97_967 quform-cf\"><select id=\"quform_97_967_6e1cb0\" name=\"quform_97_967\" class=\"quform-field quform-field-select quform-field-97_967 m8-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_968 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_969\"><div class=\"quform-element quform-element-select quform-element-97_970 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_970\"><label class=\"quform-label-text\" for=\"quform_97_970_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_970\"><div class=\"quform-input quform-input-select quform-input-97_970 quform-cf\"><select id=\"quform_97_970_6e1cb0\" name=\"quform_97_970\" class=\"quform-field quform-field-select quform-field-97_970 quform-field-select-enhanced m8-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_971\"><div class=\"quform-element quform-element-text quform-element-97_984 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_984\"><label class=\"quform-label-text\" for=\"quform_97_984_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_984\"><div class=\"quform-input quform-input-text quform-input-97_984 quform-cf\"><input type=\"text\" id=\"quform_97_984_6e1cb0\" name=\"quform_97_984\" class=\"quform-field quform-field-text quform-field-97_984 m8-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_985 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_986\"><div class=\"quform-element quform-element-date quform-element-97_987 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_987\"><label class=\"quform-label-text\" for=\"quform_97_987_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_987\"><div class=\"quform-input quform-input-date quform-input-97_987 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_987_6e1cb0\" name=\"quform_97_987\" class=\"quform-field quform-field-date quform-field-97_987 m8-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_987&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_988 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_988\"><label class=\"quform-label-text\" for=\"quform_97_988_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_988\"><div class=\"quform-input quform-input-text quform-input-97_988 quform-cf\"><input type=\"text\" id=\"quform_97_988_6e1cb0\" name=\"quform_97_988\" class=\"quform-field quform-field-text quform-field-97_988 m8-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_989\"><\/div><div class=\"quform-element quform-element-column quform-element-97_990\"><div class=\"quform-element quform-element-html quform-element-97_991 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_992 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_992\"><label class=\"quform-label-text\" id=\"quform_97_992_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_992\"><div class=\"quform-input quform-input-radio quform-input-97_992 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_992_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_992\" id=\"quform_97_992_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_992 quform-field-97_992_1 m8-toc\" value=\"main\" checked \/><label for=\"quform_97_992_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_992_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_993 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_993\"><label class=\"quform-label-text\" id=\"quform_97_993_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_993\"><div class=\"quform-input quform-input-checkbox quform-input-97_993 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_993_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_993[]\" id=\"quform_97_993_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_993 quform-field-97_993_1 m8-addcard\" value=\"gold8\" \/><label for=\"quform_97_993_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_993_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_993[]\" id=\"quform_97_993_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_993 quform-field-97_993_2 m8-addcard\" value=\"dental8\" \/><label for=\"quform_97_993_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_993_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_993[]\" id=\"quform_97_993_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_993 quform-field-97_993_3 m8-addcard\" value=\"checkup8\" \/><label for=\"quform_97_993_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_993_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1769 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1770\"><div class=\"quform-element quform-element-html quform-element-97_1771 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m8-label\"; >\u5bb6\u5c6c - 8<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1772 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m8-sname').change(function() {\n        var applicant_sname = $('.m8-sname').val();\n        var applicant_gname = $('.m8-gname').val();\n\t\tif ($('.m8-del').is(':checked')) {\n\t\t\t$('#m8-label').html(\"\u5bb6\u5c6c - 8\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel8' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m8-label').html(\"\u5bb6\u5c6c - 8\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m8-gname').change(function() {\n        var applicant_sname = $('.m8-sname').val();\n        var applicant_gname = $('.m8-gname').val();\n\t\tif ($('.m8-del').is(':checked')) {\n\t\t\t$('#m8-label').html(\"\u5bb6\u5c6c - 8\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel8' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m8-label').html(\"\u5bb6\u5c6c - 8\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m8-del').click(function() {\n        var applicant_sname = $('.m8-sname').val();\n        var applicant_gname = $('.m8-gname').val();\n\t\tif ($('.m8-del').is(':checked')) {\n    \t\t$('#m8-label').html(\"\u5bb6\u5c6c - 8\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel8' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m8-label').html(\"\u5bb6\u5c6c - 8\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1773\"><div class=\"quform-element quform-element-radio quform-element-97_1774 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1774\"><label class=\"quform-label-text\" id=\"quform_97_1774_6e1cb0_label\">Member 8 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1774\"><div class=\"quform-input quform-input-radio quform-input-97_1774 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1774_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1774\" id=\"quform_97_1774_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1774 quform-field-97_1774_1 m8-edit\" value=\"edit\" \/><label for=\"quform_97_1774_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1774_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1774\" id=\"quform_97_1774_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1774 quform-field-97_1774_2 m8-edit\" value=\"save\" checked \/><label for=\"quform_97_1774_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1774_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_922 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 9<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2046 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2047\"><div class=\"quform-element quform-element-html quform-element-97_2048 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2049\"><div class=\"quform-element quform-element-text quform-element-97_2050 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2050\"><label class=\"quform-label-text\" for=\"quform_97_2050_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2050\"><div class=\"quform-input quform-input-text quform-input-97_2050 quform-cf\"><input type=\"text\" id=\"quform_97_2050_6e1cb0\" name=\"quform_97_2050\" class=\"quform-field quform-field-text quform-field-97_2050 m9-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2051\"><div class=\"quform-element quform-element-checkbox quform-element-97_2052 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2052\"><label class=\"quform-label-text\" id=\"quform_97_2052_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2052\"><div class=\"quform-input quform-input-checkbox quform-input-97_2052 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2052_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2052[]\" id=\"quform_97_2052_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2052 quform-field-97_2052_1 m9-del\" value=\"Delete\" \/><label for=\"quform_97_2052_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2052_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2053\"><div class=\"quform-element quform-element-html quform-element-97_2054 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_923 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_924\"><div class=\"quform-element quform-element-text quform-element-97_925 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_925\"><label class=\"quform-label-text\" for=\"quform_97_925_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_925\"><div class=\"quform-input quform-input-text quform-input-97_925 quform-cf\"><input type=\"text\" id=\"quform_97_925_6e1cb0\" name=\"quform_97_925\" class=\"quform-field quform-field-text quform-field-97_925 m9-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_926\"><div class=\"quform-element quform-element-text quform-element-97_927 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_927\"><label class=\"quform-label-text\" for=\"quform_97_927_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_927\"><div class=\"quform-input quform-input-text quform-input-97_927 quform-cf\"><input type=\"text\" id=\"quform_97_927_6e1cb0\" name=\"quform_97_927\" class=\"quform-field quform-field-text quform-field-97_927 m9-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_928\"><div class=\"quform-element quform-element-select quform-element-97_929 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_929\"><label class=\"quform-label-text\" for=\"quform_97_929_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_929\"><div class=\"quform-input quform-input-select quform-input-97_929 quform-cf\"><select id=\"quform_97_929_6e1cb0\" name=\"quform_97_929\" class=\"quform-field quform-field-select quform-field-97_929 m9-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_930\"><div class=\"quform-element quform-element-select quform-element-97_931 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_931\"><label class=\"quform-label-text\" for=\"quform_97_931_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_931\"><div class=\"quform-input quform-input-select quform-input-97_931 quform-cf\"><select id=\"quform_97_931_6e1cb0\" name=\"quform_97_931\" class=\"quform-field quform-field-select quform-field-97_931 m9-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_932 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_933\"><div class=\"quform-element quform-element-select quform-element-97_934 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_934\"><label class=\"quform-label-text\" for=\"quform_97_934_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_934\"><div class=\"quform-input quform-input-select quform-input-97_934 quform-cf\"><select id=\"quform_97_934_6e1cb0\" name=\"quform_97_934\" class=\"quform-field quform-field-select quform-field-97_934 quform-field-select-enhanced m9-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_935\"><div class=\"quform-element quform-element-text quform-element-97_948 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_948\"><label class=\"quform-label-text\" for=\"quform_97_948_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_948\"><div class=\"quform-input quform-input-text quform-input-97_948 quform-cf\"><input type=\"text\" id=\"quform_97_948_6e1cb0\" name=\"quform_97_948\" class=\"quform-field quform-field-text quform-field-97_948 m9-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_949 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_950\"><div class=\"quform-element quform-element-date quform-element-97_951 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_951\"><label class=\"quform-label-text\" for=\"quform_97_951_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_951\"><div class=\"quform-input quform-input-date quform-input-97_951 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_951_6e1cb0\" name=\"quform_97_951\" class=\"quform-field quform-field-date quform-field-97_951 m9-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_951&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_952 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_952\"><label class=\"quform-label-text\" for=\"quform_97_952_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_952\"><div class=\"quform-input quform-input-text quform-input-97_952 quform-cf\"><input type=\"text\" id=\"quform_97_952_6e1cb0\" name=\"quform_97_952\" class=\"quform-field quform-field-text quform-field-97_952 m9-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_953\"><\/div><div class=\"quform-element quform-element-column quform-element-97_954\"><div class=\"quform-element quform-element-html quform-element-97_955 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_956 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_956\"><label class=\"quform-label-text\" id=\"quform_97_956_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_956\"><div class=\"quform-input quform-input-radio quform-input-97_956 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_956_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_956\" id=\"quform_97_956_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_956 quform-field-97_956_1 m9-toc\" value=\"main\" checked \/><label for=\"quform_97_956_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_956_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_957 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_957\"><label class=\"quform-label-text\" id=\"quform_97_957_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_957\"><div class=\"quform-input quform-input-checkbox quform-input-97_957 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_957_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_957[]\" id=\"quform_97_957_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_957 quform-field-97_957_1 m9-addcard\" value=\"gold9\" \/><label for=\"quform_97_957_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_957_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_957[]\" id=\"quform_97_957_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_957 quform-field-97_957_2 m9-addcard\" value=\"dental9\" \/><label for=\"quform_97_957_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_957_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_957[]\" id=\"quform_97_957_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_957 quform-field-97_957_3 m9-addcard\" value=\"checkup9\" \/><label for=\"quform_97_957_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_957_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1775 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1776\"><div class=\"quform-element quform-element-html quform-element-97_1777 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m9-label\"; >\u5bb6\u5c6c - 9<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1778 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m9-sname').change(function() {\n        var applicant_sname = $('.m9-sname').val();\n        var applicant_gname = $('.m9-gname').val();\n\t\tif ($('.m9-del').is(':checked')) {\n\t\t\t$('#m9-label').html(\"\u5bb6\u5c6c - 9\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel9' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m9-label').html(\"\u5bb6\u5c6c - 9\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m9-gname').change(function() {\n        var applicant_sname = $('.m9-sname').val();\n        var applicant_gname = $('.m9-gname').val();\n\t\tif ($('.m9-del').is(':checked')) {\n\t\t\t$('#m9-label').html(\"\u5bb6\u5c6c - 9\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel9' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m9-label').html(\"\u5bb6\u5c6c - 9\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m9-del').click(function() {\n        var applicant_sname = $('.m9-sname').val();\n        var applicant_gname = $('.m9-gname').val();\n\t\tif ($('.m9-del').is(':checked')) {\n    \t\t$('#m9-label').html(\"\u5bb6\u5c6c - 9\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel9' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m9-label').html(\"\u5bb6\u5c6c - 9\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1779\"><div class=\"quform-element quform-element-radio quform-element-97_1780 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1780\"><label class=\"quform-label-text\" id=\"quform_97_1780_6e1cb0_label\">Member 9 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1780\"><div class=\"quform-input quform-input-radio quform-input-97_1780 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1780_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1780\" id=\"quform_97_1780_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1780 quform-field-97_1780_1 m9-edit\" value=\"edit\" \/><label for=\"quform_97_1780_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1780_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1780\" id=\"quform_97_1780_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1780 quform-field-97_1780_2 m9-edit\" value=\"save\" checked \/><label for=\"quform_97_1780_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1780_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1318 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 10<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2055 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2056\"><div class=\"quform-element quform-element-html quform-element-97_2057 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2058\"><div class=\"quform-element quform-element-text quform-element-97_2059 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2059\"><label class=\"quform-label-text\" for=\"quform_97_2059_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2059\"><div class=\"quform-input quform-input-text quform-input-97_2059 quform-cf\"><input type=\"text\" id=\"quform_97_2059_6e1cb0\" name=\"quform_97_2059\" class=\"quform-field quform-field-text quform-field-97_2059 m10-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2060\"><div class=\"quform-element quform-element-checkbox quform-element-97_2061 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2061\"><label class=\"quform-label-text\" id=\"quform_97_2061_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2061\"><div class=\"quform-input quform-input-checkbox quform-input-97_2061 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2061_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2061[]\" id=\"quform_97_2061_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2061 quform-field-97_2061_1 m10-del\" value=\"Delete\" \/><label for=\"quform_97_2061_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2061_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2062\"><div class=\"quform-element quform-element-html quform-element-97_2063 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1319 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1320\"><div class=\"quform-element quform-element-text quform-element-97_1321 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1321\"><label class=\"quform-label-text\" for=\"quform_97_1321_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1321\"><div class=\"quform-input quform-input-text quform-input-97_1321 quform-cf\"><input type=\"text\" id=\"quform_97_1321_6e1cb0\" name=\"quform_97_1321\" class=\"quform-field quform-field-text quform-field-97_1321 m10-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1322\"><div class=\"quform-element quform-element-text quform-element-97_1323 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1323\"><label class=\"quform-label-text\" for=\"quform_97_1323_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1323\"><div class=\"quform-input quform-input-text quform-input-97_1323 quform-cf\"><input type=\"text\" id=\"quform_97_1323_6e1cb0\" name=\"quform_97_1323\" class=\"quform-field quform-field-text quform-field-97_1323 m10-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1324\"><div class=\"quform-element quform-element-select quform-element-97_1325 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1325\"><label class=\"quform-label-text\" for=\"quform_97_1325_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1325\"><div class=\"quform-input quform-input-select quform-input-97_1325 quform-cf\"><select id=\"quform_97_1325_6e1cb0\" name=\"quform_97_1325\" class=\"quform-field quform-field-select quform-field-97_1325 m10-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1326\"><div class=\"quform-element quform-element-select quform-element-97_1327 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1327\"><label class=\"quform-label-text\" for=\"quform_97_1327_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1327\"><div class=\"quform-input quform-input-select quform-input-97_1327 quform-cf\"><select id=\"quform_97_1327_6e1cb0\" name=\"quform_97_1327\" class=\"quform-field quform-field-select quform-field-97_1327 m10-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1328 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1329\"><div class=\"quform-element quform-element-select quform-element-97_1330 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1330\"><label class=\"quform-label-text\" for=\"quform_97_1330_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1330\"><div class=\"quform-input quform-input-select quform-input-97_1330 quform-cf\"><select id=\"quform_97_1330_6e1cb0\" name=\"quform_97_1330\" class=\"quform-field quform-field-select quform-field-97_1330 quform-field-select-enhanced m10-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1331\"><div class=\"quform-element quform-element-text quform-element-97_1344 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1344\"><label class=\"quform-label-text\" for=\"quform_97_1344_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1344\"><div class=\"quform-input quform-input-text quform-input-97_1344 quform-cf\"><input type=\"text\" id=\"quform_97_1344_6e1cb0\" name=\"quform_97_1344\" class=\"quform-field quform-field-text quform-field-97_1344 m10-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1345 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1346\"><div class=\"quform-element quform-element-date quform-element-97_1347 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1347\"><label class=\"quform-label-text\" for=\"quform_97_1347_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1347\"><div class=\"quform-input quform-input-date quform-input-97_1347 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1347_6e1cb0\" name=\"quform_97_1347\" class=\"quform-field quform-field-date quform-field-97_1347 m10-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1347&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1348 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1348\"><label class=\"quform-label-text\" for=\"quform_97_1348_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1348\"><div class=\"quform-input quform-input-text quform-input-97_1348 quform-cf\"><input type=\"text\" id=\"quform_97_1348_6e1cb0\" name=\"quform_97_1348\" class=\"quform-field quform-field-text quform-field-97_1348 m10-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1349\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1350\"><div class=\"quform-element quform-element-html quform-element-97_1351 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1352 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1352\"><label class=\"quform-label-text\" id=\"quform_97_1352_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1352\"><div class=\"quform-input quform-input-radio quform-input-97_1352 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1352_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1352\" id=\"quform_97_1352_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1352 quform-field-97_1352_1 m10-toc\" value=\"main\" checked \/><label for=\"quform_97_1352_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1352_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1353 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1353\"><label class=\"quform-label-text\" id=\"quform_97_1353_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1353\"><div class=\"quform-input quform-input-checkbox quform-input-97_1353 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1353_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1353[]\" id=\"quform_97_1353_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1353 quform-field-97_1353_1 m10-addcard\" value=\"gold10\" \/><label for=\"quform_97_1353_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1353_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1353[]\" id=\"quform_97_1353_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1353 quform-field-97_1353_2 m10-addcard\" value=\"dental10\" \/><label for=\"quform_97_1353_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1353_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1353[]\" id=\"quform_97_1353_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1353 quform-field-97_1353_3 m10-addcard\" value=\"checkup10\" \/><label for=\"quform_97_1353_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1353_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1781 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1782\"><div class=\"quform-element quform-element-html quform-element-97_1783 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m10-label\"; >\u5bb6\u5c6c - 10<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1784 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m10-sname').change(function() {\n        var applicant_sname = $('.m10-sname').val();\n        var applicant_gname = $('.m10-gname').val();\n\t\tif ($('.m10-del').is(':checked')) {\n\t\t\t$('#m10-label').html(\"\u5bb6\u5c6c - 10\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel10' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m10-label').html(\"\u5bb6\u5c6c - 10\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m10-gname').change(function() {\n        var applicant_sname = $('.m10-sname').val();\n        var applicant_gname = $('.m10-gname').val();\n\t\tif ($('.m10-del').is(':checked')) {\n\t\t\t$('#m10-label').html(\"\u5bb6\u5c6c - 10\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel10' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m10-label').html(\"\u5bb6\u5c6c - 10\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m10-del').click(function() {\n        var applicant_sname = $('.m10-sname').val();\n        var applicant_gname = $('.m10-gname').val();\n\t\tif ($('.m10-del').is(':checked')) {\n    \t\t$('#m10-label').html(\"\u5bb6\u5c6c - 10\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel10' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m10-label').html(\"\u5bb6\u5c6c - 10\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1785\"><div class=\"quform-element quform-element-radio quform-element-97_1786 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1786\"><label class=\"quform-label-text\" id=\"quform_97_1786_6e1cb0_label\">Member 10 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1786\"><div class=\"quform-input quform-input-radio quform-input-97_1786 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1786_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1786\" id=\"quform_97_1786_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1786 quform-field-97_1786_1 m10-edit\" value=\"edit\" \/><label for=\"quform_97_1786_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1786_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1786\" id=\"quform_97_1786_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1786 quform-field-97_1786_2 m10-edit\" value=\"save\" checked \/><label for=\"quform_97_1786_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1786_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1282 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 11<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2064 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2065\"><div class=\"quform-element quform-element-html quform-element-97_2066 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2067\"><div class=\"quform-element quform-element-text quform-element-97_2068 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2068\"><label class=\"quform-label-text\" for=\"quform_97_2068_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2068\"><div class=\"quform-input quform-input-text quform-input-97_2068 quform-cf\"><input type=\"text\" id=\"quform_97_2068_6e1cb0\" name=\"quform_97_2068\" class=\"quform-field quform-field-text quform-field-97_2068 m11-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2069\"><div class=\"quform-element quform-element-checkbox quform-element-97_2070 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2070\"><label class=\"quform-label-text\" id=\"quform_97_2070_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2070\"><div class=\"quform-input quform-input-checkbox quform-input-97_2070 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2070_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2070[]\" id=\"quform_97_2070_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2070 quform-field-97_2070_1 m11-del\" value=\"Delete\" \/><label for=\"quform_97_2070_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2070_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2071\"><div class=\"quform-element quform-element-html quform-element-97_2072 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1283 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1284\"><div class=\"quform-element quform-element-text quform-element-97_1285 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1285\"><label class=\"quform-label-text\" for=\"quform_97_1285_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1285\"><div class=\"quform-input quform-input-text quform-input-97_1285 quform-cf\"><input type=\"text\" id=\"quform_97_1285_6e1cb0\" name=\"quform_97_1285\" class=\"quform-field quform-field-text quform-field-97_1285 m11-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1286\"><div class=\"quform-element quform-element-text quform-element-97_1287 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1287\"><label class=\"quform-label-text\" for=\"quform_97_1287_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1287\"><div class=\"quform-input quform-input-text quform-input-97_1287 quform-cf\"><input type=\"text\" id=\"quform_97_1287_6e1cb0\" name=\"quform_97_1287\" class=\"quform-field quform-field-text quform-field-97_1287 m11-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1288\"><div class=\"quform-element quform-element-select quform-element-97_1289 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1289\"><label class=\"quform-label-text\" for=\"quform_97_1289_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1289\"><div class=\"quform-input quform-input-select quform-input-97_1289 quform-cf\"><select id=\"quform_97_1289_6e1cb0\" name=\"quform_97_1289\" class=\"quform-field quform-field-select quform-field-97_1289 m11-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1290\"><div class=\"quform-element quform-element-select quform-element-97_1291 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1291\"><label class=\"quform-label-text\" for=\"quform_97_1291_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1291\"><div class=\"quform-input quform-input-select quform-input-97_1291 quform-cf\"><select id=\"quform_97_1291_6e1cb0\" name=\"quform_97_1291\" class=\"quform-field quform-field-select quform-field-97_1291 m11-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1292 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1293\"><div class=\"quform-element quform-element-select quform-element-97_1294 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1294\"><label class=\"quform-label-text\" for=\"quform_97_1294_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1294\"><div class=\"quform-input quform-input-select quform-input-97_1294 quform-cf\"><select id=\"quform_97_1294_6e1cb0\" name=\"quform_97_1294\" class=\"quform-field quform-field-select quform-field-97_1294 quform-field-select-enhanced m11-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1295\"><div class=\"quform-element quform-element-text quform-element-97_1308 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1308\"><label class=\"quform-label-text\" for=\"quform_97_1308_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1308\"><div class=\"quform-input quform-input-text quform-input-97_1308 quform-cf\"><input type=\"text\" id=\"quform_97_1308_6e1cb0\" name=\"quform_97_1308\" class=\"quform-field quform-field-text quform-field-97_1308 m11-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1309 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1310\"><div class=\"quform-element quform-element-date quform-element-97_1311 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1311\"><label class=\"quform-label-text\" for=\"quform_97_1311_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1311\"><div class=\"quform-input quform-input-date quform-input-97_1311 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1311_6e1cb0\" name=\"quform_97_1311\" class=\"quform-field quform-field-date quform-field-97_1311 m11-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1311&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1312 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1312\"><label class=\"quform-label-text\" for=\"quform_97_1312_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1312\"><div class=\"quform-input quform-input-text quform-input-97_1312 quform-cf\"><input type=\"text\" id=\"quform_97_1312_6e1cb0\" name=\"quform_97_1312\" class=\"quform-field quform-field-text quform-field-97_1312 m11-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1313\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1314\"><div class=\"quform-element quform-element-html quform-element-97_1315 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1316 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1316\"><label class=\"quform-label-text\" id=\"quform_97_1316_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1316\"><div class=\"quform-input quform-input-radio quform-input-97_1316 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1316_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1316\" id=\"quform_97_1316_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1316 quform-field-97_1316_1 m11-toc\" value=\"main\" checked \/><label for=\"quform_97_1316_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1316_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1317 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1317\"><label class=\"quform-label-text\" id=\"quform_97_1317_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1317\"><div class=\"quform-input quform-input-checkbox quform-input-97_1317 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1317_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1317[]\" id=\"quform_97_1317_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1317 quform-field-97_1317_1 m11-addcard\" value=\"gold11\" \/><label for=\"quform_97_1317_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1317_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad) <\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1317[]\" id=\"quform_97_1317_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1317 quform-field-97_1317_2 m11-addcard\" value=\"dental11\" \/><label for=\"quform_97_1317_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1317_2\"><span class=\"quform-option-text\">DentalSure <\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1317[]\" id=\"quform_97_1317_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1317 quform-field-97_1317_3 m11-addcard\" value=\"checkup11\" \/><label for=\"quform_97_1317_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1317_3\"><span class=\"quform-option-text\">Medical Checkup <\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1787 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1788\"><div class=\"quform-element quform-element-html quform-element-97_1789 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m11-label\"; >\u5bb6\u5c6c - 11<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1790 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m11-sname').change(function() {\n        var applicant_sname = $('.m11-sname').val();\n        var applicant_gname = $('.m11-gname').val();\n\t\tif ($('.m11-del').is(':checked')) {\n\t\t\t$('#m11-label').html(\"\u5bb6\u5c6c - 11\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel11' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m11-label').html(\"\u5bb6\u5c6c - 11\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m11-gname').change(function() {\n        var applicant_sname = $('.m11-sname').val();\n        var applicant_gname = $('.m11-gname').val();\n\t\tif ($('.m11-del').is(':checked')) {\n\t\t\t$('#m11-label').html(\"\u5bb6\u5c6c - 11\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel11' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m11-label').html(\"\u5bb6\u5c6c - 11\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m11-del').click(function() {\n        var applicant_sname = $('.m11-sname').val();\n        var applicant_gname = $('.m11-gname').val();\n\t\tif ($('.m11-del').is(':checked')) {\n    \t\t$('#m11-label').html(\"\u5bb6\u5c6c - 11\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel11' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m11-label').html(\"\u5bb6\u5c6c - 11\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1791\"><div class=\"quform-element quform-element-radio quform-element-97_1792 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1792\"><label class=\"quform-label-text\" id=\"quform_97_1792_6e1cb0_label\">Member 11 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1792\"><div class=\"quform-input quform-input-radio quform-input-97_1792 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1792_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1792\" id=\"quform_97_1792_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1792 quform-field-97_1792_1 m11-edit\" value=\"edit\" \/><label for=\"quform_97_1792_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1792_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1792\" id=\"quform_97_1792_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1792 quform-field-97_1792_2 m11-edit\" value=\"save\" checked \/><label for=\"quform_97_1792_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1792_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1246 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 12<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2073 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2074\"><div class=\"quform-element quform-element-html quform-element-97_2075 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2076\"><div class=\"quform-element quform-element-text quform-element-97_2077 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2077\"><label class=\"quform-label-text\" for=\"quform_97_2077_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2077\"><div class=\"quform-input quform-input-text quform-input-97_2077 quform-cf\"><input type=\"text\" id=\"quform_97_2077_6e1cb0\" name=\"quform_97_2077\" class=\"quform-field quform-field-text quform-field-97_2077 m12-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2078\"><div class=\"quform-element quform-element-checkbox quform-element-97_2079 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2079\"><label class=\"quform-label-text\" id=\"quform_97_2079_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2079\"><div class=\"quform-input quform-input-checkbox quform-input-97_2079 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2079_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2079[]\" id=\"quform_97_2079_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2079 quform-field-97_2079_1 m12-del\" value=\"Delete\" \/><label for=\"quform_97_2079_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2079_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2080\"><div class=\"quform-element quform-element-html quform-element-97_2081 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1247 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1248\"><div class=\"quform-element quform-element-text quform-element-97_1249 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1249\"><label class=\"quform-label-text\" for=\"quform_97_1249_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1249\"><div class=\"quform-input quform-input-text quform-input-97_1249 quform-cf\"><input type=\"text\" id=\"quform_97_1249_6e1cb0\" name=\"quform_97_1249\" class=\"quform-field quform-field-text quform-field-97_1249 m12-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1250\"><div class=\"quform-element quform-element-text quform-element-97_1251 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1251\"><label class=\"quform-label-text\" for=\"quform_97_1251_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1251\"><div class=\"quform-input quform-input-text quform-input-97_1251 quform-cf\"><input type=\"text\" id=\"quform_97_1251_6e1cb0\" name=\"quform_97_1251\" class=\"quform-field quform-field-text quform-field-97_1251 m12-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1252\"><div class=\"quform-element quform-element-select quform-element-97_1253 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1253\"><label class=\"quform-label-text\" for=\"quform_97_1253_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1253\"><div class=\"quform-input quform-input-select quform-input-97_1253 quform-cf\"><select id=\"quform_97_1253_6e1cb0\" name=\"quform_97_1253\" class=\"quform-field quform-field-select quform-field-97_1253 m12-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1254\"><div class=\"quform-element quform-element-select quform-element-97_1255 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1255\"><label class=\"quform-label-text\" for=\"quform_97_1255_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1255\"><div class=\"quform-input quform-input-select quform-input-97_1255 quform-cf\"><select id=\"quform_97_1255_6e1cb0\" name=\"quform_97_1255\" class=\"quform-field quform-field-select quform-field-97_1255 m12-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1256 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1257\"><div class=\"quform-element quform-element-select quform-element-97_1258 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1258\"><label class=\"quform-label-text\" for=\"quform_97_1258_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1258\"><div class=\"quform-input quform-input-select quform-input-97_1258 quform-cf\"><select id=\"quform_97_1258_6e1cb0\" name=\"quform_97_1258\" class=\"quform-field quform-field-select quform-field-97_1258 quform-field-select-enhanced m12-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1259\"><div class=\"quform-element quform-element-text quform-element-97_1272 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1272\"><label class=\"quform-label-text\" for=\"quform_97_1272_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1272\"><div class=\"quform-input quform-input-text quform-input-97_1272 quform-cf\"><input type=\"text\" id=\"quform_97_1272_6e1cb0\" name=\"quform_97_1272\" class=\"quform-field quform-field-text quform-field-97_1272 m12-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u8eab\u4efd\u8b49\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1273 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1274\"><div class=\"quform-element quform-element-date quform-element-97_1275 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1275\"><label class=\"quform-label-text\" for=\"quform_97_1275_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1275\"><div class=\"quform-input quform-input-date quform-input-97_1275 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1275_6e1cb0\" name=\"quform_97_1275\" class=\"quform-field quform-field-date quform-field-97_1275 m12-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1275&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1276 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1276\"><label class=\"quform-label-text\" for=\"quform_97_1276_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1276\"><div class=\"quform-input quform-input-text quform-input-97_1276 quform-cf\"><input type=\"text\" id=\"quform_97_1276_6e1cb0\" name=\"quform_97_1276\" class=\"quform-field quform-field-text quform-field-97_1276 m12-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1277\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1278\"><div class=\"quform-element quform-element-html quform-element-97_1279 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1280 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1280\"><label class=\"quform-label-text\" id=\"quform_97_1280_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1280\"><div class=\"quform-input quform-input-radio quform-input-97_1280 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1280_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1280\" id=\"quform_97_1280_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1280 quform-field-97_1280_1 m12-toc\" value=\"main\" checked \/><label for=\"quform_97_1280_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1280_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1281 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1281\"><label class=\"quform-label-text\" id=\"quform_97_1281_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1281\"><div class=\"quform-input quform-input-checkbox quform-input-97_1281 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1281_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1281[]\" id=\"quform_97_1281_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1281 quform-field-97_1281_1 m12-addcard\" value=\"gold12\" \/><label for=\"quform_97_1281_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1281_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1281[]\" id=\"quform_97_1281_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1281 quform-field-97_1281_2 m12-addcard\" value=\"dental12\" \/><label for=\"quform_97_1281_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1281_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1281[]\" id=\"quform_97_1281_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1281 quform-field-97_1281_3 m12-addcard\" value=\"checkup12\" \/><label for=\"quform_97_1281_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1281_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1793 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1794\"><div class=\"quform-element quform-element-html quform-element-97_1795 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m12-label\"; >\u5bb6\u5c6c - 12<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1796 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m12-sname').change(function() {\n        var applicant_sname = $('.m12-sname').val();\n        var applicant_gname = $('.m12-gname').val();\n\t\tif ($('.m12-del').is(':checked')) {\n\t\t\t$('#m12-label').html(\"\u5bb6\u5c6c - 12\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel12' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m12-label').html(\"\u5bb6\u5c6c - 12\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m12-gname').change(function() {\n        var applicant_sname = $('.m12-sname').val();\n        var applicant_gname = $('.m12-gname').val();\n\t\tif ($('.m12-del').is(':checked')) {\n\t\t\t$('#m12-label').html(\"\u5bb6\u5c6c - 12\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel12' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m12-label').html(\"\u5bb6\u5c6c - 12\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m12-del').click(function() {\n        var applicant_sname = $('.m12-sname').val();\n        var applicant_gname = $('.m12-gname').val();\n\t\tif ($('.m12-del').is(':checked')) {\n    \t\t$('#m12-label').html(\"\u5bb6\u5c6c - 12\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel12' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m12-label').html(\"\u5bb6\u5c6c - 12\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1797\"><div class=\"quform-element quform-element-radio quform-element-97_1798 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1798\"><label class=\"quform-label-text\" id=\"quform_97_1798_6e1cb0_label\">Member 12 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1798\"><div class=\"quform-input quform-input-radio quform-input-97_1798 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1798_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1798\" id=\"quform_97_1798_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1798 quform-field-97_1798_1 m12-edit\" value=\"edit\" \/><label for=\"quform_97_1798_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1798_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1798\" id=\"quform_97_1798_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1798 quform-field-97_1798_2 m12-edit\" value=\"save\" checked \/><label for=\"quform_97_1798_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1798_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1210 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 13<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2082 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2083\"><div class=\"quform-element quform-element-html quform-element-97_2084 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2085\"><div class=\"quform-element quform-element-text quform-element-97_2086 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2086\"><label class=\"quform-label-text\" for=\"quform_97_2086_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2086\"><div class=\"quform-input quform-input-text quform-input-97_2086 quform-cf\"><input type=\"text\" id=\"quform_97_2086_6e1cb0\" name=\"quform_97_2086\" class=\"quform-field quform-field-text quform-field-97_2086 m13-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2087\"><div class=\"quform-element quform-element-checkbox quform-element-97_2088 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2088\"><label class=\"quform-label-text\" id=\"quform_97_2088_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2088\"><div class=\"quform-input quform-input-checkbox quform-input-97_2088 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2088_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2088[]\" id=\"quform_97_2088_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2088 quform-field-97_2088_1 m13-del\" value=\"Delete\" \/><label for=\"quform_97_2088_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2088_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2089\"><div class=\"quform-element quform-element-html quform-element-97_2090 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1211 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1212\"><div class=\"quform-element quform-element-text quform-element-97_1213 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1213\"><label class=\"quform-label-text\" for=\"quform_97_1213_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1213\"><div class=\"quform-input quform-input-text quform-input-97_1213 quform-cf\"><input type=\"text\" id=\"quform_97_1213_6e1cb0\" name=\"quform_97_1213\" class=\"quform-field quform-field-text quform-field-97_1213 m13-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1214\"><div class=\"quform-element quform-element-text quform-element-97_1215 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1215\"><label class=\"quform-label-text\" for=\"quform_97_1215_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1215\"><div class=\"quform-input quform-input-text quform-input-97_1215 quform-cf\"><input type=\"text\" id=\"quform_97_1215_6e1cb0\" name=\"quform_97_1215\" class=\"quform-field quform-field-text quform-field-97_1215 m13-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1216\"><div class=\"quform-element quform-element-select quform-element-97_1217 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1217\"><label class=\"quform-label-text\" for=\"quform_97_1217_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1217\"><div class=\"quform-input quform-input-select quform-input-97_1217 quform-cf\"><select id=\"quform_97_1217_6e1cb0\" name=\"quform_97_1217\" class=\"quform-field quform-field-select quform-field-97_1217 m13-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1218\"><div class=\"quform-element quform-element-select quform-element-97_1219 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1219\"><label class=\"quform-label-text\" for=\"quform_97_1219_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1219\"><div class=\"quform-input quform-input-select quform-input-97_1219 quform-cf\"><select id=\"quform_97_1219_6e1cb0\" name=\"quform_97_1219\" class=\"quform-field quform-field-select quform-field-97_1219 m13-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1220 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1221\"><div class=\"quform-element quform-element-select quform-element-97_1222 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1222\"><label class=\"quform-label-text\" for=\"quform_97_1222_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1222\"><div class=\"quform-input quform-input-select quform-input-97_1222 quform-cf\"><select id=\"quform_97_1222_6e1cb0\" name=\"quform_97_1222\" class=\"quform-field quform-field-select quform-field-97_1222 quform-field-select-enhanced m13-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1223\"><div class=\"quform-element quform-element-text quform-element-97_1236 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1236\"><label class=\"quform-label-text\" for=\"quform_97_1236_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1236\"><div class=\"quform-input quform-input-text quform-input-97_1236 quform-cf\"><input type=\"text\" id=\"quform_97_1236_6e1cb0\" name=\"quform_97_1236\" class=\"quform-field quform-field-text quform-field-97_1236 m13-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1237 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1238\"><div class=\"quform-element quform-element-date quform-element-97_1239 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1239\"><label class=\"quform-label-text\" for=\"quform_97_1239_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1239\"><div class=\"quform-input quform-input-date quform-input-97_1239 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1239_6e1cb0\" name=\"quform_97_1239\" class=\"quform-field quform-field-date quform-field-97_1239 m13-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1239&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1240 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1240\"><label class=\"quform-label-text\" for=\"quform_97_1240_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1240\"><div class=\"quform-input quform-input-text quform-input-97_1240 quform-cf\"><input type=\"text\" id=\"quform_97_1240_6e1cb0\" name=\"quform_97_1240\" class=\"quform-field quform-field-text quform-field-97_1240 m13-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1241\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1242\"><div class=\"quform-element quform-element-html quform-element-97_1243 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1244 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1244\"><label class=\"quform-label-text\" id=\"quform_97_1244_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1244\"><div class=\"quform-input quform-input-radio quform-input-97_1244 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1244_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1244\" id=\"quform_97_1244_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1244 quform-field-97_1244_1 m13-toc\" value=\"main\" checked \/><label for=\"quform_97_1244_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1244_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1245 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1245\"><label class=\"quform-label-text\" id=\"quform_97_1245_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1245\"><div class=\"quform-input quform-input-checkbox quform-input-97_1245 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1245_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1245[]\" id=\"quform_97_1245_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1245 quform-field-97_1245_1 m13-addcard\" value=\"gold13\" \/><label for=\"quform_97_1245_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1245_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1245[]\" id=\"quform_97_1245_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1245 quform-field-97_1245_2 m13-addcard\" value=\"dental13\" \/><label for=\"quform_97_1245_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1245_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1245[]\" id=\"quform_97_1245_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1245 quform-field-97_1245_3 m13-addcard\" value=\"checkup13\" \/><label for=\"quform_97_1245_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1245_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1799 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1800\"><div class=\"quform-element quform-element-html quform-element-97_1801 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m13-label\"; >\u5bb6\u5c6c - 13<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1802 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m13-sname').change(function() {\n        var applicant_sname = $('.m13-sname').val();\n        var applicant_gname = $('.m13-gname').val();\n\t\tif ($('.m13-del').is(':checked')) {\n\t\t\t$('#m13-label').html(\"\u5bb6\u5c6c - 13\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel13' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m13-label').html(\"\u5bb6\u5c6c - 13\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m13-gname').change(function() {\n        var applicant_sname = $('.m13-sname').val();\n        var applicant_gname = $('.m13-gname').val();\n\t\tif ($('.m13-del').is(':checked')) {\n\t\t\t$('#m13-label').html(\"\u5bb6\u5c6c - 13\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel13' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m13-label').html(\"\u5bb6\u5c6c - 13\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m13-del').click(function() {\n        var applicant_sname = $('.m13-sname').val();\n        var applicant_gname = $('.m13-gname').val();\n\t\tif ($('.m13-del').is(':checked')) {\n    \t\t$('#m13-label').html(\"\u5bb6\u5c6c - 13\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel13' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m13-label').html(\"\u5bb6\u5c6c - 13\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1803\"><div class=\"quform-element quform-element-radio quform-element-97_1804 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1804\"><label class=\"quform-label-text\" id=\"quform_97_1804_6e1cb0_label\">Member 13 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1804\"><div class=\"quform-input quform-input-radio quform-input-97_1804 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1804_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1804\" id=\"quform_97_1804_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1804 quform-field-97_1804_1 m13-edit\" value=\"edit\" \/><label for=\"quform_97_1804_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1804_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1804\" id=\"quform_97_1804_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1804 quform-field-97_1804_2 m13-edit\" value=\"save\" checked \/><label for=\"quform_97_1804_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1804_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1174 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 14<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2091 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2092\"><div class=\"quform-element quform-element-html quform-element-97_2093 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2094\"><div class=\"quform-element quform-element-text quform-element-97_2095 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2095\"><label class=\"quform-label-text\" for=\"quform_97_2095_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2095\"><div class=\"quform-input quform-input-text quform-input-97_2095 quform-cf\"><input type=\"text\" id=\"quform_97_2095_6e1cb0\" name=\"quform_97_2095\" class=\"quform-field quform-field-text quform-field-97_2095 m14-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2096\"><div class=\"quform-element quform-element-checkbox quform-element-97_2097 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2097\"><label class=\"quform-label-text\" id=\"quform_97_2097_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2097\"><div class=\"quform-input quform-input-checkbox quform-input-97_2097 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2097_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2097[]\" id=\"quform_97_2097_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2097 quform-field-97_2097_1 m14-del\" value=\"Delete\" \/><label for=\"quform_97_2097_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2097_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2098\"><div class=\"quform-element quform-element-html quform-element-97_2099 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1175 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1176\"><div class=\"quform-element quform-element-text quform-element-97_1177 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1177\"><label class=\"quform-label-text\" for=\"quform_97_1177_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1177\"><div class=\"quform-input quform-input-text quform-input-97_1177 quform-cf\"><input type=\"text\" id=\"quform_97_1177_6e1cb0\" name=\"quform_97_1177\" class=\"quform-field quform-field-text quform-field-97_1177 m14-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1178\"><div class=\"quform-element quform-element-text quform-element-97_1179 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1179\"><label class=\"quform-label-text\" for=\"quform_97_1179_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1179\"><div class=\"quform-input quform-input-text quform-input-97_1179 quform-cf\"><input type=\"text\" id=\"quform_97_1179_6e1cb0\" name=\"quform_97_1179\" class=\"quform-field quform-field-text quform-field-97_1179 m14-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1180\"><div class=\"quform-element quform-element-select quform-element-97_1181 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1181\"><label class=\"quform-label-text\" for=\"quform_97_1181_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1181\"><div class=\"quform-input quform-input-select quform-input-97_1181 quform-cf\"><select id=\"quform_97_1181_6e1cb0\" name=\"quform_97_1181\" class=\"quform-field quform-field-select quform-field-97_1181 m14-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1182\"><div class=\"quform-element quform-element-select quform-element-97_1183 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1183\"><label class=\"quform-label-text\" for=\"quform_97_1183_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1183\"><div class=\"quform-input quform-input-select quform-input-97_1183 quform-cf\"><select id=\"quform_97_1183_6e1cb0\" name=\"quform_97_1183\" class=\"quform-field quform-field-select quform-field-97_1183 m14-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1184 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1185\"><div class=\"quform-element quform-element-select quform-element-97_1186 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1186\"><label class=\"quform-label-text\" for=\"quform_97_1186_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1186\"><div class=\"quform-input quform-input-select quform-input-97_1186 quform-cf\"><select id=\"quform_97_1186_6e1cb0\" name=\"quform_97_1186\" class=\"quform-field quform-field-select quform-field-97_1186 quform-field-select-enhanced m14-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1187\"><div class=\"quform-element quform-element-text quform-element-97_1200 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1200\"><label class=\"quform-label-text\" for=\"quform_97_1200_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1200\"><div class=\"quform-input quform-input-text quform-input-97_1200 quform-cf\"><input type=\"text\" id=\"quform_97_1200_6e1cb0\" name=\"quform_97_1200\" class=\"quform-field quform-field-text quform-field-97_1200 m14-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1201 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1202\"><div class=\"quform-element quform-element-date quform-element-97_1203 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1203\"><label class=\"quform-label-text\" for=\"quform_97_1203_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1203\"><div class=\"quform-input quform-input-date quform-input-97_1203 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1203_6e1cb0\" name=\"quform_97_1203\" class=\"quform-field quform-field-date quform-field-97_1203 m14-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1203&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1204 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1204\"><label class=\"quform-label-text\" for=\"quform_97_1204_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1204\"><div class=\"quform-input quform-input-text quform-input-97_1204 quform-cf\"><input type=\"text\" id=\"quform_97_1204_6e1cb0\" name=\"quform_97_1204\" class=\"quform-field quform-field-text quform-field-97_1204 m14-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1205\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1206\"><div class=\"quform-element quform-element-html quform-element-97_1207 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1208 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1208\"><label class=\"quform-label-text\" id=\"quform_97_1208_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1208\"><div class=\"quform-input quform-input-radio quform-input-97_1208 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1208_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1208\" id=\"quform_97_1208_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1208 quform-field-97_1208_1 m14-toc\" value=\"main\" checked \/><label for=\"quform_97_1208_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1208_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1209 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1209\"><label class=\"quform-label-text\" id=\"quform_97_1209_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1209\"><div class=\"quform-input quform-input-checkbox quform-input-97_1209 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1209_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1209[]\" id=\"quform_97_1209_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1209 quform-field-97_1209_1 m14-addcard\" value=\"gold14\" \/><label for=\"quform_97_1209_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1209_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1209[]\" id=\"quform_97_1209_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1209 quform-field-97_1209_2 m14-addcard\" value=\"dental14\" \/><label for=\"quform_97_1209_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1209_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1209[]\" id=\"quform_97_1209_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1209 quform-field-97_1209_3 m14-addcard\" value=\"checkup14\" \/><label for=\"quform_97_1209_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1209_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1805 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1806\"><div class=\"quform-element quform-element-html quform-element-97_1807 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m14-label\"; >\u5bb6\u5c6c - 14<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1808 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m14-sname').change(function() {\n        var applicant_sname = $('.m14-sname').val();\n        var applicant_gname = $('.m14-gname').val();\n\t\tif ($('.m14-del').is(':checked')) {\n\t\t\t$('#m14-label').html(\"\u5bb6\u5c6c - 14\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel14' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m14-label').html(\"\u5bb6\u5c6c - 14\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m14-gname').change(function() {\n        var applicant_sname = $('.m14-sname').val();\n        var applicant_gname = $('.m14-gname').val();\n\t\tif ($('.m14-del').is(':checked')) {\n\t\t\t$('#m14-label').html(\"\u5bb6\u5c6c - 14\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel14' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m14-label').html(\"\u5bb6\u5c6c - 14\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m14-del').click(function() {\n        var applicant_sname = $('.m14-sname').val();\n        var applicant_gname = $('.m14-gname').val();\n\t\tif ($('.m14-del').is(':checked')) {\n    \t\t$('#m14-label').html(\"\u5bb6\u5c6c - 14\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel14' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m14-label').html(\"\u5bb6\u5c6c - 14\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1809\"><div class=\"quform-element quform-element-radio quform-element-97_1810 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1810\"><label class=\"quform-label-text\" id=\"quform_97_1810_6e1cb0_label\">Member 14 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1810\"><div class=\"quform-input quform-input-radio quform-input-97_1810 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1810_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1810\" id=\"quform_97_1810_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1810 quform-field-97_1810_1 m14-edit\" value=\"edit\" \/><label for=\"quform_97_1810_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1810_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1810\" id=\"quform_97_1810_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1810 quform-field-97_1810_2 m14-edit\" value=\"save\" checked \/><label for=\"quform_97_1810_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1810_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1138 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 15<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2100 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2101\"><div class=\"quform-element quform-element-html quform-element-97_2102 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2103\"><div class=\"quform-element quform-element-text quform-element-97_2104 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2104\"><label class=\"quform-label-text\" for=\"quform_97_2104_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2104\"><div class=\"quform-input quform-input-text quform-input-97_2104 quform-cf\"><input type=\"text\" id=\"quform_97_2104_6e1cb0\" name=\"quform_97_2104\" class=\"quform-field quform-field-text quform-field-97_2104 m15-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2105\"><div class=\"quform-element quform-element-checkbox quform-element-97_2106 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2106\"><label class=\"quform-label-text\" id=\"quform_97_2106_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2106\"><div class=\"quform-input quform-input-checkbox quform-input-97_2106 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2106_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2106[]\" id=\"quform_97_2106_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2106 quform-field-97_2106_1 m15-del\" value=\"Delete\" \/><label for=\"quform_97_2106_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2106_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2107\"><div class=\"quform-element quform-element-html quform-element-97_2108 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1139 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1140\"><div class=\"quform-element quform-element-text quform-element-97_1141 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1141\"><label class=\"quform-label-text\" for=\"quform_97_1141_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1141\"><div class=\"quform-input quform-input-text quform-input-97_1141 quform-cf\"><input type=\"text\" id=\"quform_97_1141_6e1cb0\" name=\"quform_97_1141\" class=\"quform-field quform-field-text quform-field-97_1141 m15-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1142\"><div class=\"quform-element quform-element-text quform-element-97_1143 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1143\"><label class=\"quform-label-text\" for=\"quform_97_1143_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1143\"><div class=\"quform-input quform-input-text quform-input-97_1143 quform-cf\"><input type=\"text\" id=\"quform_97_1143_6e1cb0\" name=\"quform_97_1143\" class=\"quform-field quform-field-text quform-field-97_1143 m15-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1144\"><div class=\"quform-element quform-element-select quform-element-97_1145 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1145\"><label class=\"quform-label-text\" for=\"quform_97_1145_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1145\"><div class=\"quform-input quform-input-select quform-input-97_1145 quform-cf\"><select id=\"quform_97_1145_6e1cb0\" name=\"quform_97_1145\" class=\"quform-field quform-field-select quform-field-97_1145 m15-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1146\"><div class=\"quform-element quform-element-select quform-element-97_1147 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1147\"><label class=\"quform-label-text\" for=\"quform_97_1147_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1147\"><div class=\"quform-input quform-input-select quform-input-97_1147 quform-cf\"><select id=\"quform_97_1147_6e1cb0\" name=\"quform_97_1147\" class=\"quform-field quform-field-select quform-field-97_1147 m15-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1148 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1149\"><div class=\"quform-element quform-element-select quform-element-97_1150 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1150\"><label class=\"quform-label-text\" for=\"quform_97_1150_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1150\"><div class=\"quform-input quform-input-select quform-input-97_1150 quform-cf\"><select id=\"quform_97_1150_6e1cb0\" name=\"quform_97_1150\" class=\"quform-field quform-field-select quform-field-97_1150 quform-field-select-enhanced m15-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1151\"><div class=\"quform-element quform-element-text quform-element-97_1164 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1164\"><label class=\"quform-label-text\" for=\"quform_97_1164_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1164\"><div class=\"quform-input quform-input-text quform-input-97_1164 quform-cf\"><input type=\"text\" id=\"quform_97_1164_6e1cb0\" name=\"quform_97_1164\" class=\"quform-field quform-field-text quform-field-97_1164 m15-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1165 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1166\"><div class=\"quform-element quform-element-date quform-element-97_1167 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1167\"><label class=\"quform-label-text\" for=\"quform_97_1167_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1167\"><div class=\"quform-input quform-input-date quform-input-97_1167 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1167_6e1cb0\" name=\"quform_97_1167\" class=\"quform-field quform-field-date quform-field-97_1167 m15-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1167&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1168 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1168\"><label class=\"quform-label-text\" for=\"quform_97_1168_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1168\"><div class=\"quform-input quform-input-text quform-input-97_1168 quform-cf\"><input type=\"text\" id=\"quform_97_1168_6e1cb0\" name=\"quform_97_1168\" class=\"quform-field quform-field-text quform-field-97_1168 m15-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1169\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1170\"><div class=\"quform-element quform-element-html quform-element-97_1171 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1172 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1172\"><label class=\"quform-label-text\" id=\"quform_97_1172_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1172\"><div class=\"quform-input quform-input-radio quform-input-97_1172 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1172_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1172\" id=\"quform_97_1172_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1172 quform-field-97_1172_1 m15-toc\" value=\"main\" checked \/><label for=\"quform_97_1172_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1172_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1173 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1173\"><label class=\"quform-label-text\" id=\"quform_97_1173_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1173\"><div class=\"quform-input quform-input-checkbox quform-input-97_1173 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1173_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1173[]\" id=\"quform_97_1173_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1173 quform-field-97_1173_1 m15-addcard\" value=\"gold15\" \/><label for=\"quform_97_1173_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1173_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1173[]\" id=\"quform_97_1173_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1173 quform-field-97_1173_2 m15-addcard\" value=\"dental15\" \/><label for=\"quform_97_1173_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1173_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1173[]\" id=\"quform_97_1173_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1173 quform-field-97_1173_3 m15-addcard\" value=\"checkup15\" \/><label for=\"quform_97_1173_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1173_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1811 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1812\"><div class=\"quform-element quform-element-html quform-element-97_1813 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m15-label\"; >\u5bb6\u5c6c - 15<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1814 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m15-sname').change(function() {\n        var applicant_sname = $('.m15-sname').val();\n        var applicant_gname = $('.m15-gname').val();\n\t\tif ($('.m15-del').is(':checked')) {\n\t\t\t$('#m15-label').html(\"\u5bb6\u5c6c - 15\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel15' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m15-label').html(\"\u5bb6\u5c6c - 15\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m15-gname').change(function() {\n        var applicant_sname = $('.m15-sname').val();\n        var applicant_gname = $('.m15-gname').val();\n\t\tif ($('.m15-del').is(':checked')) {\n\t\t\t$('#m15-label').html(\"\u5bb6\u5c6c - 15\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel15' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m15-label').html(\"\u5bb6\u5c6c - 15\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m15-del').click(function() {\n        var applicant_sname = $('.m15-sname').val();\n        var applicant_gname = $('.m15-gname').val();\n\t\tif ($('.m15-del').is(':checked')) {\n    \t\t$('#m15-label').html(\"\u5bb6\u5c6c - 15\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel15' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m15-label').html(\"\u5bb6\u5c6c - 15\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1815\"><div class=\"quform-element quform-element-radio quform-element-97_1816 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1816\"><label class=\"quform-label-text\" id=\"quform_97_1816_6e1cb0_label\">Member 15 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1816\"><div class=\"quform-input quform-input-radio quform-input-97_1816 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1816_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1816\" id=\"quform_97_1816_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1816 quform-field-97_1816_1 m15-edit\" value=\"edit\" \/><label for=\"quform_97_1816_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1816_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1816\" id=\"quform_97_1816_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1816 quform-field-97_1816_2 m15-edit\" value=\"save\" checked \/><label for=\"quform_97_1816_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1816_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1102 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 16<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2109 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2110\"><div class=\"quform-element quform-element-html quform-element-97_2111 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2112\"><div class=\"quform-element quform-element-text quform-element-97_2113 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2113\"><label class=\"quform-label-text\" for=\"quform_97_2113_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2113\"><div class=\"quform-input quform-input-text quform-input-97_2113 quform-cf\"><input type=\"text\" id=\"quform_97_2113_6e1cb0\" name=\"quform_97_2113\" class=\"quform-field quform-field-text quform-field-97_2113 m16-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2114\"><div class=\"quform-element quform-element-checkbox quform-element-97_2115 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2115\"><label class=\"quform-label-text\" id=\"quform_97_2115_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2115\"><div class=\"quform-input quform-input-checkbox quform-input-97_2115 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2115_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2115[]\" id=\"quform_97_2115_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2115 quform-field-97_2115_1 m16-del\" value=\"Delete\" \/><label for=\"quform_97_2115_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2115_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2116\"><div class=\"quform-element quform-element-html quform-element-97_2117 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1103 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1104\"><div class=\"quform-element quform-element-text quform-element-97_1105 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1105\"><label class=\"quform-label-text\" for=\"quform_97_1105_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1105\"><div class=\"quform-input quform-input-text quform-input-97_1105 quform-cf\"><input type=\"text\" id=\"quform_97_1105_6e1cb0\" name=\"quform_97_1105\" class=\"quform-field quform-field-text quform-field-97_1105 m16-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1106\"><div class=\"quform-element quform-element-text quform-element-97_1107 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1107\"><label class=\"quform-label-text\" for=\"quform_97_1107_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1107\"><div class=\"quform-input quform-input-text quform-input-97_1107 quform-cf\"><input type=\"text\" id=\"quform_97_1107_6e1cb0\" name=\"quform_97_1107\" class=\"quform-field quform-field-text quform-field-97_1107 m16-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1108\"><div class=\"quform-element quform-element-select quform-element-97_1109 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1109\"><label class=\"quform-label-text\" for=\"quform_97_1109_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1109\"><div class=\"quform-input quform-input-select quform-input-97_1109 quform-cf\"><select id=\"quform_97_1109_6e1cb0\" name=\"quform_97_1109\" class=\"quform-field quform-field-select quform-field-97_1109 m16-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1110\"><div class=\"quform-element quform-element-select quform-element-97_1111 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1111\"><label class=\"quform-label-text\" for=\"quform_97_1111_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1111\"><div class=\"quform-input quform-input-select quform-input-97_1111 quform-cf\"><select id=\"quform_97_1111_6e1cb0\" name=\"quform_97_1111\" class=\"quform-field quform-field-select quform-field-97_1111 m16-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1112 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1113\"><div class=\"quform-element quform-element-select quform-element-97_1114 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1114\"><label class=\"quform-label-text\" for=\"quform_97_1114_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1114\"><div class=\"quform-input quform-input-select quform-input-97_1114 quform-cf\"><select id=\"quform_97_1114_6e1cb0\" name=\"quform_97_1114\" class=\"quform-field quform-field-select quform-field-97_1114 quform-field-select-enhanced m16-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1115\"><div class=\"quform-element quform-element-text quform-element-97_1128 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1128\"><label class=\"quform-label-text\" for=\"quform_97_1128_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1128\"><div class=\"quform-input quform-input-text quform-input-97_1128 quform-cf\"><input type=\"text\" id=\"quform_97_1128_6e1cb0\" name=\"quform_97_1128\" class=\"quform-field quform-field-text quform-field-97_1128 m16-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1129 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1130\"><div class=\"quform-element quform-element-date quform-element-97_1131 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1131\"><label class=\"quform-label-text\" for=\"quform_97_1131_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1131\"><div class=\"quform-input quform-input-date quform-input-97_1131 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1131_6e1cb0\" name=\"quform_97_1131\" class=\"quform-field quform-field-date quform-field-97_1131 m16-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1131&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1132 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1132\"><label class=\"quform-label-text\" for=\"quform_97_1132_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1132\"><div class=\"quform-input quform-input-text quform-input-97_1132 quform-cf\"><input type=\"text\" id=\"quform_97_1132_6e1cb0\" name=\"quform_97_1132\" class=\"quform-field quform-field-text quform-field-97_1132 m16-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1133\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1134\"><div class=\"quform-element quform-element-html quform-element-97_1135 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1136 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1136\"><label class=\"quform-label-text\" id=\"quform_97_1136_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1136\"><div class=\"quform-input quform-input-radio quform-input-97_1136 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1136_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1136\" id=\"quform_97_1136_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1136 quform-field-97_1136_1 m16-toc\" value=\"main\" checked \/><label for=\"quform_97_1136_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1136_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1137 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1137\"><label class=\"quform-label-text\" id=\"quform_97_1137_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1137\"><div class=\"quform-input quform-input-checkbox quform-input-97_1137 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1137_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1137[]\" id=\"quform_97_1137_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1137 quform-field-97_1137_1 m16-addcard\" value=\"gold16\" \/><label for=\"quform_97_1137_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1137_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1137[]\" id=\"quform_97_1137_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1137 quform-field-97_1137_2 m16-addcard\" value=\"dental16\" \/><label for=\"quform_97_1137_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1137_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1137[]\" id=\"quform_97_1137_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1137 quform-field-97_1137_3 m16-addcard\" value=\"checkup16\" \/><label for=\"quform_97_1137_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1137_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1817 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1818\"><div class=\"quform-element quform-element-html quform-element-97_1819 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m16-label\"; >\u5bb6\u5c6c - 16<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1820 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m16-sname').change(function() {\n        var applicant_sname = $('.m16-sname').val();\n        var applicant_gname = $('.m16-gname').val();\n\t\tif ($('.m16-del').is(':checked')) {\n\t\t\t$('#m16-label').html(\"\u5bb6\u5c6c - 16\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel16' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m16-label').html(\"\u5bb6\u5c6c - 16\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m16-gname').change(function() {\n        var applicant_sname = $('.m16-sname').val();\n        var applicant_gname = $('.m16-gname').val();\n\t\tif ($('.m16-del').is(':checked')) {\n\t\t\t$('#m16-label').html(\"\u5bb6\u5c6c - 16\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel16' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m16-label').html(\"\u5bb6\u5c6c - 16\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m16-del').click(function() {\n        var applicant_sname = $('.m16-sname').val();\n        var applicant_gname = $('.m16-gname').val();\n\t\tif ($('.m16-del').is(':checked')) {\n    \t\t$('#m16-label').html(\"\u5bb6\u5c6c - 16\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel16' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m16-label').html(\"\u5bb6\u5c6c - 16\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1821\"><div class=\"quform-element quform-element-radio quform-element-97_1822 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1822\"><label class=\"quform-label-text\" id=\"quform_97_1822_6e1cb0_label\">Member 16 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1822\"><div class=\"quform-input quform-input-radio quform-input-97_1822 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1822_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1822\" id=\"quform_97_1822_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1822 quform-field-97_1822_1 m16-edit\" value=\"edit\" \/><label for=\"quform_97_1822_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1822_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1822\" id=\"quform_97_1822_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1822 quform-field-97_1822_2 m16-edit\" value=\"save\" checked \/><label for=\"quform_97_1822_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1822_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1066 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 17<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2118 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2119\"><div class=\"quform-element quform-element-html quform-element-97_2120 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2121\"><div class=\"quform-element quform-element-text quform-element-97_2122 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2122\"><label class=\"quform-label-text\" for=\"quform_97_2122_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2122\"><div class=\"quform-input quform-input-text quform-input-97_2122 quform-cf\"><input type=\"text\" id=\"quform_97_2122_6e1cb0\" name=\"quform_97_2122\" class=\"quform-field quform-field-text quform-field-97_2122 m17-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2123\"><div class=\"quform-element quform-element-checkbox quform-element-97_2124 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2124\"><label class=\"quform-label-text\" id=\"quform_97_2124_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2124\"><div class=\"quform-input quform-input-checkbox quform-input-97_2124 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2124_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2124[]\" id=\"quform_97_2124_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2124 quform-field-97_2124_1 m17-del\" value=\"Delete\" \/><label for=\"quform_97_2124_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2124_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2125\"><div class=\"quform-element quform-element-html quform-element-97_2126 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1067 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1068\"><div class=\"quform-element quform-element-text quform-element-97_1069 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1069\"><label class=\"quform-label-text\" for=\"quform_97_1069_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1069\"><div class=\"quform-input quform-input-text quform-input-97_1069 quform-cf\"><input type=\"text\" id=\"quform_97_1069_6e1cb0\" name=\"quform_97_1069\" class=\"quform-field quform-field-text quform-field-97_1069 m17-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1070\"><div class=\"quform-element quform-element-text quform-element-97_1071 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1071\"><label class=\"quform-label-text\" for=\"quform_97_1071_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1071\"><div class=\"quform-input quform-input-text quform-input-97_1071 quform-cf\"><input type=\"text\" id=\"quform_97_1071_6e1cb0\" name=\"quform_97_1071\" class=\"quform-field quform-field-text quform-field-97_1071 m17-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1072\"><div class=\"quform-element quform-element-select quform-element-97_1073 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1073\"><label class=\"quform-label-text\" for=\"quform_97_1073_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1073\"><div class=\"quform-input quform-input-select quform-input-97_1073 quform-cf\"><select id=\"quform_97_1073_6e1cb0\" name=\"quform_97_1073\" class=\"quform-field quform-field-select quform-field-97_1073 m17-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1074\"><div class=\"quform-element quform-element-select quform-element-97_1075 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1075\"><label class=\"quform-label-text\" for=\"quform_97_1075_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1075\"><div class=\"quform-input quform-input-select quform-input-97_1075 quform-cf\"><select id=\"quform_97_1075_6e1cb0\" name=\"quform_97_1075\" class=\"quform-field quform-field-select quform-field-97_1075 m17-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1076 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1077\"><div class=\"quform-element quform-element-select quform-element-97_1078 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1078\"><label class=\"quform-label-text\" for=\"quform_97_1078_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1078\"><div class=\"quform-input quform-input-select quform-input-97_1078 quform-cf\"><select id=\"quform_97_1078_6e1cb0\" name=\"quform_97_1078\" class=\"quform-field quform-field-select quform-field-97_1078 quform-field-select-enhanced m17-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1079\"><div class=\"quform-element quform-element-text quform-element-97_1092 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1092\"><label class=\"quform-label-text\" for=\"quform_97_1092_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1092\"><div class=\"quform-input quform-input-text quform-input-97_1092 quform-cf\"><input type=\"text\" id=\"quform_97_1092_6e1cb0\" name=\"quform_97_1092\" class=\"quform-field quform-field-text quform-field-97_1092 m17-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1093 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1094\"><div class=\"quform-element quform-element-date quform-element-97_1095 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1095\"><label class=\"quform-label-text\" for=\"quform_97_1095_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1095\"><div class=\"quform-input quform-input-date quform-input-97_1095 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1095_6e1cb0\" name=\"quform_97_1095\" class=\"quform-field quform-field-date quform-field-97_1095 m17-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1095&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1096 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1096\"><label class=\"quform-label-text\" for=\"quform_97_1096_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1096\"><div class=\"quform-input quform-input-text quform-input-97_1096 quform-cf\"><input type=\"text\" id=\"quform_97_1096_6e1cb0\" name=\"quform_97_1096\" class=\"quform-field quform-field-text quform-field-97_1096 m17-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1097\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1098\"><div class=\"quform-element quform-element-html quform-element-97_1099 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1100 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1100\"><label class=\"quform-label-text\" id=\"quform_97_1100_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1100\"><div class=\"quform-input quform-input-radio quform-input-97_1100 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1100_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1100\" id=\"quform_97_1100_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1100 quform-field-97_1100_1 m17-toc\" value=\"main\" checked \/><label for=\"quform_97_1100_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1100_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1101 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1101\"><label class=\"quform-label-text\" id=\"quform_97_1101_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1101\"><div class=\"quform-input quform-input-checkbox quform-input-97_1101 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1101_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1101[]\" id=\"quform_97_1101_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1101 quform-field-97_1101_1 m17-addcard\" value=\"gold17\" \/><label for=\"quform_97_1101_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1101_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1101[]\" id=\"quform_97_1101_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1101 quform-field-97_1101_2 m17-addcard\" value=\"dental17\" \/><label for=\"quform_97_1101_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1101_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1101[]\" id=\"quform_97_1101_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1101 quform-field-97_1101_3 m17-addcard\" value=\"checkup17\" \/><label for=\"quform_97_1101_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1101_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1823 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1824\"><div class=\"quform-element quform-element-html quform-element-97_1825 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m17-label\"; >\u5bb6\u5c6c - 17<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1826 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m17-sname').change(function() {\n        var applicant_sname = $('.m17-sname').val();\n        var applicant_gname = $('.m17-gname').val();\n\t\tif ($('.m17-del').is(':checked')) {\n\t\t\t$('#m17-label').html(\"\u5bb6\u5c6c - 17\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel17' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m17-label').html(\"\u5bb6\u5c6c - 17\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m17-gname').change(function() {\n        var applicant_sname = $('.m17-sname').val();\n        var applicant_gname = $('.m17-gname').val();\n\t\tif ($('.m17-del').is(':checked')) {\n\t\t\t$('#m17-label').html(\"\u5bb6\u5c6c - 17\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel17' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m17-label').html(\"\u5bb6\u5c6c - 17\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m17-del').click(function() {\n        var applicant_sname = $('.m17-sname').val();\n        var applicant_gname = $('.m17-gname').val();\n\t\tif ($('.m17-del').is(':checked')) {\n    \t\t$('#m17-label').html(\"\u5bb6\u5c6c - 17\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel17' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m17-label').html(\"\u5bb6\u5c6c - 17\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1827\"><div class=\"quform-element quform-element-radio quform-element-97_1828 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1828\"><label class=\"quform-label-text\" id=\"quform_97_1828_6e1cb0_label\">Member 17 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1828\"><div class=\"quform-input quform-input-radio quform-input-97_1828 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1828_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1828\" id=\"quform_97_1828_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1828 quform-field-97_1828_1 m17-edit\" value=\"edit\" \/><label for=\"quform_97_1828_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1828_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1828\" id=\"quform_97_1828_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1828 quform-field-97_1828_2 m17-edit\" value=\"save\" checked \/><label for=\"quform_97_1828_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1828_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1030 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 18<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2127 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2128\"><div class=\"quform-element quform-element-html quform-element-97_2129 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2130\"><div class=\"quform-element quform-element-text quform-element-97_2131 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2131\"><label class=\"quform-label-text\" for=\"quform_97_2131_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2131\"><div class=\"quform-input quform-input-text quform-input-97_2131 quform-cf\"><input type=\"text\" id=\"quform_97_2131_6e1cb0\" name=\"quform_97_2131\" class=\"quform-field quform-field-text quform-field-97_2131 m18-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2132\"><div class=\"quform-element quform-element-checkbox quform-element-97_2133 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2133\"><label class=\"quform-label-text\" id=\"quform_97_2133_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2133\"><div class=\"quform-input quform-input-checkbox quform-input-97_2133 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2133_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2133[]\" id=\"quform_97_2133_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2133 quform-field-97_2133_1 m18-del\" value=\"Delete\" \/><label for=\"quform_97_2133_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2133_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2134\"><div class=\"quform-element quform-element-html quform-element-97_2135 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1031 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1032\"><div class=\"quform-element quform-element-text quform-element-97_1033 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1033\"><label class=\"quform-label-text\" for=\"quform_97_1033_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1033\"><div class=\"quform-input quform-input-text quform-input-97_1033 quform-cf\"><input type=\"text\" id=\"quform_97_1033_6e1cb0\" name=\"quform_97_1033\" class=\"quform-field quform-field-text quform-field-97_1033 m18-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1034\"><div class=\"quform-element quform-element-text quform-element-97_1035 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1035\"><label class=\"quform-label-text\" for=\"quform_97_1035_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1035\"><div class=\"quform-input quform-input-text quform-input-97_1035 quform-cf\"><input type=\"text\" id=\"quform_97_1035_6e1cb0\" name=\"quform_97_1035\" class=\"quform-field quform-field-text quform-field-97_1035 m18-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1036\"><div class=\"quform-element quform-element-select quform-element-97_1037 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1037\"><label class=\"quform-label-text\" for=\"quform_97_1037_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1037\"><div class=\"quform-input quform-input-select quform-input-97_1037 quform-cf\"><select id=\"quform_97_1037_6e1cb0\" name=\"quform_97_1037\" class=\"quform-field quform-field-select quform-field-97_1037 m18-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1038\"><div class=\"quform-element quform-element-select quform-element-97_1039 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1039\"><label class=\"quform-label-text\" for=\"quform_97_1039_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1039\"><div class=\"quform-input quform-input-select quform-input-97_1039 quform-cf\"><select id=\"quform_97_1039_6e1cb0\" name=\"quform_97_1039\" class=\"quform-field quform-field-select quform-field-97_1039 m18-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1040 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1041\"><div class=\"quform-element quform-element-select quform-element-97_1042 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1042\"><label class=\"quform-label-text\" for=\"quform_97_1042_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1042\"><div class=\"quform-input quform-input-select quform-input-97_1042 quform-cf\"><select id=\"quform_97_1042_6e1cb0\" name=\"quform_97_1042\" class=\"quform-field quform-field-select quform-field-97_1042 quform-field-select-enhanced m18-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1043\"><div class=\"quform-element quform-element-text quform-element-97_1056 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1056\"><label class=\"quform-label-text\" for=\"quform_97_1056_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1056\"><div class=\"quform-input quform-input-text quform-input-97_1056 quform-cf\"><input type=\"text\" id=\"quform_97_1056_6e1cb0\" name=\"quform_97_1056\" class=\"quform-field quform-field-text quform-field-97_1056 m18-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1057 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1058\"><div class=\"quform-element quform-element-date quform-element-97_1059 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1059\"><label class=\"quform-label-text\" for=\"quform_97_1059_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1059\"><div class=\"quform-input quform-input-date quform-input-97_1059 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1059_6e1cb0\" name=\"quform_97_1059\" class=\"quform-field quform-field-date quform-field-97_1059 m18-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1059&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1060 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1060\"><label class=\"quform-label-text\" for=\"quform_97_1060_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1060\"><div class=\"quform-input quform-input-text quform-input-97_1060 quform-cf\"><input type=\"text\" id=\"quform_97_1060_6e1cb0\" name=\"quform_97_1060\" class=\"quform-field quform-field-text quform-field-97_1060 m18-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1061\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1062\"><div class=\"quform-element quform-element-html quform-element-97_1063 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1064 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1064\"><label class=\"quform-label-text\" id=\"quform_97_1064_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1064\"><div class=\"quform-input quform-input-radio quform-input-97_1064 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1064_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1064\" id=\"quform_97_1064_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1064 quform-field-97_1064_1 m18-toc\" value=\"main\" checked \/><label for=\"quform_97_1064_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1064_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1065 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1065\"><label class=\"quform-label-text\" id=\"quform_97_1065_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1065\"><div class=\"quform-input quform-input-checkbox quform-input-97_1065 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1065_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1065[]\" id=\"quform_97_1065_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1065 quform-field-97_1065_1 m18-addcard\" value=\"gold18\" \/><label for=\"quform_97_1065_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1065_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1065[]\" id=\"quform_97_1065_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1065 quform-field-97_1065_2 m18-addcard\" value=\"dental18\" \/><label for=\"quform_97_1065_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1065_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1065[]\" id=\"quform_97_1065_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1065 quform-field-97_1065_3 m18-addcard\" value=\"checkup18\" \/><label for=\"quform_97_1065_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1065_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1829 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1830\"><div class=\"quform-element quform-element-html quform-element-97_1831 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m18-label\"; >\u5bb6\u5c6c - 18<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1832 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m18-sname').change(function() {\n        var applicant_sname = $('.m18-sname').val();\n        var applicant_gname = $('.m18-gname').val();\n\t\tif ($('.m18-del').is(':checked')) {\n\t\t\t$('#m18-label').html(\"\u5bb6\u5c6c - 18\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel18' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m18-label').html(\"\u5bb6\u5c6c - 18\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m18-gname').change(function() {\n        var applicant_sname = $('.m18-sname').val();\n        var applicant_gname = $('.m18-gname').val();\n\t\tif ($('.m18-del').is(':checked')) {\n\t\t\t$('#m18-label').html(\"\u5bb6\u5c6c - 18\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel18' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m18-label').html(\"\u5bb6\u5c6c - 18\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m18-del').click(function() {\n        var applicant_sname = $('.m18-sname').val();\n        var applicant_gname = $('.m18-gname').val();\n\t\tif ($('.m18-del').is(':checked')) {\n    \t\t$('#m18-label').html(\"\u5bb6\u5c6c - 18\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel18' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m18-label').html(\"\u5bb6\u5c6c - 18\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1833\"><div class=\"quform-element quform-element-radio quform-element-97_1834 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1834\"><label class=\"quform-label-text\" id=\"quform_97_1834_6e1cb0_label\">Member 18 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1834\"><div class=\"quform-input quform-input-radio quform-input-97_1834 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1834_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1834\" id=\"quform_97_1834_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1834 quform-field-97_1834_1 m18-edit\" value=\"edit\" \/><label for=\"quform_97_1834_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1834_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1834\" id=\"quform_97_1834_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1834 quform-field-97_1834_2 m18-edit\" value=\"save\" checked \/><label for=\"quform_97_1834_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1834_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_994 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 19<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2136 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2137\"><div class=\"quform-element quform-element-html quform-element-97_2138 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2139\"><div class=\"quform-element quform-element-text quform-element-97_2140 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2140\"><label class=\"quform-label-text\" for=\"quform_97_2140_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2140\"><div class=\"quform-input quform-input-text quform-input-97_2140 quform-cf\"><input type=\"text\" id=\"quform_97_2140_6e1cb0\" name=\"quform_97_2140\" class=\"quform-field quform-field-text quform-field-97_2140 m19-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2141\"><div class=\"quform-element quform-element-checkbox quform-element-97_2142 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2142\"><label class=\"quform-label-text\" id=\"quform_97_2142_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2142\"><div class=\"quform-input quform-input-checkbox quform-input-97_2142 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2142_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2142[]\" id=\"quform_97_2142_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2142 quform-field-97_2142_1 m19-del\" value=\"Delete\" \/><label for=\"quform_97_2142_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2142_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2143\"><div class=\"quform-element quform-element-html quform-element-97_2144 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_995 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_996\"><div class=\"quform-element quform-element-text quform-element-97_997 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_997\"><label class=\"quform-label-text\" for=\"quform_97_997_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_997\"><div class=\"quform-input quform-input-text quform-input-97_997 quform-cf\"><input type=\"text\" id=\"quform_97_997_6e1cb0\" name=\"quform_97_997\" class=\"quform-field quform-field-text quform-field-97_997 m19-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_998\"><div class=\"quform-element quform-element-text quform-element-97_999 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_999\"><label class=\"quform-label-text\" for=\"quform_97_999_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_999\"><div class=\"quform-input quform-input-text quform-input-97_999 quform-cf\"><input type=\"text\" id=\"quform_97_999_6e1cb0\" name=\"quform_97_999\" class=\"quform-field quform-field-text quform-field-97_999 m19-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1000\"><div class=\"quform-element quform-element-select quform-element-97_1001 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1001\"><label class=\"quform-label-text\" for=\"quform_97_1001_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1001\"><div class=\"quform-input quform-input-select quform-input-97_1001 quform-cf\"><select id=\"quform_97_1001_6e1cb0\" name=\"quform_97_1001\" class=\"quform-field quform-field-select quform-field-97_1001 m19-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1002\"><div class=\"quform-element quform-element-select quform-element-97_1003 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1003\"><label class=\"quform-label-text\" for=\"quform_97_1003_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1003\"><div class=\"quform-input quform-input-select quform-input-97_1003 quform-cf\"><select id=\"quform_97_1003_6e1cb0\" name=\"quform_97_1003\" class=\"quform-field quform-field-select quform-field-97_1003 m19-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1004 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1005\"><div class=\"quform-element quform-element-select quform-element-97_1006 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1006\"><label class=\"quform-label-text\" for=\"quform_97_1006_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1006\"><div class=\"quform-input quform-input-select quform-input-97_1006 quform-cf\"><select id=\"quform_97_1006_6e1cb0\" name=\"quform_97_1006\" class=\"quform-field quform-field-select quform-field-97_1006 quform-field-select-enhanced m19-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1007\"><div class=\"quform-element quform-element-text quform-element-97_1020 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1020\"><label class=\"quform-label-text\" for=\"quform_97_1020_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1020\"><div class=\"quform-input quform-input-text quform-input-97_1020 quform-cf\"><input type=\"text\" id=\"quform_97_1020_6e1cb0\" name=\"quform_97_1020\" class=\"quform-field quform-field-text quform-field-97_1020 m19-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1021 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1022\"><div class=\"quform-element quform-element-date quform-element-97_1023 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1023\"><label class=\"quform-label-text\" for=\"quform_97_1023_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1023\"><div class=\"quform-input quform-input-date quform-input-97_1023 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1023_6e1cb0\" name=\"quform_97_1023\" class=\"quform-field quform-field-date quform-field-97_1023 m19-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1023&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1024 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1024\"><label class=\"quform-label-text\" for=\"quform_97_1024_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1024\"><div class=\"quform-input quform-input-text quform-input-97_1024 quform-cf\"><input type=\"text\" id=\"quform_97_1024_6e1cb0\" name=\"quform_97_1024\" class=\"quform-field quform-field-text quform-field-97_1024 m19-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1025\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1026\"><div class=\"quform-element quform-element-html quform-element-97_1027 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1028 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1028\"><label class=\"quform-label-text\" id=\"quform_97_1028_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1028\"><div class=\"quform-input quform-input-radio quform-input-97_1028 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1028_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1028\" id=\"quform_97_1028_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1028 quform-field-97_1028_1 m19-toc\" value=\"main\" checked \/><label for=\"quform_97_1028_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1028_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1029 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1029\"><label class=\"quform-label-text\" id=\"quform_97_1029_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1029\"><div class=\"quform-input quform-input-checkbox quform-input-97_1029 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1029_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1029[]\" id=\"quform_97_1029_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1029 quform-field-97_1029_1 m19-addcard\" value=\"gold19\" \/><label for=\"quform_97_1029_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1029_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1029[]\" id=\"quform_97_1029_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1029 quform-field-97_1029_2 m19-addcard\" value=\"dental19\" \/><label for=\"quform_97_1029_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1029_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1029[]\" id=\"quform_97_1029_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1029 quform-field-97_1029_3 m19-addcard\" value=\"checkup19\" \/><label for=\"quform_97_1029_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1029_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1835 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1836\"><div class=\"quform-element quform-element-html quform-element-97_1837 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m19-label\"; >\u5bb6\u5c6c - 19<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1838 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m19-sname').change(function() {\n        var applicant_sname = $('.m19-sname').val();\n        var applicant_gname = $('.m19-gname').val();\n\t\tif ($('.m19-del').is(':checked')) {\n\t\t\t$('#m19-label').html(\"\u5bb6\u5c6c - 19\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel19' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m19-label').html(\"\u5bb6\u5c6c - 19\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m19-gname').change(function() {\n        var applicant_sname = $('.m19-sname').val();\n        var applicant_gname = $('.m19-gname').val();\n\t\tif ($('.m19-del').is(':checked')) {\n\t\t\t$('#m19-label').html(\"\u5bb6\u5c6c - 19\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel19' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m19-label').html(\"\u5bb6\u5c6c - 19\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m19-del').click(function() {\n        var applicant_sname = $('.m19-sname').val();\n        var applicant_gname = $('.m19-gname').val();\n\t\tif ($('.m19-del').is(':checked')) {\n    \t\t$('#m19-label').html(\"\u5bb6\u5c6c - 19\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel19' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m19-label').html(\"\u5bb6\u5c6c - 19\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1839\"><div class=\"quform-element quform-element-radio quform-element-97_1840 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1840\"><label class=\"quform-label-text\" id=\"quform_97_1840_6e1cb0_label\">Member 19 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1840\"><div class=\"quform-input quform-input-radio quform-input-97_1840 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1840_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1840\" id=\"quform_97_1840_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1840 quform-field-97_1840_1 m19-edit\" value=\"edit\" \/><label for=\"quform_97_1840_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1840_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1840\" id=\"quform_97_1840_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1840 quform-field-97_1840_2 m19-edit\" value=\"save\" checked \/><label for=\"quform_97_1840_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1840_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_886 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 20<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2145 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2146\"><div class=\"quform-element quform-element-html quform-element-97_2147 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2148\"><div class=\"quform-element quform-element-text quform-element-97_2149 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2149\"><label class=\"quform-label-text\" for=\"quform_97_2149_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2149\"><div class=\"quform-input quform-input-text quform-input-97_2149 quform-cf\"><input type=\"text\" id=\"quform_97_2149_6e1cb0\" name=\"quform_97_2149\" class=\"quform-field quform-field-text quform-field-97_2149 m20-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2150\"><div class=\"quform-element quform-element-checkbox quform-element-97_2151 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2151\"><label class=\"quform-label-text\" id=\"quform_97_2151_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2151\"><div class=\"quform-input quform-input-checkbox quform-input-97_2151 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2151_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2151[]\" id=\"quform_97_2151_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2151 quform-field-97_2151_1 m20-del\" value=\"Delete\" \/><label for=\"quform_97_2151_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2151_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2152\"><div class=\"quform-element quform-element-html quform-element-97_2153 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_887 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_888\"><div class=\"quform-element quform-element-text quform-element-97_889 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_889\"><label class=\"quform-label-text\" for=\"quform_97_889_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_889\"><div class=\"quform-input quform-input-text quform-input-97_889 quform-cf\"><input type=\"text\" id=\"quform_97_889_6e1cb0\" name=\"quform_97_889\" class=\"quform-field quform-field-text quform-field-97_889 m20-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_890\"><div class=\"quform-element quform-element-text quform-element-97_891 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_891\"><label class=\"quform-label-text\" for=\"quform_97_891_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_891\"><div class=\"quform-input quform-input-text quform-input-97_891 quform-cf\"><input type=\"text\" id=\"quform_97_891_6e1cb0\" name=\"quform_97_891\" class=\"quform-field quform-field-text quform-field-97_891 m20-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_892\"><div class=\"quform-element quform-element-select quform-element-97_893 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_893\"><label class=\"quform-label-text\" for=\"quform_97_893_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_893\"><div class=\"quform-input quform-input-select quform-input-97_893 quform-cf\"><select id=\"quform_97_893_6e1cb0\" name=\"quform_97_893\" class=\"quform-field quform-field-select quform-field-97_893 m20-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_894\"><div class=\"quform-element quform-element-select quform-element-97_895 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_895\"><label class=\"quform-label-text\" for=\"quform_97_895_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_895\"><div class=\"quform-input quform-input-select quform-input-97_895 quform-cf\"><select id=\"quform_97_895_6e1cb0\" name=\"quform_97_895\" class=\"quform-field quform-field-select quform-field-97_895 m20-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_896 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_897\"><div class=\"quform-element quform-element-select quform-element-97_898 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_898\"><label class=\"quform-label-text\" for=\"quform_97_898_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_898\"><div class=\"quform-input quform-input-select quform-input-97_898 quform-cf\"><select id=\"quform_97_898_6e1cb0\" name=\"quform_97_898\" class=\"quform-field quform-field-select quform-field-97_898 quform-field-select-enhanced m20-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_899\"><div class=\"quform-element quform-element-text quform-element-97_912 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_912\"><label class=\"quform-label-text\" for=\"quform_97_912_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_912\"><div class=\"quform-input quform-input-text quform-input-97_912 quform-cf\"><input type=\"text\" id=\"quform_97_912_6e1cb0\" name=\"quform_97_912\" class=\"quform-field quform-field-text quform-field-97_912 m20-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_913 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_914\"><div class=\"quform-element quform-element-date quform-element-97_915 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_915\"><label class=\"quform-label-text\" for=\"quform_97_915_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_915\"><div class=\"quform-input quform-input-date quform-input-97_915 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_915_6e1cb0\" name=\"quform_97_915\" class=\"quform-field quform-field-date quform-field-97_915 m20-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_915&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_916 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_916\"><label class=\"quform-label-text\" for=\"quform_97_916_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_916\"><div class=\"quform-input quform-input-text quform-input-97_916 quform-cf\"><input type=\"text\" id=\"quform_97_916_6e1cb0\" name=\"quform_97_916\" class=\"quform-field quform-field-text quform-field-97_916 m20-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_917\"><\/div><div class=\"quform-element quform-element-column quform-element-97_918\"><div class=\"quform-element quform-element-html quform-element-97_919 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_920 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_920\"><label class=\"quform-label-text\" id=\"quform_97_920_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_920\"><div class=\"quform-input quform-input-radio quform-input-97_920 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_920_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_920\" id=\"quform_97_920_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_920 quform-field-97_920_1 m20-toc\" value=\"main\" checked \/><label for=\"quform_97_920_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_920_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_921 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_921\"><label class=\"quform-label-text\" id=\"quform_97_921_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_921\"><div class=\"quform-input quform-input-checkbox quform-input-97_921 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_921_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_921[]\" id=\"quform_97_921_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_921 quform-field-97_921_1 m20-addcard\" value=\"gold20\" \/><label for=\"quform_97_921_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_921_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_921[]\" id=\"quform_97_921_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_921 quform-field-97_921_2 m20-addcard\" value=\"dental20\" \/><label for=\"quform_97_921_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_921_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_921[]\" id=\"quform_97_921_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_921 quform-field-97_921_3 m20-addcard\" value=\"checkup20\" \/><label for=\"quform_97_921_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_921_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1841 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1842\"><div class=\"quform-element quform-element-html quform-element-97_1843 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m20-label\"; >\u5bb6\u5c6c - 20<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1844 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m20-sname').change(function() {\n        var applicant_sname = $('.m20-sname').val();\n        var applicant_gname = $('.m20-gname').val();\n\t\tif ($('.m20-del').is(':checked')) {\n\t\t\t$('#m20-label').html(\"\u5bb6\u5c6c - 20\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel20' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m20-label').html(\"\u5bb6\u5c6c - 20\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m20-gname').change(function() {\n        var applicant_sname = $('.m20-sname').val();\n        var applicant_gname = $('.m20-gname').val();\n\t\tif ($('.m20-del').is(':checked')) {\n\t\t\t$('#m20-label').html(\"\u5bb6\u5c6c - 20\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel20' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m20-label').html(\"\u5bb6\u5c6c - 20\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m20-del').click(function() {\n        var applicant_sname = $('.m20-sname').val();\n        var applicant_gname = $('.m20-gname').val();\n\t\tif ($('.m20-del').is(':checked')) {\n    \t\t$('#m20-label').html(\"\u5bb6\u5c6c - 20\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel20' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m20-label').html(\"\u5bb6\u5c6c - 20\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1845\"><div class=\"quform-element quform-element-radio quform-element-97_1846 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1846\"><label class=\"quform-label-text\" id=\"quform_97_1846_6e1cb0_label\">Member 20 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1846\"><div class=\"quform-input quform-input-radio quform-input-97_1846 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1846_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1846\" id=\"quform_97_1846_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1846 quform-field-97_1846_1 m20-edit\" value=\"edit\" \/><label for=\"quform_97_1846_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1846_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1846\" id=\"quform_97_1846_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1846 quform-field-97_1846_2 m20-edit\" value=\"save\" checked \/><label for=\"quform_97_1846_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1846_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1354 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 21<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2154 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2155\"><div class=\"quform-element quform-element-html quform-element-97_2156 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2157\"><div class=\"quform-element quform-element-text quform-element-97_2158 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2158\"><label class=\"quform-label-text\" for=\"quform_97_2158_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2158\"><div class=\"quform-input quform-input-text quform-input-97_2158 quform-cf\"><input type=\"text\" id=\"quform_97_2158_6e1cb0\" name=\"quform_97_2158\" class=\"quform-field quform-field-text quform-field-97_2158 m21-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2159\"><div class=\"quform-element quform-element-checkbox quform-element-97_2160 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2160\"><label class=\"quform-label-text\" id=\"quform_97_2160_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2160\"><div class=\"quform-input quform-input-checkbox quform-input-97_2160 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2160_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2160[]\" id=\"quform_97_2160_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2160 quform-field-97_2160_1 m21-del\" value=\"Delete\" \/><label for=\"quform_97_2160_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2160_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2161\"><div class=\"quform-element quform-element-html quform-element-97_2162 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1355 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1356\"><div class=\"quform-element quform-element-text quform-element-97_1357 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1357\"><label class=\"quform-label-text\" for=\"quform_97_1357_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1357\"><div class=\"quform-input quform-input-text quform-input-97_1357 quform-cf\"><input type=\"text\" id=\"quform_97_1357_6e1cb0\" name=\"quform_97_1357\" class=\"quform-field quform-field-text quform-field-97_1357 m21-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1358\"><div class=\"quform-element quform-element-text quform-element-97_1359 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1359\"><label class=\"quform-label-text\" for=\"quform_97_1359_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1359\"><div class=\"quform-input quform-input-text quform-input-97_1359 quform-cf\"><input type=\"text\" id=\"quform_97_1359_6e1cb0\" name=\"quform_97_1359\" class=\"quform-field quform-field-text quform-field-97_1359 m21-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1360\"><div class=\"quform-element quform-element-select quform-element-97_1361 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1361\"><label class=\"quform-label-text\" for=\"quform_97_1361_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1361\"><div class=\"quform-input quform-input-select quform-input-97_1361 quform-cf\"><select id=\"quform_97_1361_6e1cb0\" name=\"quform_97_1361\" class=\"quform-field quform-field-select quform-field-97_1361 m21-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1362\"><div class=\"quform-element quform-element-select quform-element-97_1363 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1363\"><label class=\"quform-label-text\" for=\"quform_97_1363_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1363\"><div class=\"quform-input quform-input-select quform-input-97_1363 quform-cf\"><select id=\"quform_97_1363_6e1cb0\" name=\"quform_97_1363\" class=\"quform-field quform-field-select quform-field-97_1363 m21-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1364 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1365\"><div class=\"quform-element quform-element-select quform-element-97_1366 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1366\"><label class=\"quform-label-text\" for=\"quform_97_1366_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1366\"><div class=\"quform-input quform-input-select quform-input-97_1366 quform-cf\"><select id=\"quform_97_1366_6e1cb0\" name=\"quform_97_1366\" class=\"quform-field quform-field-select quform-field-97_1366 quform-field-select-enhanced m21-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1367\"><div class=\"quform-element quform-element-text quform-element-97_1380 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1380\"><label class=\"quform-label-text\" for=\"quform_97_1380_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1380\"><div class=\"quform-input quform-input-text quform-input-97_1380 quform-cf\"><input type=\"text\" id=\"quform_97_1380_6e1cb0\" name=\"quform_97_1380\" class=\"quform-field quform-field-text quform-field-97_1380 m21-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1381 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1382\"><div class=\"quform-element quform-element-date quform-element-97_1383 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1383\"><label class=\"quform-label-text\" for=\"quform_97_1383_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1383\"><div class=\"quform-input quform-input-date quform-input-97_1383 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1383_6e1cb0\" name=\"quform_97_1383\" class=\"quform-field quform-field-date quform-field-97_1383 m21-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1383&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1384 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1384\"><label class=\"quform-label-text\" for=\"quform_97_1384_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1384\"><div class=\"quform-input quform-input-text quform-input-97_1384 quform-cf\"><input type=\"text\" id=\"quform_97_1384_6e1cb0\" name=\"quform_97_1384\" class=\"quform-field quform-field-text quform-field-97_1384 m21-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1385\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1386\"><div class=\"quform-element quform-element-html quform-element-97_1387 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1388 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1388\"><label class=\"quform-label-text\" id=\"quform_97_1388_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1388\"><div class=\"quform-input quform-input-radio quform-input-97_1388 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1388_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1388\" id=\"quform_97_1388_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1388 quform-field-97_1388_1 m21-toc\" value=\"main\" checked \/><label for=\"quform_97_1388_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1388_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1389 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1389\"><label class=\"quform-label-text\" id=\"quform_97_1389_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1389\"><div class=\"quform-input quform-input-checkbox quform-input-97_1389 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1389_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1389[]\" id=\"quform_97_1389_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1389 quform-field-97_1389_1 m21-addcard\" value=\"gold21\" \/><label for=\"quform_97_1389_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1389_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1389[]\" id=\"quform_97_1389_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1389 quform-field-97_1389_2 m21-addcard\" value=\"dental21\" \/><label for=\"quform_97_1389_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1389_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1389[]\" id=\"quform_97_1389_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1389 quform-field-97_1389_3 m21-addcard\" value=\"checkup21\" \/><label for=\"quform_97_1389_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1389_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1847 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1848\"><div class=\"quform-element quform-element-html quform-element-97_1849 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m21-label\"; >\u5bb6\u5c6c - 21<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1850 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m21-sname').change(function() {\n        var applicant_sname = $('.m21-sname').val();\n        var applicant_gname = $('.m21-gname').val();\n\t\tif ($('.m21-del').is(':checked')) {\n\t\t\t$('#m21-label').html(\"\u5bb6\u5c6c - 21\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel21' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m21-label').html(\"\u5bb6\u5c6c - 21\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m21-gname').change(function() {\n        var applicant_sname = $('.m21-sname').val();\n        var applicant_gname = $('.m21-gname').val();\n\t\tif ($('.m21-del').is(':checked')) {\n\t\t\t$('#m21-label').html(\"\u5bb6\u5c6c - 21\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel21' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m21-label').html(\"\u5bb6\u5c6c - 21\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m21-del').click(function() {\n        var applicant_sname = $('.m21-sname').val();\n        var applicant_gname = $('.m21-gname').val();\n\t\tif ($('.m21-del').is(':checked')) {\n    \t\t$('#m21-label').html(\"\u5bb6\u5c6c - 21\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel21' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m21-label').html(\"\u5bb6\u5c6c - 21\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1851\"><div class=\"quform-element quform-element-radio quform-element-97_1852 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1852\"><label class=\"quform-label-text\" id=\"quform_97_1852_6e1cb0_label\">Member 21 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1852\"><div class=\"quform-input quform-input-radio quform-input-97_1852 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1852_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1852\" id=\"quform_97_1852_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1852 quform-field-97_1852_1 m21-edit\" value=\"edit\" \/><label for=\"quform_97_1852_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1852_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1852\" id=\"quform_97_1852_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1852 quform-field-97_1852_2 m21-edit\" value=\"save\" checked \/><label for=\"quform_97_1852_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1852_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1426 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 22<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2163 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2164\"><div class=\"quform-element quform-element-html quform-element-97_2165 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2166\"><div class=\"quform-element quform-element-text quform-element-97_2167 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2167\"><label class=\"quform-label-text\" for=\"quform_97_2167_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2167\"><div class=\"quform-input quform-input-text quform-input-97_2167 quform-cf\"><input type=\"text\" id=\"quform_97_2167_6e1cb0\" name=\"quform_97_2167\" class=\"quform-field quform-field-text quform-field-97_2167 m22-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2168\"><div class=\"quform-element quform-element-checkbox quform-element-97_2169 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2169\"><label class=\"quform-label-text\" id=\"quform_97_2169_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2169\"><div class=\"quform-input quform-input-checkbox quform-input-97_2169 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2169_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2169[]\" id=\"quform_97_2169_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2169 quform-field-97_2169_1 m22-del\" value=\"Delete\" \/><label for=\"quform_97_2169_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2169_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2170\"><div class=\"quform-element quform-element-html quform-element-97_2171 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1427 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1428\"><div class=\"quform-element quform-element-text quform-element-97_1429 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1429\"><label class=\"quform-label-text\" for=\"quform_97_1429_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1429\"><div class=\"quform-input quform-input-text quform-input-97_1429 quform-cf\"><input type=\"text\" id=\"quform_97_1429_6e1cb0\" name=\"quform_97_1429\" class=\"quform-field quform-field-text quform-field-97_1429 m22-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1430\"><div class=\"quform-element quform-element-text quform-element-97_1431 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1431\"><label class=\"quform-label-text\" for=\"quform_97_1431_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1431\"><div class=\"quform-input quform-input-text quform-input-97_1431 quform-cf\"><input type=\"text\" id=\"quform_97_1431_6e1cb0\" name=\"quform_97_1431\" class=\"quform-field quform-field-text quform-field-97_1431 m22-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1432\"><div class=\"quform-element quform-element-select quform-element-97_1433 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1433\"><label class=\"quform-label-text\" for=\"quform_97_1433_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1433\"><div class=\"quform-input quform-input-select quform-input-97_1433 quform-cf\"><select id=\"quform_97_1433_6e1cb0\" name=\"quform_97_1433\" class=\"quform-field quform-field-select quform-field-97_1433 m22-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1434\"><div class=\"quform-element quform-element-select quform-element-97_1435 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1435\"><label class=\"quform-label-text\" for=\"quform_97_1435_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1435\"><div class=\"quform-input quform-input-select quform-input-97_1435 quform-cf\"><select id=\"quform_97_1435_6e1cb0\" name=\"quform_97_1435\" class=\"quform-field quform-field-select quform-field-97_1435 m22-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1436 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1437\"><div class=\"quform-element quform-element-select quform-element-97_1438 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1438\"><label class=\"quform-label-text\" for=\"quform_97_1438_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1438\"><div class=\"quform-input quform-input-select quform-input-97_1438 quform-cf\"><select id=\"quform_97_1438_6e1cb0\" name=\"quform_97_1438\" class=\"quform-field quform-field-select quform-field-97_1438 quform-field-select-enhanced m22-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1439\"><div class=\"quform-element quform-element-text quform-element-97_1452 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1452\"><label class=\"quform-label-text\" for=\"quform_97_1452_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1452\"><div class=\"quform-input quform-input-text quform-input-97_1452 quform-cf\"><input type=\"text\" id=\"quform_97_1452_6e1cb0\" name=\"quform_97_1452\" class=\"quform-field quform-field-text quform-field-97_1452 m22-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1453 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1454\"><div class=\"quform-element quform-element-date quform-element-97_1455 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1455\"><label class=\"quform-label-text\" for=\"quform_97_1455_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1455\"><div class=\"quform-input quform-input-date quform-input-97_1455 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1455_6e1cb0\" name=\"quform_97_1455\" class=\"quform-field quform-field-date quform-field-97_1455 m22-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1455&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1456 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1456\"><label class=\"quform-label-text\" for=\"quform_97_1456_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1456\"><div class=\"quform-input quform-input-text quform-input-97_1456 quform-cf\"><input type=\"text\" id=\"quform_97_1456_6e1cb0\" name=\"quform_97_1456\" class=\"quform-field quform-field-text quform-field-97_1456 m22-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1457\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1458\"><div class=\"quform-element quform-element-html quform-element-97_1459 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1460 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1460\"><label class=\"quform-label-text\" id=\"quform_97_1460_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1460\"><div class=\"quform-input quform-input-radio quform-input-97_1460 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1460_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1460\" id=\"quform_97_1460_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1460 quform-field-97_1460_1 m22-toc\" value=\"main\" checked \/><label for=\"quform_97_1460_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1460_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1461 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1461\"><label class=\"quform-label-text\" id=\"quform_97_1461_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1461\"><div class=\"quform-input quform-input-checkbox quform-input-97_1461 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1461_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1461[]\" id=\"quform_97_1461_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1461 quform-field-97_1461_1 m22-addcard\" value=\"gold22\" \/><label for=\"quform_97_1461_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1461_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1461[]\" id=\"quform_97_1461_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1461 quform-field-97_1461_2 m22-addcard\" value=\"dental22\" \/><label for=\"quform_97_1461_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1461_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1461[]\" id=\"quform_97_1461_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1461 quform-field-97_1461_3 m22-addcard\" value=\"checkup22\" \/><label for=\"quform_97_1461_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1461_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1853 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1854\"><div class=\"quform-element quform-element-html quform-element-97_1855 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m22-label\"; >\u5bb6\u5c6c - 22<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1856 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m22-sname').change(function() {\n        var applicant_sname = $('.m22-sname').val();\n        var applicant_gname = $('.m22-gname').val();\n\t\tif ($('.m22-del').is(':checked')) {\n\t\t\t$('#m22-label').html(\"\u5bb6\u5c6c - 22\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel22' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m22-label').html(\"\u5bb6\u5c6c - 22\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m22-gname').change(function() {\n        var applicant_sname = $('.m22-sname').val();\n        var applicant_gname = $('.m22-gname').val();\n\t\tif ($('.m22-del').is(':checked')) {\n\t\t\t$('#m22-label').html(\"\u5bb6\u5c6c - 22\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel22' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m22-label').html(\"\u5bb6\u5c6c - 22\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m22-del').click(function() {\n        var applicant_sname = $('.m22-sname').val();\n        var applicant_gname = $('.m22-gname').val();\n\t\tif ($('.m22-del').is(':checked')) {\n    \t\t$('#m22-label').html(\"\u5bb6\u5c6c - 22\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel22' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m22-label').html(\"\u5bb6\u5c6c - 22\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1857\"><div class=\"quform-element quform-element-radio quform-element-97_1858 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1858\"><label class=\"quform-label-text\" id=\"quform_97_1858_6e1cb0_label\">Member 22 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1858\"><div class=\"quform-input quform-input-radio quform-input-97_1858 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1858_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1858\" id=\"quform_97_1858_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1858 quform-field-97_1858_1 m22-edit\" value=\"edit\" \/><label for=\"quform_97_1858_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1858_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1858\" id=\"quform_97_1858_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1858 quform-field-97_1858_2 m22-edit\" value=\"save\" checked \/><label for=\"quform_97_1858_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1858_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1390 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 23<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2172 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2173\"><div class=\"quform-element quform-element-html quform-element-97_2174 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2175\"><div class=\"quform-element quform-element-text quform-element-97_2176 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2176\"><label class=\"quform-label-text\" for=\"quform_97_2176_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2176\"><div class=\"quform-input quform-input-text quform-input-97_2176 quform-cf\"><input type=\"text\" id=\"quform_97_2176_6e1cb0\" name=\"quform_97_2176\" class=\"quform-field quform-field-text quform-field-97_2176 m23-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2177\"><div class=\"quform-element quform-element-checkbox quform-element-97_2178 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2178\"><label class=\"quform-label-text\" id=\"quform_97_2178_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2178\"><div class=\"quform-input quform-input-checkbox quform-input-97_2178 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2178_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2178[]\" id=\"quform_97_2178_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2178 quform-field-97_2178_1 m23-del\" value=\"Delete\" \/><label for=\"quform_97_2178_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2178_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2179\"><div class=\"quform-element quform-element-html quform-element-97_2180 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1391 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1392\"><div class=\"quform-element quform-element-text quform-element-97_1393 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1393\"><label class=\"quform-label-text\" for=\"quform_97_1393_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1393\"><div class=\"quform-input quform-input-text quform-input-97_1393 quform-cf\"><input type=\"text\" id=\"quform_97_1393_6e1cb0\" name=\"quform_97_1393\" class=\"quform-field quform-field-text quform-field-97_1393 m23-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1394\"><div class=\"quform-element quform-element-text quform-element-97_1395 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1395\"><label class=\"quform-label-text\" for=\"quform_97_1395_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1395\"><div class=\"quform-input quform-input-text quform-input-97_1395 quform-cf\"><input type=\"text\" id=\"quform_97_1395_6e1cb0\" name=\"quform_97_1395\" class=\"quform-field quform-field-text quform-field-97_1395 m23-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1396\"><div class=\"quform-element quform-element-select quform-element-97_1397 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1397\"><label class=\"quform-label-text\" for=\"quform_97_1397_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1397\"><div class=\"quform-input quform-input-select quform-input-97_1397 quform-cf\"><select id=\"quform_97_1397_6e1cb0\" name=\"quform_97_1397\" class=\"quform-field quform-field-select quform-field-97_1397 m23-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1398\"><div class=\"quform-element quform-element-select quform-element-97_1399 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1399\"><label class=\"quform-label-text\" for=\"quform_97_1399_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1399\"><div class=\"quform-input quform-input-select quform-input-97_1399 quform-cf\"><select id=\"quform_97_1399_6e1cb0\" name=\"quform_97_1399\" class=\"quform-field quform-field-select quform-field-97_1399 m23-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1400 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1401\"><div class=\"quform-element quform-element-select quform-element-97_1402 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1402\"><label class=\"quform-label-text\" for=\"quform_97_1402_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1402\"><div class=\"quform-input quform-input-select quform-input-97_1402 quform-cf\"><select id=\"quform_97_1402_6e1cb0\" name=\"quform_97_1402\" class=\"quform-field quform-field-select quform-field-97_1402 quform-field-select-enhanced m23-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1403\"><div class=\"quform-element quform-element-text quform-element-97_1416 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1416\"><label class=\"quform-label-text\" for=\"quform_97_1416_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1416\"><div class=\"quform-input quform-input-text quform-input-97_1416 quform-cf\"><input type=\"text\" id=\"quform_97_1416_6e1cb0\" name=\"quform_97_1416\" class=\"quform-field quform-field-text quform-field-97_1416 m23-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1417 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1418\"><div class=\"quform-element quform-element-date quform-element-97_1419 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1419\"><label class=\"quform-label-text\" for=\"quform_97_1419_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1419\"><div class=\"quform-input quform-input-date quform-input-97_1419 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1419_6e1cb0\" name=\"quform_97_1419\" class=\"quform-field quform-field-date quform-field-97_1419 m23-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1419&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1420 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1420\"><label class=\"quform-label-text\" for=\"quform_97_1420_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1420\"><div class=\"quform-input quform-input-text quform-input-97_1420 quform-cf\"><input type=\"text\" id=\"quform_97_1420_6e1cb0\" name=\"quform_97_1420\" class=\"quform-field quform-field-text quform-field-97_1420 m23-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1421\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1422\"><div class=\"quform-element quform-element-html quform-element-97_1423 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1424 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1424\"><label class=\"quform-label-text\" id=\"quform_97_1424_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1424\"><div class=\"quform-input quform-input-radio quform-input-97_1424 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1424_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1424\" id=\"quform_97_1424_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1424 quform-field-97_1424_1 m23-toc\" value=\"main\" checked \/><label for=\"quform_97_1424_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1424_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1425 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1425\"><label class=\"quform-label-text\" id=\"quform_97_1425_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1425\"><div class=\"quform-input quform-input-checkbox quform-input-97_1425 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1425_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1425[]\" id=\"quform_97_1425_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1425 quform-field-97_1425_1 m23-addcard\" value=\"gold23\" \/><label for=\"quform_97_1425_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1425_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1425[]\" id=\"quform_97_1425_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1425 quform-field-97_1425_2 m23-addcard\" value=\"dental23\" \/><label for=\"quform_97_1425_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1425_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1425[]\" id=\"quform_97_1425_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1425 quform-field-97_1425_3 m23-addcard\" value=\"checkup23\" \/><label for=\"quform_97_1425_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1425_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1859 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1860\"><div class=\"quform-element quform-element-html quform-element-97_1861 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m23-label\"; >\u5bb6\u5c6c - 23<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1862 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m23-sname').change(function() {\n        var applicant_sname = $('.m23-sname').val();\n        var applicant_gname = $('.m23-gname').val();\n\t\tif ($('.m23-del').is(':checked')) {\n\t\t\t$('#m23-label').html(\"\u5bb6\u5c6c - 23\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel23' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m23-label').html(\"\u5bb6\u5c6c - 23\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m23-gname').change(function() {\n        var applicant_sname = $('.m23-sname').val();\n        var applicant_gname = $('.m23-gname').val();\n\t\tif ($('.m23-del').is(':checked')) {\n\t\t\t$('#m23-label').html(\"\u5bb6\u5c6c - 23\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel23' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m23-label').html(\"\u5bb6\u5c6c - 23\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m23-del').click(function() {\n        var applicant_sname = $('.m23-sname').val();\n        var applicant_gname = $('.m23-gname').val();\n\t\tif ($('.m23-del').is(':checked')) {\n    \t\t$('#m23-label').html(\"\u5bb6\u5c6c - 23\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel23' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m23-label').html(\"\u5bb6\u5c6c - 23\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1863\"><div class=\"quform-element quform-element-radio quform-element-97_1864 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1864\"><label class=\"quform-label-text\" id=\"quform_97_1864_6e1cb0_label\">Member 23 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1864\"><div class=\"quform-input quform-input-radio quform-input-97_1864 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1864_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1864\" id=\"quform_97_1864_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1864 quform-field-97_1864_1 m23-edit\" value=\"edit\" \/><label for=\"quform_97_1864_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1864_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1864\" id=\"quform_97_1864_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1864 quform-field-97_1864_2 m23-edit\" value=\"save\" checked \/><label for=\"quform_97_1864_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1864_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1678 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 24<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2181 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2182\"><div class=\"quform-element quform-element-html quform-element-97_2183 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2184\"><div class=\"quform-element quform-element-text quform-element-97_2185 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2185\"><label class=\"quform-label-text\" for=\"quform_97_2185_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2185\"><div class=\"quform-input quform-input-text quform-input-97_2185 quform-cf\"><input type=\"text\" id=\"quform_97_2185_6e1cb0\" name=\"quform_97_2185\" class=\"quform-field quform-field-text quform-field-97_2185 m24-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2186\"><div class=\"quform-element quform-element-checkbox quform-element-97_2187 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2187\"><label class=\"quform-label-text\" id=\"quform_97_2187_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2187\"><div class=\"quform-input quform-input-checkbox quform-input-97_2187 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2187_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2187[]\" id=\"quform_97_2187_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2187 quform-field-97_2187_1 m24-del\" value=\"Delete\" \/><label for=\"quform_97_2187_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2187_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2188\"><div class=\"quform-element quform-element-html quform-element-97_2189 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1679 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1680\"><div class=\"quform-element quform-element-text quform-element-97_1681 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1681\"><label class=\"quform-label-text\" for=\"quform_97_1681_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1681\"><div class=\"quform-input quform-input-text quform-input-97_1681 quform-cf\"><input type=\"text\" id=\"quform_97_1681_6e1cb0\" name=\"quform_97_1681\" class=\"quform-field quform-field-text quform-field-97_1681 m23-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1682\"><div class=\"quform-element quform-element-text quform-element-97_1683 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1683\"><label class=\"quform-label-text\" for=\"quform_97_1683_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1683\"><div class=\"quform-input quform-input-text quform-input-97_1683 quform-cf\"><input type=\"text\" id=\"quform_97_1683_6e1cb0\" name=\"quform_97_1683\" class=\"quform-field quform-field-text quform-field-97_1683 m23-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1684\"><div class=\"quform-element quform-element-select quform-element-97_1685 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1685\"><label class=\"quform-label-text\" for=\"quform_97_1685_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1685\"><div class=\"quform-input quform-input-select quform-input-97_1685 quform-cf\"><select id=\"quform_97_1685_6e1cb0\" name=\"quform_97_1685\" class=\"quform-field quform-field-select quform-field-97_1685 m23-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1686\"><div class=\"quform-element quform-element-select quform-element-97_1687 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1687\"><label class=\"quform-label-text\" for=\"quform_97_1687_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1687\"><div class=\"quform-input quform-input-select quform-input-97_1687 quform-cf\"><select id=\"quform_97_1687_6e1cb0\" name=\"quform_97_1687\" class=\"quform-field quform-field-select quform-field-97_1687 m23-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1688 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1689\"><div class=\"quform-element quform-element-select quform-element-97_1690 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1690\"><label class=\"quform-label-text\" for=\"quform_97_1690_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1690\"><div class=\"quform-input quform-input-select quform-input-97_1690 quform-cf\"><select id=\"quform_97_1690_6e1cb0\" name=\"quform_97_1690\" class=\"quform-field quform-field-select quform-field-97_1690 quform-field-select-enhanced m23-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1691\"><div class=\"quform-element quform-element-text quform-element-97_1704 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1704\"><label class=\"quform-label-text\" for=\"quform_97_1704_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1704\"><div class=\"quform-input quform-input-text quform-input-97_1704 quform-cf\"><input type=\"text\" id=\"quform_97_1704_6e1cb0\" name=\"quform_97_1704\" class=\"quform-field quform-field-text quform-field-97_1704 m23-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u8eab\u4efd\u8b49\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1705 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1706\"><div class=\"quform-element quform-element-date quform-element-97_1707 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1707\"><label class=\"quform-label-text\" for=\"quform_97_1707_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1707\"><div class=\"quform-input quform-input-date quform-input-97_1707 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1707_6e1cb0\" name=\"quform_97_1707\" class=\"quform-field quform-field-date quform-field-97_1707 m23-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1707&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1708 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1708\"><label class=\"quform-label-text\" for=\"quform_97_1708_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1708\"><div class=\"quform-input quform-input-text quform-input-97_1708 quform-cf\"><input type=\"text\" id=\"quform_97_1708_6e1cb0\" name=\"quform_97_1708\" class=\"quform-field quform-field-text quform-field-97_1708 m23-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1709\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1710\"><div class=\"quform-element quform-element-html quform-element-97_1711 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1712 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1712\"><label class=\"quform-label-text\" id=\"quform_97_1712_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1712\"><div class=\"quform-input quform-input-radio quform-input-97_1712 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1712_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1712\" id=\"quform_97_1712_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1712 quform-field-97_1712_1 m23-toc\" value=\"main\" checked \/><label for=\"quform_97_1712_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1712_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1713 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1713\"><label class=\"quform-label-text\" id=\"quform_97_1713_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1713\"><div class=\"quform-input quform-input-checkbox quform-input-97_1713 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1713_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1713[]\" id=\"quform_97_1713_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1713 quform-field-97_1713_1 m23-addcard\" value=\"gold24\" \/><label for=\"quform_97_1713_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1713_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1713[]\" id=\"quform_97_1713_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1713 quform-field-97_1713_2 m23-addcard\" value=\"dental24\" \/><label for=\"quform_97_1713_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1713_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1713[]\" id=\"quform_97_1713_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1713 quform-field-97_1713_3 m23-addcard\" value=\"checkup24\" \/><label for=\"quform_97_1713_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1713_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1865 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1866\"><div class=\"quform-element quform-element-html quform-element-97_1867 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m24-label\"; >\u5bb6\u5c6c - 24<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1868 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m24-sname').change(function() {\n        var applicant_sname = $('.m24-sname').val();\n        var applicant_gname = $('.m24-gname').val();\n\t\tif ($('.m24-del').is(':checked')) {\n\t\t\t$('#m24-label').html(\"\u5bb6\u5c6c - 24\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel24' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m24-label').html(\"\u5bb6\u5c6c - 24\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m24-gname').change(function() {\n        var applicant_sname = $('.m24-sname').val();\n        var applicant_gname = $('.m24-gname').val();\n\t\tif ($('.m24-del').is(':checked')) {\n\t\t\t$('#m24-label').html(\"\u5bb6\u5c6c - 24\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel24' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m24-label').html(\"\u5bb6\u5c6c - 24\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m24-del').click(function() {\n        var applicant_sname = $('.m24-sname').val();\n        var applicant_gname = $('.m24-gname').val();\n\t\tif ($('.m24-del').is(':checked')) {\n    \t\t$('#m24-label').html(\"\u5bb6\u5c6c - 24\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel24' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m24-label').html(\"\u5bb6\u5c6c - 24\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1869\"><div class=\"quform-element quform-element-radio quform-element-97_1870 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1870\"><label class=\"quform-label-text\" id=\"quform_97_1870_6e1cb0_label\">Member 24 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1870\"><div class=\"quform-input quform-input-radio quform-input-97_1870 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1870_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1870\" id=\"quform_97_1870_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1870 quform-field-97_1870_1 m24-edit\" value=\"edit\" \/><label for=\"quform_97_1870_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1870_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1870\" id=\"quform_97_1870_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1870 quform-field-97_1870_2 m24-edit\" value=\"save\" checked \/><label for=\"quform_97_1870_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1870_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1642 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 25<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2190 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2191\"><div class=\"quform-element quform-element-html quform-element-97_2192 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2193\"><div class=\"quform-element quform-element-text quform-element-97_2194 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2194\"><label class=\"quform-label-text\" for=\"quform_97_2194_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2194\"><div class=\"quform-input quform-input-text quform-input-97_2194 quform-cf\"><input type=\"text\" id=\"quform_97_2194_6e1cb0\" name=\"quform_97_2194\" class=\"quform-field quform-field-text quform-field-97_2194 m25-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2195\"><div class=\"quform-element quform-element-checkbox quform-element-97_2196 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2196\"><label class=\"quform-label-text\" id=\"quform_97_2196_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2196\"><div class=\"quform-input quform-input-checkbox quform-input-97_2196 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2196_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2196[]\" id=\"quform_97_2196_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2196 quform-field-97_2196_1 m25-del\" value=\"Delete\" \/><label for=\"quform_97_2196_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2196_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2197\"><div class=\"quform-element quform-element-html quform-element-97_2198 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1643 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1644\"><div class=\"quform-element quform-element-text quform-element-97_1645 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1645\"><label class=\"quform-label-text\" for=\"quform_97_1645_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1645\"><div class=\"quform-input quform-input-text quform-input-97_1645 quform-cf\"><input type=\"text\" id=\"quform_97_1645_6e1cb0\" name=\"quform_97_1645\" class=\"quform-field quform-field-text quform-field-97_1645 m25-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1646\"><div class=\"quform-element quform-element-text quform-element-97_1647 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1647\"><label class=\"quform-label-text\" for=\"quform_97_1647_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1647\"><div class=\"quform-input quform-input-text quform-input-97_1647 quform-cf\"><input type=\"text\" id=\"quform_97_1647_6e1cb0\" name=\"quform_97_1647\" class=\"quform-field quform-field-text quform-field-97_1647 m25-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1648\"><div class=\"quform-element quform-element-select quform-element-97_1649 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1649\"><label class=\"quform-label-text\" for=\"quform_97_1649_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1649\"><div class=\"quform-input quform-input-select quform-input-97_1649 quform-cf\"><select id=\"quform_97_1649_6e1cb0\" name=\"quform_97_1649\" class=\"quform-field quform-field-select quform-field-97_1649 m25-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1650\"><div class=\"quform-element quform-element-select quform-element-97_1651 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1651\"><label class=\"quform-label-text\" for=\"quform_97_1651_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1651\"><div class=\"quform-input quform-input-select quform-input-97_1651 quform-cf\"><select id=\"quform_97_1651_6e1cb0\" name=\"quform_97_1651\" class=\"quform-field quform-field-select quform-field-97_1651 m25-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1652 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1653\"><div class=\"quform-element quform-element-select quform-element-97_1654 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1654\"><label class=\"quform-label-text\" for=\"quform_97_1654_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1654\"><div class=\"quform-input quform-input-select quform-input-97_1654 quform-cf\"><select id=\"quform_97_1654_6e1cb0\" name=\"quform_97_1654\" class=\"quform-field quform-field-select quform-field-97_1654 quform-field-select-enhanced m25-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1655\"><div class=\"quform-element quform-element-text quform-element-97_1668 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1668\"><label class=\"quform-label-text\" for=\"quform_97_1668_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1668\"><div class=\"quform-input quform-input-text quform-input-97_1668 quform-cf\"><input type=\"text\" id=\"quform_97_1668_6e1cb0\" name=\"quform_97_1668\" class=\"quform-field quform-field-text quform-field-97_1668 m25-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1669 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1670\"><div class=\"quform-element quform-element-date quform-element-97_1671 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1671\"><label class=\"quform-label-text\" for=\"quform_97_1671_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1671\"><div class=\"quform-input quform-input-date quform-input-97_1671 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1671_6e1cb0\" name=\"quform_97_1671\" class=\"quform-field quform-field-date quform-field-97_1671 m25-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1671&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1672 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1672\"><label class=\"quform-label-text\" for=\"quform_97_1672_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1672\"><div class=\"quform-input quform-input-text quform-input-97_1672 quform-cf\"><input type=\"text\" id=\"quform_97_1672_6e1cb0\" name=\"quform_97_1672\" class=\"quform-field quform-field-text quform-field-97_1672 m25-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1673\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1674\"><div class=\"quform-element quform-element-html quform-element-97_1675 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1676 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1676\"><label class=\"quform-label-text\" id=\"quform_97_1676_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1676\"><div class=\"quform-input quform-input-radio quform-input-97_1676 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1676_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1676\" id=\"quform_97_1676_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1676 quform-field-97_1676_1 m25-toc\" value=\"main\" checked \/><label for=\"quform_97_1676_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1676_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1677 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1677\"><label class=\"quform-label-text\" id=\"quform_97_1677_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1677\"><div class=\"quform-input quform-input-checkbox quform-input-97_1677 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1677_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1677[]\" id=\"quform_97_1677_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1677 quform-field-97_1677_1 m25-addcard\" value=\"gold25\" \/><label for=\"quform_97_1677_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1677_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1677[]\" id=\"quform_97_1677_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1677 quform-field-97_1677_2 m25-addcard\" value=\"dental25\" \/><label for=\"quform_97_1677_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1677_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1677[]\" id=\"quform_97_1677_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1677 quform-field-97_1677_3 m25-addcard\" value=\"checkup25\" \/><label for=\"quform_97_1677_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1677_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1871 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1872\"><div class=\"quform-element quform-element-html quform-element-97_1873 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m25-label\"; >\u5bb6\u5c6c - 25<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1874 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m25-sname').change(function() {\n        var applicant_sname = $('.m25-sname').val();\n        var applicant_gname = $('.m25-gname').val();\n\t\tif ($('.m25-del').is(':checked')) {\n\t\t\t$('#m25-label').html(\"\u5bb6\u5c6c - 25\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel25' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m25-label').html(\"\u5bb6\u5c6c - 25\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m25-gname').change(function() {\n        var applicant_sname = $('.m25-sname').val();\n        var applicant_gname = $('.m25-gname').val();\n\t\tif ($('.m25-del').is(':checked')) {\n\t\t\t$('#m25-label').html(\"\u5bb6\u5c6c - 25\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel25' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m25-label').html(\"\u5bb6\u5c6c - 25\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m25-del').click(function() {\n        var applicant_sname = $('.m25-sname').val();\n        var applicant_gname = $('.m25-gname').val();\n\t\tif ($('.m25-del').is(':checked')) {\n    \t\t$('#m25-label').html(\"\u5bb6\u5c6c - 25\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel25' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m25-label').html(\"\u5bb6\u5c6c - 25\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1875\"><div class=\"quform-element quform-element-radio quform-element-97_1876 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1876\"><label class=\"quform-label-text\" id=\"quform_97_1876_6e1cb0_label\">Member 25 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1876\"><div class=\"quform-input quform-input-radio quform-input-97_1876 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1876_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1876\" id=\"quform_97_1876_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1876 quform-field-97_1876_1 m25-edit\" value=\"edit\" \/><label for=\"quform_97_1876_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1876_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1876\" id=\"quform_97_1876_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1876 quform-field-97_1876_2 m25-edit\" value=\"save\" checked \/><label for=\"quform_97_1876_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1876_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1606 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 26<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2199 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2200\"><div class=\"quform-element quform-element-html quform-element-97_2201 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2202\"><div class=\"quform-element quform-element-text quform-element-97_2203 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2203\"><label class=\"quform-label-text\" for=\"quform_97_2203_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2203\"><div class=\"quform-input quform-input-text quform-input-97_2203 quform-cf\"><input type=\"text\" id=\"quform_97_2203_6e1cb0\" name=\"quform_97_2203\" class=\"quform-field quform-field-text quform-field-97_2203 m26-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2204\"><div class=\"quform-element quform-element-checkbox quform-element-97_2205 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2205\"><label class=\"quform-label-text\" id=\"quform_97_2205_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2205\"><div class=\"quform-input quform-input-checkbox quform-input-97_2205 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2205_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2205[]\" id=\"quform_97_2205_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2205 quform-field-97_2205_1 m26-del\" value=\"Delete\" \/><label for=\"quform_97_2205_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2205_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2206\"><div class=\"quform-element quform-element-html quform-element-97_2207 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1607 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1608\"><div class=\"quform-element quform-element-text quform-element-97_1609 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1609\"><label class=\"quform-label-text\" for=\"quform_97_1609_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1609\"><div class=\"quform-input quform-input-text quform-input-97_1609 quform-cf\"><input type=\"text\" id=\"quform_97_1609_6e1cb0\" name=\"quform_97_1609\" class=\"quform-field quform-field-text quform-field-97_1609 m26-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1610\"><div class=\"quform-element quform-element-text quform-element-97_1611 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1611\"><label class=\"quform-label-text\" for=\"quform_97_1611_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1611\"><div class=\"quform-input quform-input-text quform-input-97_1611 quform-cf\"><input type=\"text\" id=\"quform_97_1611_6e1cb0\" name=\"quform_97_1611\" class=\"quform-field quform-field-text quform-field-97_1611 m26-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1612\"><div class=\"quform-element quform-element-select quform-element-97_1613 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1613\"><label class=\"quform-label-text\" for=\"quform_97_1613_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1613\"><div class=\"quform-input quform-input-select quform-input-97_1613 quform-cf\"><select id=\"quform_97_1613_6e1cb0\" name=\"quform_97_1613\" class=\"quform-field quform-field-select quform-field-97_1613 m26-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1614\"><div class=\"quform-element quform-element-select quform-element-97_1615 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1615\"><label class=\"quform-label-text\" for=\"quform_97_1615_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1615\"><div class=\"quform-input quform-input-select quform-input-97_1615 quform-cf\"><select id=\"quform_97_1615_6e1cb0\" name=\"quform_97_1615\" class=\"quform-field quform-field-select quform-field-97_1615 m26-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1616 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1617\"><div class=\"quform-element quform-element-select quform-element-97_1618 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1618\"><label class=\"quform-label-text\" for=\"quform_97_1618_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1618\"><div class=\"quform-input quform-input-select quform-input-97_1618 quform-cf\"><select id=\"quform_97_1618_6e1cb0\" name=\"quform_97_1618\" class=\"quform-field quform-field-select quform-field-97_1618 quform-field-select-enhanced m26-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1619\"><div class=\"quform-element quform-element-text quform-element-97_1632 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1632\"><label class=\"quform-label-text\" for=\"quform_97_1632_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1632\"><div class=\"quform-input quform-input-text quform-input-97_1632 quform-cf\"><input type=\"text\" id=\"quform_97_1632_6e1cb0\" name=\"quform_97_1632\" class=\"quform-field quform-field-text quform-field-97_1632 m26-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1633 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1634\"><div class=\"quform-element quform-element-date quform-element-97_1635 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1635\"><label class=\"quform-label-text\" for=\"quform_97_1635_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1635\"><div class=\"quform-input quform-input-date quform-input-97_1635 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1635_6e1cb0\" name=\"quform_97_1635\" class=\"quform-field quform-field-date quform-field-97_1635 m26-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1635&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1636 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1636\"><label class=\"quform-label-text\" for=\"quform_97_1636_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1636\"><div class=\"quform-input quform-input-text quform-input-97_1636 quform-cf\"><input type=\"text\" id=\"quform_97_1636_6e1cb0\" name=\"quform_97_1636\" class=\"quform-field quform-field-text quform-field-97_1636 m26-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1637\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1638\"><div class=\"quform-element quform-element-html quform-element-97_1639 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1640 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1640\"><label class=\"quform-label-text\" id=\"quform_97_1640_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1640\"><div class=\"quform-input quform-input-radio quform-input-97_1640 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1640_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1640\" id=\"quform_97_1640_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1640 quform-field-97_1640_1 m26-toc\" value=\"main\" checked \/><label for=\"quform_97_1640_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1640_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1641 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1641\"><label class=\"quform-label-text\" id=\"quform_97_1641_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1641\"><div class=\"quform-input quform-input-checkbox quform-input-97_1641 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1641_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1641[]\" id=\"quform_97_1641_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1641 quform-field-97_1641_1 m26-addcard\" value=\"gold26\" \/><label for=\"quform_97_1641_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1641_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1641[]\" id=\"quform_97_1641_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1641 quform-field-97_1641_2 m26-addcard\" value=\"dental26\" \/><label for=\"quform_97_1641_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1641_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1641[]\" id=\"quform_97_1641_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1641 quform-field-97_1641_3 m26-addcard\" value=\"checkup26\" \/><label for=\"quform_97_1641_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1641_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1877 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1878\"><div class=\"quform-element quform-element-html quform-element-97_1879 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m26-label\"; >\u5bb6\u5c6c - 26<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1880 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m26-sname').change(function() {\n        var applicant_sname = $('.m26-sname').val();\n        var applicant_gname = $('.m26-gname').val();\n\t\tif ($('.m26-del').is(':checked')) {\n\t\t\t$('#m26-label').html(\"\u5bb6\u5c6c - 26\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel26' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m26-label').html(\"\u5bb6\u5c6c - 26\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m26-gname').change(function() {\n        var applicant_sname = $('.m26-sname').val();\n        var applicant_gname = $('.m26-gname').val();\n\t\tif ($('.m26-del').is(':checked')) {\n\t\t\t$('#m26-label').html(\"\u5bb6\u5c6c - 26\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel26' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m26-label').html(\"\u5bb6\u5c6c - 26\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m26-del').click(function() {\n        var applicant_sname = $('.m26-sname').val();\n        var applicant_gname = $('.m26-gname').val();\n\t\tif ($('.m26-del').is(':checked')) {\n    \t\t$('#m26-label').html(\"\u5bb6\u5c6c - 26\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel26' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m26-label').html(\"\u5bb6\u5c6c - 26\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1881\"><div class=\"quform-element quform-element-radio quform-element-97_1882 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1882\"><label class=\"quform-label-text\" id=\"quform_97_1882_6e1cb0_label\">Member 26 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1882\"><div class=\"quform-input quform-input-radio quform-input-97_1882 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1882_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1882\" id=\"quform_97_1882_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1882 quform-field-97_1882_1 m26-edit\" value=\"edit\" \/><label for=\"quform_97_1882_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1882_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1882\" id=\"quform_97_1882_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1882 quform-field-97_1882_2 m26-edit\" value=\"save\" checked \/><label for=\"quform_97_1882_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1882_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1570 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 27<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2208 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2209\"><div class=\"quform-element quform-element-html quform-element-97_2210 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2211\"><div class=\"quform-element quform-element-text quform-element-97_2212 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2212\"><label class=\"quform-label-text\" for=\"quform_97_2212_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2212\"><div class=\"quform-input quform-input-text quform-input-97_2212 quform-cf\"><input type=\"text\" id=\"quform_97_2212_6e1cb0\" name=\"quform_97_2212\" class=\"quform-field quform-field-text quform-field-97_2212 m27-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2213\"><div class=\"quform-element quform-element-checkbox quform-element-97_2214 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2214\"><label class=\"quform-label-text\" id=\"quform_97_2214_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2214\"><div class=\"quform-input quform-input-checkbox quform-input-97_2214 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2214_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2214[]\" id=\"quform_97_2214_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2214 quform-field-97_2214_1 m27-del\" value=\"Delete\" \/><label for=\"quform_97_2214_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2214_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2215\"><div class=\"quform-element quform-element-html quform-element-97_2216 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1571 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1572\"><div class=\"quform-element quform-element-text quform-element-97_1573 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1573\"><label class=\"quform-label-text\" for=\"quform_97_1573_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1573\"><div class=\"quform-input quform-input-text quform-input-97_1573 quform-cf\"><input type=\"text\" id=\"quform_97_1573_6e1cb0\" name=\"quform_97_1573\" class=\"quform-field quform-field-text quform-field-97_1573 m27-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1574\"><div class=\"quform-element quform-element-text quform-element-97_1575 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1575\"><label class=\"quform-label-text\" for=\"quform_97_1575_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1575\"><div class=\"quform-input quform-input-text quform-input-97_1575 quform-cf\"><input type=\"text\" id=\"quform_97_1575_6e1cb0\" name=\"quform_97_1575\" class=\"quform-field quform-field-text quform-field-97_1575 m27-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1576\"><div class=\"quform-element quform-element-select quform-element-97_1577 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1577\"><label class=\"quform-label-text\" for=\"quform_97_1577_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1577\"><div class=\"quform-input quform-input-select quform-input-97_1577 quform-cf\"><select id=\"quform_97_1577_6e1cb0\" name=\"quform_97_1577\" class=\"quform-field quform-field-select quform-field-97_1577 m27-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1578\"><div class=\"quform-element quform-element-select quform-element-97_1579 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1579\"><label class=\"quform-label-text\" for=\"quform_97_1579_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1579\"><div class=\"quform-input quform-input-select quform-input-97_1579 quform-cf\"><select id=\"quform_97_1579_6e1cb0\" name=\"quform_97_1579\" class=\"quform-field quform-field-select quform-field-97_1579 m27-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1580 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1581\"><div class=\"quform-element quform-element-select quform-element-97_1582 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1582\"><label class=\"quform-label-text\" for=\"quform_97_1582_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1582\"><div class=\"quform-input quform-input-select quform-input-97_1582 quform-cf\"><select id=\"quform_97_1582_6e1cb0\" name=\"quform_97_1582\" class=\"quform-field quform-field-select quform-field-97_1582 quform-field-select-enhanced m27-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1583\"><div class=\"quform-element quform-element-text quform-element-97_1596 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1596\"><label class=\"quform-label-text\" for=\"quform_97_1596_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1596\"><div class=\"quform-input quform-input-text quform-input-97_1596 quform-cf\"><input type=\"text\" id=\"quform_97_1596_6e1cb0\" name=\"quform_97_1596\" class=\"quform-field quform-field-text quform-field-97_1596 m27-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1597 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1598\"><div class=\"quform-element quform-element-date quform-element-97_1599 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1599\"><label class=\"quform-label-text\" for=\"quform_97_1599_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1599\"><div class=\"quform-input quform-input-date quform-input-97_1599 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1599_6e1cb0\" name=\"quform_97_1599\" class=\"quform-field quform-field-date quform-field-97_1599 m27-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1599&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1600 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1600\"><label class=\"quform-label-text\" for=\"quform_97_1600_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1600\"><div class=\"quform-input quform-input-text quform-input-97_1600 quform-cf\"><input type=\"text\" id=\"quform_97_1600_6e1cb0\" name=\"quform_97_1600\" class=\"quform-field quform-field-text quform-field-97_1600 m27-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1601\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1602\"><div class=\"quform-element quform-element-html quform-element-97_1603 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1604 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1604\"><label class=\"quform-label-text\" id=\"quform_97_1604_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1604\"><div class=\"quform-input quform-input-radio quform-input-97_1604 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1604_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1604\" id=\"quform_97_1604_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1604 quform-field-97_1604_1 m27-toc\" value=\"main\" checked \/><label for=\"quform_97_1604_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1604_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1605 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1605\"><label class=\"quform-label-text\" id=\"quform_97_1605_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1605\"><div class=\"quform-input quform-input-checkbox quform-input-97_1605 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1605_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1605[]\" id=\"quform_97_1605_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1605 quform-field-97_1605_1 m27-addcard\" value=\"gold27\" \/><label for=\"quform_97_1605_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1605_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1605[]\" id=\"quform_97_1605_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1605 quform-field-97_1605_2 m27-addcard\" value=\"dental27\" \/><label for=\"quform_97_1605_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1605_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1605[]\" id=\"quform_97_1605_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1605 quform-field-97_1605_3 m27-addcard\" value=\"checkup27\" \/><label for=\"quform_97_1605_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1605_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1931 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1932\"><div class=\"quform-element quform-element-html quform-element-97_1933 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m27-label\"; >\u5bb6\u5c6c - 27<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1934 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m27-sname').change(function() {\n        var applicant_sname = $('.m27-sname').val();\n        var applicant_gname = $('.m27-gname').val();\n\t\tif ($('.m27-del').is(':checked')) {\n\t\t\t$('#m27-label').html(\"\u5bb6\u5c6c - 27\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel27' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m27-label').html(\"\u5bb6\u5c6c - 27\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m27-gname').change(function() {\n        var applicant_sname = $('.m27-sname').val();\n        var applicant_gname = $('.m27-gname').val();\n\t\tif ($('.m27-del').is(':checked')) {\n\t\t\t$('#m27-label').html(\"\u5bb6\u5c6c - 27\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel27' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m27-label').html(\"\u5bb6\u5c6c - 27\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m27-del').click(function() {\n        var applicant_sname = $('.m27-sname').val();\n        var applicant_gname = $('.m27-gname').val();\n\t\tif ($('.m27-del').is(':checked')) {\n    \t\t$('#m27-label').html(\"\u5bb6\u5c6c - 27\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel27' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m27-label').html(\"\u5bb6\u5c6c - 27\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1935\"><div class=\"quform-element quform-element-radio quform-element-97_1936 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1936\"><label class=\"quform-label-text\" id=\"quform_97_1936_6e1cb0_label\">Member 27 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1936\"><div class=\"quform-input quform-input-radio quform-input-97_1936 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1936_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1936\" id=\"quform_97_1936_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1936 quform-field-97_1936_1 m27-edit\" value=\"edit\" \/><label for=\"quform_97_1936_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1936_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1936\" id=\"quform_97_1936_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1936 quform-field-97_1936_2 m27-edit\" value=\"save\" checked \/><label for=\"quform_97_1936_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1936_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1534 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 28<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2217 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2218\"><div class=\"quform-element quform-element-html quform-element-97_2219 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2220\"><div class=\"quform-element quform-element-text quform-element-97_2221 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2221\"><label class=\"quform-label-text\" for=\"quform_97_2221_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2221\"><div class=\"quform-input quform-input-text quform-input-97_2221 quform-cf\"><input type=\"text\" id=\"quform_97_2221_6e1cb0\" name=\"quform_97_2221\" class=\"quform-field quform-field-text quform-field-97_2221 m28-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2222\"><div class=\"quform-element quform-element-checkbox quform-element-97_2223 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2223\"><label class=\"quform-label-text\" id=\"quform_97_2223_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2223\"><div class=\"quform-input quform-input-checkbox quform-input-97_2223 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2223_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2223[]\" id=\"quform_97_2223_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2223 quform-field-97_2223_1 m28-del\" value=\"Delete\" \/><label for=\"quform_97_2223_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2223_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2224\"><div class=\"quform-element quform-element-html quform-element-97_2225 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1535 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1536\"><div class=\"quform-element quform-element-text quform-element-97_1537 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1537\"><label class=\"quform-label-text\" for=\"quform_97_1537_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1537\"><div class=\"quform-input quform-input-text quform-input-97_1537 quform-cf\"><input type=\"text\" id=\"quform_97_1537_6e1cb0\" name=\"quform_97_1537\" class=\"quform-field quform-field-text quform-field-97_1537 m28-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1538\"><div class=\"quform-element quform-element-text quform-element-97_1539 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1539\"><label class=\"quform-label-text\" for=\"quform_97_1539_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1539\"><div class=\"quform-input quform-input-text quform-input-97_1539 quform-cf\"><input type=\"text\" id=\"quform_97_1539_6e1cb0\" name=\"quform_97_1539\" class=\"quform-field quform-field-text quform-field-97_1539 m28-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1540\"><div class=\"quform-element quform-element-select quform-element-97_1541 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1541\"><label class=\"quform-label-text\" for=\"quform_97_1541_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1541\"><div class=\"quform-input quform-input-select quform-input-97_1541 quform-cf\"><select id=\"quform_97_1541_6e1cb0\" name=\"quform_97_1541\" class=\"quform-field quform-field-select quform-field-97_1541 m28-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1542\"><div class=\"quform-element quform-element-select quform-element-97_1543 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1543\"><label class=\"quform-label-text\" for=\"quform_97_1543_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1543\"><div class=\"quform-input quform-input-select quform-input-97_1543 quform-cf\"><select id=\"quform_97_1543_6e1cb0\" name=\"quform_97_1543\" class=\"quform-field quform-field-select quform-field-97_1543 m28-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1544 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1545\"><div class=\"quform-element quform-element-select quform-element-97_1546 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1546\"><label class=\"quform-label-text\" for=\"quform_97_1546_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1546\"><div class=\"quform-input quform-input-select quform-input-97_1546 quform-cf\"><select id=\"quform_97_1546_6e1cb0\" name=\"quform_97_1546\" class=\"quform-field quform-field-select quform-field-97_1546 quform-field-select-enhanced m28-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1547\"><div class=\"quform-element quform-element-text quform-element-97_1560 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1560\"><label class=\"quform-label-text\" for=\"quform_97_1560_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1560\"><div class=\"quform-input quform-input-text quform-input-97_1560 quform-cf\"><input type=\"text\" id=\"quform_97_1560_6e1cb0\" name=\"quform_97_1560\" class=\"quform-field quform-field-text quform-field-97_1560 m28-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1561 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1562\"><div class=\"quform-element quform-element-date quform-element-97_1563 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1563\"><label class=\"quform-label-text\" for=\"quform_97_1563_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1563\"><div class=\"quform-input quform-input-date quform-input-97_1563 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1563_6e1cb0\" name=\"quform_97_1563\" class=\"quform-field quform-field-date quform-field-97_1563 m28-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1563&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1564 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1564\"><label class=\"quform-label-text\" for=\"quform_97_1564_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1564\"><div class=\"quform-input quform-input-text quform-input-97_1564 quform-cf\"><input type=\"text\" id=\"quform_97_1564_6e1cb0\" name=\"quform_97_1564\" class=\"quform-field quform-field-text quform-field-97_1564 m28-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1565\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1566\"><div class=\"quform-element quform-element-html quform-element-97_1567 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1568 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1568\"><label class=\"quform-label-text\" id=\"quform_97_1568_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1568\"><div class=\"quform-input quform-input-radio quform-input-97_1568 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1568_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1568\" id=\"quform_97_1568_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1568 quform-field-97_1568_1 m28-toc\" value=\"main\" checked \/><label for=\"quform_97_1568_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1568_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1569 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1569\"><label class=\"quform-label-text\" id=\"quform_97_1569_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1569\"><div class=\"quform-input quform-input-checkbox quform-input-97_1569 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1569_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1569[]\" id=\"quform_97_1569_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1569 quform-field-97_1569_1 m28-addcard\" value=\"gold28\" \/><label for=\"quform_97_1569_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1569_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1569[]\" id=\"quform_97_1569_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1569 quform-field-97_1569_2 m28-addcard\" value=\"dental28\" \/><label for=\"quform_97_1569_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1569_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1569[]\" id=\"quform_97_1569_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1569 quform-field-97_1569_3 m28-addcard\" value=\"checkup28\" \/><label for=\"quform_97_1569_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1569_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1937 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1938\"><div class=\"quform-element quform-element-html quform-element-97_1939 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m28-label\"; >\u5bb6\u5c6c - 28<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1940 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m28-sname').change(function() {\n        var applicant_sname = $('.m28-sname').val();\n        var applicant_gname = $('.m28-gname').val();\n\t\tif ($('.m28-del').is(':checked')) {\n\t\t\t$('#m28-label').html(\"\u5bb6\u5c6c - 28\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel28' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m28-label').html(\"\u5bb6\u5c6c - 28\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m28-gname').change(function() {\n        var applicant_sname = $('.m28-sname').val();\n        var applicant_gname = $('.m28-gname').val();\n\t\tif ($('.m28-del').is(':checked')) {\n\t\t\t$('#m28-label').html(\"\u5bb6\u5c6c - 28\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel28' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m28-label').html(\"\u5bb6\u5c6c - 28\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m28-del').click(function() {\n        var applicant_sname = $('.m28-sname').val();\n        var applicant_gname = $('.m28-gname').val();\n\t\tif ($('.m28-del').is(':checked')) {\n    \t\t$('#m28-label').html(\"\u5bb6\u5c6c - 28\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel28' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m28-label').html(\"\u5bb6\u5c6c - 28\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1941\"><div class=\"quform-element quform-element-radio quform-element-97_1942 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1942\"><label class=\"quform-label-text\" id=\"quform_97_1942_6e1cb0_label\">Member 28 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1942\"><div class=\"quform-input quform-input-radio quform-input-97_1942 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1942_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1942\" id=\"quform_97_1942_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1942 quform-field-97_1942_1 m28-edit\" value=\"edit\" \/><label for=\"quform_97_1942_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1942_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1942\" id=\"quform_97_1942_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1942 quform-field-97_1942_2 m28-edit\" value=\"save\" checked \/><label for=\"quform_97_1942_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1942_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1498 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 29<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2226 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2227\"><div class=\"quform-element quform-element-html quform-element-97_2228 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2229\"><div class=\"quform-element quform-element-text quform-element-97_2230 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2230\"><label class=\"quform-label-text\" for=\"quform_97_2230_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2230\"><div class=\"quform-input quform-input-text quform-input-97_2230 quform-cf\"><input type=\"text\" id=\"quform_97_2230_6e1cb0\" name=\"quform_97_2230\" class=\"quform-field quform-field-text quform-field-97_2230 m29-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2231\"><div class=\"quform-element quform-element-checkbox quform-element-97_2232 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2232\"><label class=\"quform-label-text\" id=\"quform_97_2232_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2232\"><div class=\"quform-input quform-input-checkbox quform-input-97_2232 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2232_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2232[]\" id=\"quform_97_2232_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2232 quform-field-97_2232_1 m29-del\" value=\"Delete\" \/><label for=\"quform_97_2232_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2232_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2233\"><div class=\"quform-element quform-element-html quform-element-97_2234 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1499 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1500\"><div class=\"quform-element quform-element-text quform-element-97_1501 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1501\"><label class=\"quform-label-text\" for=\"quform_97_1501_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1501\"><div class=\"quform-input quform-input-text quform-input-97_1501 quform-cf\"><input type=\"text\" id=\"quform_97_1501_6e1cb0\" name=\"quform_97_1501\" class=\"quform-field quform-field-text quform-field-97_1501 m29-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1502\"><div class=\"quform-element quform-element-text quform-element-97_1503 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1503\"><label class=\"quform-label-text\" for=\"quform_97_1503_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1503\"><div class=\"quform-input quform-input-text quform-input-97_1503 quform-cf\"><input type=\"text\" id=\"quform_97_1503_6e1cb0\" name=\"quform_97_1503\" class=\"quform-field quform-field-text quform-field-97_1503 m29-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1504\"><div class=\"quform-element quform-element-select quform-element-97_1505 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1505\"><label class=\"quform-label-text\" for=\"quform_97_1505_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1505\"><div class=\"quform-input quform-input-select quform-input-97_1505 quform-cf\"><select id=\"quform_97_1505_6e1cb0\" name=\"quform_97_1505\" class=\"quform-field quform-field-select quform-field-97_1505 m29-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1506\"><div class=\"quform-element quform-element-select quform-element-97_1507 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1507\"><label class=\"quform-label-text\" for=\"quform_97_1507_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1507\"><div class=\"quform-input quform-input-select quform-input-97_1507 quform-cf\"><select id=\"quform_97_1507_6e1cb0\" name=\"quform_97_1507\" class=\"quform-field quform-field-select quform-field-97_1507 m29-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1508 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1509\"><div class=\"quform-element quform-element-select quform-element-97_1510 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1510\"><label class=\"quform-label-text\" for=\"quform_97_1510_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1510\"><div class=\"quform-input quform-input-select quform-input-97_1510 quform-cf\"><select id=\"quform_97_1510_6e1cb0\" name=\"quform_97_1510\" class=\"quform-field quform-field-select quform-field-97_1510 quform-field-select-enhanced m29-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1511\"><div class=\"quform-element quform-element-text quform-element-97_1524 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1524\"><label class=\"quform-label-text\" for=\"quform_97_1524_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1524\"><div class=\"quform-input quform-input-text quform-input-97_1524 quform-cf\"><input type=\"text\" id=\"quform_97_1524_6e1cb0\" name=\"quform_97_1524\" class=\"quform-field quform-field-text quform-field-97_1524 m29-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1525 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1526\"><div class=\"quform-element quform-element-date quform-element-97_1527 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1527\"><label class=\"quform-label-text\" for=\"quform_97_1527_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1527\"><div class=\"quform-input quform-input-date quform-input-97_1527 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1527_6e1cb0\" name=\"quform_97_1527\" class=\"quform-field quform-field-date quform-field-97_1527 m29-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1527&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1528 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1528\"><label class=\"quform-label-text\" for=\"quform_97_1528_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1528\"><div class=\"quform-input quform-input-text quform-input-97_1528 quform-cf\"><input type=\"text\" id=\"quform_97_1528_6e1cb0\" name=\"quform_97_1528\" class=\"quform-field quform-field-text quform-field-97_1528 m29-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1529\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1530\"><div class=\"quform-element quform-element-html quform-element-97_1531 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1532 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1532\"><label class=\"quform-label-text\" id=\"quform_97_1532_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1532\"><div class=\"quform-input quform-input-radio quform-input-97_1532 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1532_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1532\" id=\"quform_97_1532_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1532 quform-field-97_1532_1 m29-toc\" value=\"main\" checked \/><label for=\"quform_97_1532_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1532_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1533 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1533\"><label class=\"quform-label-text\" id=\"quform_97_1533_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1533\"><div class=\"quform-input quform-input-checkbox quform-input-97_1533 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1533_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1533[]\" id=\"quform_97_1533_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1533 quform-field-97_1533_1 m29-addcard\" value=\"gold29\" \/><label for=\"quform_97_1533_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1533_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1533[]\" id=\"quform_97_1533_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1533 quform-field-97_1533_2 m29-addcard\" value=\"dental29\" \/><label for=\"quform_97_1533_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1533_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1533[]\" id=\"quform_97_1533_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1533 quform-field-97_1533_3 m29-addcard\" value=\"checkup29\" \/><label for=\"quform_97_1533_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1533_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1943 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1944\"><div class=\"quform-element quform-element-html quform-element-97_1945 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m29-label\"; >\u5bb6\u5c6c - 29<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1946 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m29-sname').change(function() {\n        var applicant_sname = $('.m29-sname').val();\n        var applicant_gname = $('.m29-gname').val();\n\t\tif ($('.m29-del').is(':checked')) {\n\t\t\t$('#m29-label').html(\"\u5bb6\u5c6c - 29\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel29' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m29-label').html(\"\u5bb6\u5c6c - 29\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m29-gname').change(function() {\n        var applicant_sname = $('.m29-sname').val();\n        var applicant_gname = $('.m29-gname').val();\n\t\tif ($('.m29-del').is(':checked')) {\n\t\t\t$('#m29-label').html(\"\u5bb6\u5c6c - 29\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel29' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m29-label').html(\"\u5bb6\u5c6c - 29\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m29-del').click(function() {\n        var applicant_sname = $('.m29-sname').val();\n        var applicant_gname = $('.m29-gname').val();\n\t\tif ($('.m29-del').is(':checked')) {\n    \t\t$('#m29-label').html(\"\u5bb6\u5c6c - 29\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel29' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m29-label').html(\"\u5bb6\u5c6c - 29\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1947\"><div class=\"quform-element quform-element-radio quform-element-97_1948 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1948\"><label class=\"quform-label-text\" id=\"quform_97_1948_6e1cb0_label\">Member 29 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1948\"><div class=\"quform-input quform-input-radio quform-input-97_1948 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1948_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1948\" id=\"quform_97_1948_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1948 quform-field-97_1948_1 m29-edit\" value=\"edit\" \/><label for=\"quform_97_1948_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1948_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1948\" id=\"quform_97_1948_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1948 quform-field-97_1948_2 m29-edit\" value=\"save\" checked \/><label for=\"quform_97_1948_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1948_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_1462 quform-cf quform-group-style-bordered\"><div class=\"quform-spacer\"><div class=\"quform-group-title-description\"><div class=\"quform-group-title\">\u5bb6\u5c6c - 30<\/div><\/div><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2235 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2236\"><div class=\"quform-element quform-element-html quform-element-97_2237 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" class=\"col-md-4 control-label\" for=\"\">\u6703\u54e1\u7de8\u865f<br \/>Membership No.<\/label><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2238\"><div class=\"quform-element quform-element-text quform-element-97_2239 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2239\"><label class=\"quform-label-text\" for=\"quform_97_2239_6e1cb0\">Membership No<\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_2239\"><div class=\"quform-input quform-input-text quform-input-97_2239 quform-cf\"><input type=\"text\" id=\"quform_97_2239_6e1cb0\" name=\"quform_97_2239\" class=\"quform-field quform-field-text quform-field-97_2239 m30-memberid\" readonly \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2240\"><div class=\"quform-element quform-element-checkbox quform-element-97_2241 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_2241\"><label class=\"quform-label-text\" id=\"quform_97_2241_6e1cb0_label\">Delete<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_2241\"><div class=\"quform-input quform-input-checkbox quform-input-97_2241 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-style-button quform-button-style-sexy-silver quform-button-icon-right\" role=\"group\" aria-labelledby=\"quform_97_2241_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_2241[]\" id=\"quform_97_2241_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_2241 quform-field-97_2241_1 m30-del\" value=\"Delete\" \/><label for=\"quform_97_2241_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_2241_1\"><span class=\"quform-option-text\">Delete<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2242\"><div class=\"quform-element quform-element-html quform-element-97_2243 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: left; font-family: kaiti; font-size: 1.2rem; color: red;\" class=\"col-md-4 control-label\" for=\"\">\u522a\u9664<\/label><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1463 quform-4-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1464\"><div class=\"quform-element quform-element-text quform-element-97_1465 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1465\"><label class=\"quform-label-text\" for=\"quform_97_1465_6e1cb0\">\u59d3 Surname<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1465\"><div class=\"quform-input quform-input-text quform-input-97_1465 quform-cf\"><input type=\"text\" id=\"quform_97_1465_6e1cb0\" name=\"quform_97_1465\" class=\"quform-field quform-field-text quform-field-97_1465 m30-sname\" placeholder=\"\u59d3 Surname\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1466\"><div class=\"quform-element quform-element-text quform-element-97_1467 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1467\"><label class=\"quform-label-text\" for=\"quform_97_1467_6e1cb0\">\u540d Given Name<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1467\"><div class=\"quform-input quform-input-text quform-input-97_1467 quform-cf\"><input type=\"text\" id=\"quform_97_1467_6e1cb0\" name=\"quform_97_1467\" class=\"quform-field quform-field-text quform-field-97_1467 m30-gname\" placeholder=\"\u540d Given Name\" \/><\/div><p class=\"quform-description quform-description-below\">(\u8acb\u4f7f\u7528\u82f1\u6587\u586b\u5beb)<\/p><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1468\"><div class=\"quform-element quform-element-select quform-element-97_1469 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1469\"><label class=\"quform-label-text\" for=\"quform_97_1469_6e1cb0\">\u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1469\"><div class=\"quform-input quform-input-select quform-input-97_1469 quform-cf\"><select id=\"quform_97_1469_6e1cb0\" name=\"quform_97_1469\" class=\"quform-field quform-field-select quform-field-97_1469 m30-rel\"><option value=\"\" selected=\"selected\">  \u8207\u7533\u8acb\u4eba\u95dc\u4fc2 <\/option><option value=\"\u7236\u6bcd\">\u7236\u6bcd<\/option><option value=\"\u914d\u5076\">\u914d\u5076<\/option><option value=\"\u5b50\u5973\">\u5b50\u5973<\/option><option value=\"\u5144\u5f1f\u59d0\u59b9\">\u5144\u5f1f\u59d0\u59b9<\/option><option value=\"\u914d\u5076\u7236\u6bcd\">\u914d\u5076\u7236\u6bcd<\/option><option value=\"\u914d\u5076\u5144\u5f1f\u59d0\u59b9\">\u914d\u5076\u5144\u5f1f\u59d0\u59b9<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1470\"><div class=\"quform-element quform-element-select quform-element-97_1471 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1471\"><label class=\"quform-label-text\" for=\"quform_97_1471_6e1cb0\">\u6027\u5225<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1471\"><div class=\"quform-input quform-input-select quform-input-97_1471 quform-cf\"><select id=\"quform_97_1471_6e1cb0\" name=\"quform_97_1471\" class=\"quform-field quform-field-select quform-field-97_1471 m30-sex\"><option value=\"\" selected=\"selected\">  \u6027\u5225 Sex<\/option><option value=\"M\">\u7537<\/option><option value=\"F\">\u5973<\/option><\/select><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1472 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1473\"><div class=\"quform-element quform-element-select quform-element-97_1474 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1474\"><label class=\"quform-label-text\" for=\"quform_97_1474_6e1cb0\">\u8eab\u4efd\u8b49\u660e<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-select quform-inner-97_1474\"><div class=\"quform-input quform-input-select quform-input-97_1474 quform-cf\"><select id=\"quform_97_1474_6e1cb0\" name=\"quform_97_1474\" class=\"quform-field quform-field-select quform-field-97_1474 quform-field-select-enhanced m30-idtype\" data-options=\"{&quot;rtl&quot;:false,&quot;search&quot;:false,&quot;noResultsFound&quot;:&quot;No results found.&quot;}\" style=\"width: 100%;\"><option value=\"HKID\" selected=\"selected\">\u9999\u6e2f\u8eab\u4efd\u8b49<\/option><option value=\"Passport\">\u8b77\u7167<\/option><option value=\"others\">\u5176\u4ed6<\/option><\/select><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1475\"><div class=\"quform-element quform-element-text quform-element-97_1488 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1488\"><label class=\"quform-label-text\" for=\"quform_97_1488_6e1cb0\">\u8b49\u4ef6\u865f\u78bc<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1488\"><div class=\"quform-input quform-input-text quform-input-97_1488 quform-cf\"><input type=\"text\" id=\"quform_97_1488_6e1cb0\" name=\"quform_97_1488\" class=\"quform-field quform-field-text quform-field-97_1488 m30-idno\" placeholder=\"\u8b49\u4ef6\u865f\u78bc - A123456(7), \u8acb\u586b A1234567\" \/><\/div><p class=\"quform-description quform-description-below\">\u865f\u78bc\u5fc5\u9700\u6b63\u78ba\u7121\u8aa4, \u5426\u5247\u91ab\u7642\u6a5f\u69cb\u7121\u6cd5\u8655\u7406<\/p><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1489 quform-3-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1490\"><div class=\"quform-element quform-element-date quform-element-97_1491 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1491\"><label class=\"quform-label-text\" for=\"quform_97_1491_6e1cb0\">\u51fa\u751f\u65e5\u671f Date of Birth <span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-date quform-inner-97_1491\"><div class=\"quform-input quform-input-date quform-input-97_1491 quform-cf quform-has-field-icon-right\"><input type=\"text\" id=\"quform_97_1491_6e1cb0\" name=\"quform_97_1491\" class=\"quform-field quform-field-date quform-field-97_1491 m30-dob\" placeholder=\"YYYY-MM-DD\" data-options=\"{&quot;format&quot;:&quot;dd\\\/MM\\\/yyyy&quot;,&quot;min&quot;:&quot;&quot;,&quot;max&quot;:&quot;2026-04-09&quot;,&quot;start&quot;:&quot;century&quot;,&quot;depth&quot;:&quot;month&quot;,&quot;showFooter&quot;:false,&quot;locale&quot;:&quot;en-HK&quot;,&quot;placeholder&quot;:&quot;DD\\\/MM\\\/YYYY&quot;,&quot;autoOpen&quot;:true,&quot;identifier&quot;:&quot;97_1491&quot;}\" \/><span class=\"quform-field-icon quform-field-icon-right\"><i class=\"qicon-calendar\"><\/i><\/span><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-text quform-element-97_1492 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1492\"><label class=\"quform-label-text\" for=\"quform_97_1492_6e1cb0\">\u806f\u7d61\u96fb\u8a71 Tel No.<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-text quform-inner-97_1492\"><div class=\"quform-input quform-input-text quform-input-97_1492 quform-cf\"><input type=\"text\" id=\"quform_97_1492_6e1cb0\" name=\"quform_97_1492\" class=\"quform-field quform-field-text quform-field-97_1492 m30-tel\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1493\"><\/div><div class=\"quform-element quform-element-column quform-element-97_1494\"><div class=\"quform-element quform-element-html quform-element-97_1495 quform-cf\"><div class=\"quform-spacer\"><label style=\"text-align: center; font-family: kaiti; font-size: 1.6rem;\" class=\"col-md-4 control-label\" for=\"\"><b>\u7533\u8acb\u985e\u5225 Type of Cover<\/b><\/label><\/div><\/div><div class=\"quform-element quform-element-radio quform-element-97_1496 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1496\"><label class=\"quform-label-text\" id=\"quform_97_1496_6e1cb0_label\">\u7533\u8acb\u985e\u5225 Type of Cover<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1496\"><div class=\"quform-input quform-input-radio quform-input-97_1496 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"radiogroup\" aria-labelledby=\"quform_97_1496_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1496\" id=\"quform_97_1496_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1496 quform-field-97_1496_1 m30-toc\" value=\"main\" checked \/><label for=\"quform_97_1496_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1496_1\"><span class=\"quform-option-text\">HealthCare<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_1497 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1497\"><label class=\"quform-label-text\" id=\"quform_97_1497_6e1cb0_label\">Additional Card<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_1497\"><div class=\"quform-input quform-input-checkbox quform-input-97_1497 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_1497_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1497[]\" id=\"quform_97_1497_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_1497 quform-field-97_1497_1 m30-addcard\" value=\"gold30\" \/><label for=\"quform_97_1497_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1497_1\"><span class=\"quform-option-text\">Medicard (\u91d1\u54ad)<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1497[]\" id=\"quform_97_1497_6e1cb0_2\" class=\"quform-field quform-field-checkbox quform-field-97_1497 quform-field-97_1497_2 m30-addcard\" value=\"dental30\" \/><label for=\"quform_97_1497_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1497_2\"><span class=\"quform-option-text\">DentalSure<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_1497[]\" id=\"quform_97_1497_6e1cb0_3\" class=\"quform-field quform-field-checkbox quform-field-97_1497 quform-field-97_1497_3 m30-addcard\" value=\"checkup30\" \/><label for=\"quform_97_1497_6e1cb0_3\" class=\"quform-option-label quform-option-label-97_1497_3\"><span class=\"quform-option-text\">Medical Checkup<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_1949 quform-2-columns quform-element-row-size-float quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_1950\"><div class=\"quform-element quform-element-html quform-element-97_1951 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"m30-label\"; >\u5bb6\u5c6c - 30<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_1952 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {\n    $('.m30-sname').change(function() {\n        var applicant_sname = $('.m30-sname').val();\n        var applicant_gname = $('.m30-gname').val();\n\t\tif ($('.m30-del').is(':checked')) {\n\t\t\t$('#m30-label').html(\"\u5bb6\u5c6c - 30\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel30' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m30-label').html(\"\u5bb6\u5c6c - 30\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    $('.m30-gname').change(function() {\n        var applicant_sname = $('.m30-sname').val();\n        var applicant_gname = $('.m30-gname').val();\n\t\tif ($('.m30-del').is(':checked')) {\n\t\t\t$('#m30-label').html(\"\u5bb6\u5c6c - 30\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel30' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m30-label').html(\"\u5bb6\u5c6c - 30\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n\t$('.m30-del').click(function() {\n        var applicant_sname = $('.m30-sname').val();\n        var applicant_gname = $('.m30-gname').val();\n\t\tif ($('.m30-del').is(':checked')) {\n    \t\t$('#m30-label').html(\"\u5bb6\u5c6c - 30\uff1a\"+applicant_sname+\" \"+applicant_gname+\"<span id='mdel30' style='color:red';>&nbsp;&nbsp;&nbsp; [\u522a\u9664]<\/span>\");\n\t\t} else {\n\t\t\t$('#m30-label').html(\"\u5bb6\u5c6c - 30\uff1a\"+applicant_sname+\" \"+applicant_gname);\n\t\t}\n    });\n    });  \/\/end document ready\n<\/script><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_1953\"><div class=\"quform-element quform-element-radio quform-element-97_1954 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_1954\"><label class=\"quform-label-text\" id=\"quform_97_1954_6e1cb0_label\">Member 30 edit<\/label><\/div><div class=\"quform-inner quform-inner-radio quform-inner-97_1954\"><div class=\"quform-input quform-input-radio quform-input-97_1954 quform-cf\"><div class=\"quform-options quform-cf quform-options-columns quform-2-columns quform-responsive-columns-phone-landscape quform-options-style-button quform-button-style-bootstrap-primary quform-button-size-medium quform-button-width-full quform-button-icon-right\" role=\"radiogroup\" aria-labelledby=\"quform_97_1954_6e1cb0_label\"><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1954\" id=\"quform_97_1954_6e1cb0_1\" class=\"quform-field quform-field-radio quform-field-97_1954 quform-field-97_1954_1 m30-edit\" value=\"edit\" \/><label for=\"quform_97_1954_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_1954_1\"><span class=\"quform-option-icon\"><i class=\"fa fa-chevron-down\"><\/i><\/span><span class=\"quform-option-text\">\u7de8\u8f2f<\/span><\/label><\/div><div class=\"quform-option\"><input type=\"radio\" name=\"quform_97_1954\" id=\"quform_97_1954_6e1cb0_2\" class=\"quform-field quform-field-radio quform-field-97_1954 quform-field-97_1954_2 m30-edit\" value=\"save\" checked \/><label for=\"quform_97_1954_6e1cb0_2\" class=\"quform-option-label quform-option-label-97_1954_2\"><span class=\"quform-option-icon\"><i class=\"fa fa-save\"><\/i><\/span><span class=\"quform-option-text\">\u5b58\u6a94<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-checkbox quform-element-97_652 quform-cf quform-element-optional\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_652\"><label class=\"quform-label-text\" id=\"quform_97_652_6e1cb0_label\">Marketing<\/label><\/div><div class=\"quform-inner quform-inner-checkbox quform-inner-97_652\"><div class=\"quform-input quform-input-checkbox quform-input-97_652 quform-cf\"><div class=\"quform-options quform-cf quform-options-block quform-options-simple\" role=\"group\" aria-labelledby=\"quform_97_652_6e1cb0_label\"><div class=\"quform-option\"><input type=\"checkbox\" name=\"quform_97_652[]\" id=\"quform_97_652_6e1cb0_1\" class=\"quform-field quform-field-checkbox quform-field-97_652 quform-field-97_652_1\" value=\"nonpromote\" \/><label for=\"quform_97_652_6e1cb0_1\" class=\"quform-option-label quform-option-label-97_652_1\"><span class=\"quform-option-text\">\u672c\u4eba\u4e0d\u9858\u610f\u65e5\u5f8c\u63a5\u6536\u76f8\u95dc\u7522\u54c1\u63a8\u5ee3<\/span><\/label><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_653 quform-cf\"><div class=\"quform-spacer\"><span style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\">\u8acb\u78ba\u4fdd\u6240\u6709\u8f38\u5165\u8cc7\u6599\uff0c\u5426\u5247\u7533\u8acb\u6709\u6a5f\u6703\u7121\u6548<\/span><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3617 quform-cf\"><div class=\"quform-spacer\"><script>\njQuery(document).ready(function($){\nif (typeof applicant !== 'undefined') {\n    console.log(applicant);\n    if(applicant !=''){\n       $('.a-memberid').val(applicant.member_no);\n    }\n }\n\nif (typeof members !== 'undefined') {\n    console.log(members);\n}\n\n    \n\n\n});\n<\/script><\/div><\/div><div class=\"quform-element quform-element-captcha quform-element-97_3624 quform-cf quform-element-required\"><div class=\"quform-spacer\"><div class=\"quform-label quform-label-97_3624\"><label class=\"quform-label-text\" for=\"quform_97_3624_6e1cb0\">\u8acb\u8f38\u5165\u5716\u4e2d\u6587\u5b57<span class=\"quform-required\">*<\/span><\/label><\/div><div class=\"quform-inner quform-inner-captcha quform-inner-97_3624\"><div class=\"quform-input quform-input-captcha quform-input-97_3624 quform-cf\"><input type=\"text\" id=\"quform_97_3624_6e1cb0\" name=\"quform_97_3624\" class=\"quform-field quform-field-captcha quform-field-97_3624\" \/><\/div><div class=\"quform-captcha quform-cf\"><div class=\"quform-captcha-image quform-captcha-image-97_3624\"><img loading=\"lazy\" decoding=\"async\" class=\"quform-captcha-image-img\" src=\"data:image\/png;base64,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\" alt=\"CAPTCHA image\" data-element-id=\"3624\" width=\"115\" height=\"40\" \/><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-submit quform-element-97_2 quform-cf quform-button-style-sexy-silver quform-button-size-fat quform-button-width-medium\"><div class=\"quform-button-next quform-button-next-default quform-button-next-97_2\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-next\" value=\"submit\"><span class=\"quform-button-text quform-button-next-text\">\u4e0b\u4e00\u6b65<\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-left quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-page quform-page-654 quform-page-97_654 quform-cf quform-group-style-plain quform-last-page\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-group quform-element-97_3607 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-html quform-element-97_2244 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u9999\u6e2f\u8b66\u5bdf\u968a\u54e1\u4f50\u7d1a\u5354\u6703JPOA<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3698 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u57f9\u6b63\u5c08\u696d\u66f8\u9662<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3676 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">GC CO Plan<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3711 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u9999\u6e2f\u65b0\u754c\u5ee0\u5546\u806f\u5408\u6703NTMA<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3716 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u7f8e\u5609\u5927\u5065\u5eb7\u96c6\u5718\u6709\u9650\u516c\u53f8<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3684 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">MediPanda Plan<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3677 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u5168\u7403\u5927\u5b78\u6821\u53cb\u6703\u806f\u76df<br \/>\u7f8e\u570b\u7ba1\u7406\u79d1\u6280\u5927\u5b78\u9999\u6e2f\u6821\u53cb\u6703<br \/>\u9999\u6e2f\u5c4b\u5b87\u53ca\u8a2d\u5099\u5de5\u7a0b\u5e2b\u5b78\u6703<br \/>\u9999\u6e2f\u570b\u969b\u590f\u5a01\u5937\u821e\u5354\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br \/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3623 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u61f2\u6559\u4e8b\u52d9\u8077\u54e1\u5354\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3712 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u9999\u6e2f\u8f14\u52a9\u8b66\u5bdf\u6703HKAP<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3605 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u9999\u6e2f\u7ae5\u8ecd\u7e3d\u6703\u65b0\u754c\u6771\u5730\u57df<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3688 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u9999\u6e2f\u7ae5\u8ecd\u7e3d\u6703\u65b0\u754c\u5730\u57df<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3604 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u9999\u6e2f\u6d88\u9632\u8655\u6551\u8b77\u54e1\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3606 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3630 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u6e2f\u4e5d\u52de\u5de5\u793e\u5718\u806f\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3634 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u9999\u6e2f\u8b66\u52d9\u7763\u5bdf\u5354\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3633 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u9999\u6e2f\u7279\u5340\u653f\u5e9c\u516c\u52d9\u4eba\u54e1\u806f\u6703\/\u570b\u5bb6\u884c\u653f\u5b78\u9662\u9999\u6e2f\u540c\u5b78\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3723 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u9999\u6e2f\u516c\u52d9\u54e1\u7e3d\u5de5\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3632 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u9999\u6e2f\u5165\u5883\u4e8b\u52d9\u52a9\u7406\u54e1\u5de5\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3631 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u9999\u6e2f\u6d88\u9632\u8655\u8077\u5de5\u7e3d\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3644 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u9999\u6e2f\u6d77\u95dc\u5b98\u54e1\u5354\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3656 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u9999\u6e2f\u8b66\u5bdf\u968a\u54e1\u4f50\u7d1a\u5354\u6703\u5275\u5efa\u4eba\u9000\u5f79\u540c\u50da\u806f\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3657 quform-cf\"><div class=\"quform-spacer\"><h1 class=\"fs-title\" style=\"text-align: center;\">\u9999\u6e2f\u6d88\u9632\u63a7\u5236\u7d44\u7e54\u54e1\u6703<br \/>\u5065\u9053\u91ab\u7642\u670d\u52d9\u7533\u8acb\u5c08\u9801<br\/>\u78ba\u8a8d\u7533\u8acb<\/h1><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2245 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: center; font-family: kaiti; font-size: 1.46rem;\"><span><div style=\"text-align: center;\"><span>\u7533\u8acb\u985e\u5225 Type of Cover<\/span><\/div><\/span><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2359 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2360\"><\/div><div class=\"quform-element quform-element-column quform-element-97_2361\"><div class=\"quform-element quform-element-html quform-element-97_2247 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"appcard\";>HealthCard<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2362\"><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2246 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: center; font-family: kaiti; font-size: 1.46rem;\"><span><div style=\"text-align: center;\"><span>\u7533\u8acb\u4eba\u8cc7\u6599 Applicant Info<\/span><\/div><\/span><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2275 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2254 quform-2-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2255\"><div class=\"quform-element quform-element-html quform-element-97_656 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\">\u7533\u8acb\u4eba\u59d3\u540d: <\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2256\"><div class=\"quform-element quform-element-html quform-element-97_2257 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"appname\";>\u7533\u8acb\u4eba\u59d3\u540d (Name): <\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2295 quform-2-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2296\"><div class=\"quform-element quform-element-html quform-element-97_2279 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\">\u6027\u5225: <\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2298\"><div class=\"quform-element quform-element-html quform-element-97_2288 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"appsex\";>\u7533\u8acb\u4eba\u6027\u5225 (Sex) : <\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2300 quform-2-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2301\"><div class=\"quform-element quform-element-html quform-element-97_2280 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\">\u6240\u5c6c\u6703\u54e1\u7de8\u865f : <\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2302\"><div class=\"quform-element quform-element-html quform-element-97_2289 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"appmemid\";>\u6240\u5c6c\u6703\u54e1\u7de8\u865f : <\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2303 quform-2-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2304\"><div class=\"quform-element quform-element-html quform-element-97_2281 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\">\u9999\u6e2f\u8eab\u4efd\u8b49: <\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2305\"><div class=\"quform-element quform-element-html quform-element-97_2290 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"apphkid\";>\u9999\u6e2f\u8eab\u4efd\u8b49 (HKID) : <\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2306 quform-2-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2307\"><div class=\"quform-element quform-element-html quform-element-97_2282 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\">\u51fa\u751f\u65e5\u671f: <\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2308\"><div class=\"quform-element quform-element-html quform-element-97_2291 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"appdob\";>\u51fa\u751f\u65e5\u671f : <\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2309 quform-2-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2310\"><div class=\"quform-element quform-element-html quform-element-97_2283 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\">\u901a\u8a0a\u5730\u5740: <\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2311\"><div class=\"quform-element quform-element-html quform-element-97_2292 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"appadd\";>Correspondence Address<\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2312 quform-2-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2313\"><div class=\"quform-element quform-element-html quform-element-97_2284 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\">\u806f\u7d61\u96fb\u8a71: <\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2314\"><div class=\"quform-element quform-element-html quform-element-97_2293 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"apptel\";>\u806f\u7d61\u96fb\u8a71 (Tel No.) : <\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2315 quform-2-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2316\"><div class=\"quform-element quform-element-html quform-element-97_2285 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\">\u96fb\u90f5: <\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2317\"><div class=\"quform-element quform-element-html quform-element-97_2294 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"appemail\";>\u96fb\u90f5 (Email) :<\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_3589 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_3591 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3592\"><div class=\"quform-element quform-element-html quform-element-97_3593 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\">\u5730\u5340\u7de8\u865f<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3594\"><div class=\"quform-element quform-element-html quform-element-97_3595 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"appdistrict\";>District Code<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3596\"><div class=\"quform-element quform-element-html quform-element-97_3598 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\">\u9867\u554f\u7de8\u865f<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3597\"><div class=\"quform-element quform-element-html quform-element-97_3599 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\" id=\"appagent\";>agent<\/div><\/div><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2449 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2274 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: center; font-family: kaiti; font-size: 1.46rem;\"><span><div style=\"text-align: center;\"><span>\u7533\u8acb\u4eba\u5bb6\u5c6c\u8cc7\u6599 Applicant Family Info<\/span><\/div><\/span><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2399 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2406 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2407\"><div class=\"quform-element quform-element-html quform-element-97_2329 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2411\"><div class=\"quform-element quform-element-html quform-element-97_2339 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m1name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2445\"><div class=\"quform-element quform-element-html quform-element-97_2330 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2446\"><div class=\"quform-element quform-element-html quform-element-97_2341 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m1sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2420 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2421\"><div class=\"quform-element quform-element-html quform-element-97_2331 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2422\"><div class=\"quform-element quform-element-html quform-element-97_2343 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m1rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2441\"><div class=\"quform-element quform-element-html quform-element-97_2334 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2442\"><div class=\"quform-element quform-element-html quform-element-97_2349 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m1tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2435 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2436\"><div class=\"quform-element quform-element-html quform-element-97_2332 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2437\"><div class=\"quform-element quform-element-html quform-element-97_2345 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m1idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2443\"><div class=\"quform-element quform-element-html quform-element-97_2333 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2444\"><div class=\"quform-element quform-element-html quform-element-97_2347 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m1dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2426 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2427\"><div class=\"quform-element quform-element-html quform-element-97_2335 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2428\"><div class=\"quform-element quform-element-html quform-element-97_2351 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m1serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2447\"><div class=\"quform-element quform-element-html quform-element-97_2336 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2448\"><div class=\"quform-element quform-element-html quform-element-97_2353 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m1amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2398 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2450 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2451 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2452\"><div class=\"quform-element quform-element-html quform-element-97_2453 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2454\"><div class=\"quform-element quform-element-html quform-element-97_2455 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m2name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2456\"><div class=\"quform-element quform-element-html quform-element-97_2457 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2458\"><div class=\"quform-element quform-element-html quform-element-97_2459 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m2sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2460 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2461\"><div class=\"quform-element quform-element-html quform-element-97_2462 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2463\"><div class=\"quform-element quform-element-html quform-element-97_2464 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m2rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2465\"><div class=\"quform-element quform-element-html quform-element-97_2466 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2467\"><div class=\"quform-element quform-element-html quform-element-97_2468 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m2tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2469 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2470\"><div class=\"quform-element quform-element-html quform-element-97_2471 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2472\"><div class=\"quform-element quform-element-html quform-element-97_2473 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m2idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2474\"><div class=\"quform-element quform-element-html quform-element-97_2475 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2476\"><div class=\"quform-element quform-element-html quform-element-97_2477 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m2dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2478 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2479\"><div class=\"quform-element quform-element-html quform-element-97_2480 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2481\"><div class=\"quform-element quform-element-html quform-element-97_2482 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m2serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2483\"><div class=\"quform-element quform-element-html quform-element-97_2484 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2485\"><div class=\"quform-element quform-element-html quform-element-97_2486 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m2amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2487 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2488 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2489 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2490\"><div class=\"quform-element quform-element-html quform-element-97_2491 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2492\"><div class=\"quform-element quform-element-html quform-element-97_2493 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m3name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2494\"><div class=\"quform-element quform-element-html quform-element-97_2495 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2496\"><div class=\"quform-element quform-element-html quform-element-97_2497 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m3sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2498 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2499\"><div class=\"quform-element quform-element-html quform-element-97_2500 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2501\"><div class=\"quform-element quform-element-html quform-element-97_2502 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m3rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2503\"><div class=\"quform-element quform-element-html quform-element-97_2504 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2505\"><div class=\"quform-element quform-element-html quform-element-97_2506 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m3tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2507 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2508\"><div class=\"quform-element quform-element-html quform-element-97_2509 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2510\"><div class=\"quform-element quform-element-html quform-element-97_2511 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m3idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2512\"><div class=\"quform-element quform-element-html quform-element-97_2513 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2514\"><div class=\"quform-element quform-element-html quform-element-97_2515 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m3dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2516 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2517\"><div class=\"quform-element quform-element-html quform-element-97_2518 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2519\"><div class=\"quform-element quform-element-html quform-element-97_2520 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m3serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2521\"><div class=\"quform-element quform-element-html quform-element-97_2522 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2523\"><div class=\"quform-element quform-element-html quform-element-97_2524 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m3amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2525 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2526 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2527 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2528\"><div class=\"quform-element quform-element-html quform-element-97_2529 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2530\"><div class=\"quform-element quform-element-html quform-element-97_2531 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m4name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2532\"><div class=\"quform-element quform-element-html quform-element-97_2533 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2534\"><div class=\"quform-element quform-element-html quform-element-97_2535 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m4sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2536 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2537\"><div class=\"quform-element quform-element-html quform-element-97_2538 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2539\"><div class=\"quform-element quform-element-html quform-element-97_2540 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m4rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2541\"><div class=\"quform-element quform-element-html quform-element-97_2542 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2543\"><div class=\"quform-element quform-element-html quform-element-97_2544 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m4tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2545 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2546\"><div class=\"quform-element quform-element-html quform-element-97_2547 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2548\"><div class=\"quform-element quform-element-html quform-element-97_2549 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m4idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2550\"><div class=\"quform-element quform-element-html quform-element-97_2551 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2552\"><div class=\"quform-element quform-element-html quform-element-97_2553 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m4dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2554 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2555\"><div class=\"quform-element quform-element-html quform-element-97_2556 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2557\"><div class=\"quform-element quform-element-html quform-element-97_2558 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m4serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2559\"><div class=\"quform-element quform-element-html quform-element-97_2560 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2561\"><div class=\"quform-element quform-element-html quform-element-97_2562 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m4amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2563 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2564 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2565 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2566\"><div class=\"quform-element quform-element-html quform-element-97_2567 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2568\"><div class=\"quform-element quform-element-html quform-element-97_2569 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m5name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2570\"><div class=\"quform-element quform-element-html quform-element-97_2571 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2572\"><div class=\"quform-element quform-element-html quform-element-97_2573 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m5sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2574 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2575\"><div class=\"quform-element quform-element-html quform-element-97_2576 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2577\"><div class=\"quform-element quform-element-html quform-element-97_2578 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m5rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2579\"><div class=\"quform-element quform-element-html quform-element-97_2580 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2581\"><div class=\"quform-element quform-element-html quform-element-97_2582 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m5tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2583 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2584\"><div class=\"quform-element quform-element-html quform-element-97_2585 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2586\"><div class=\"quform-element quform-element-html quform-element-97_2587 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m5idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2588\"><div class=\"quform-element quform-element-html quform-element-97_2589 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2590\"><div class=\"quform-element quform-element-html quform-element-97_2591 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m5dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2592 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2593\"><div class=\"quform-element quform-element-html quform-element-97_2594 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2595\"><div class=\"quform-element quform-element-html quform-element-97_2596 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m5serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2597\"><div class=\"quform-element quform-element-html quform-element-97_2598 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2599\"><div class=\"quform-element quform-element-html quform-element-97_2600 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m5amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2601 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2602 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2603 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2604\"><div class=\"quform-element quform-element-html quform-element-97_2605 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2606\"><div class=\"quform-element quform-element-html quform-element-97_2607 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m6name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2608\"><div class=\"quform-element quform-element-html quform-element-97_2609 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2610\"><div class=\"quform-element quform-element-html quform-element-97_2611 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m6sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2612 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2613\"><div class=\"quform-element quform-element-html quform-element-97_2614 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2615\"><div class=\"quform-element quform-element-html quform-element-97_2616 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m6rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2617\"><div class=\"quform-element quform-element-html quform-element-97_2618 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2619\"><div class=\"quform-element quform-element-html quform-element-97_2620 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m6tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2621 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2622\"><div class=\"quform-element quform-element-html quform-element-97_2623 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2624\"><div class=\"quform-element quform-element-html quform-element-97_2625 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m6idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2626\"><div class=\"quform-element quform-element-html quform-element-97_2627 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2628\"><div class=\"quform-element quform-element-html quform-element-97_2629 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m6dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2630 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2631\"><div class=\"quform-element quform-element-html quform-element-97_2632 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2633\"><div class=\"quform-element quform-element-html quform-element-97_2634 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m6serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2635\"><div class=\"quform-element quform-element-html quform-element-97_2636 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2637\"><div class=\"quform-element quform-element-html quform-element-97_2638 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m6amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2639 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2640 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2641 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2642\"><div class=\"quform-element quform-element-html quform-element-97_2643 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2644\"><div class=\"quform-element quform-element-html quform-element-97_2645 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m7name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2646\"><div class=\"quform-element quform-element-html quform-element-97_2647 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2648\"><div class=\"quform-element quform-element-html quform-element-97_2649 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m7sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2650 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2651\"><div class=\"quform-element quform-element-html quform-element-97_2652 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2653\"><div class=\"quform-element quform-element-html quform-element-97_2654 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m7rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2655\"><div class=\"quform-element quform-element-html quform-element-97_2656 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2657\"><div class=\"quform-element quform-element-html quform-element-97_2658 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m7tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2659 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2660\"><div class=\"quform-element quform-element-html quform-element-97_2661 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2662\"><div class=\"quform-element quform-element-html quform-element-97_2663 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m7idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2664\"><div class=\"quform-element quform-element-html quform-element-97_2665 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2666\"><div class=\"quform-element quform-element-html quform-element-97_2667 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m7dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2668 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2669\"><div class=\"quform-element quform-element-html quform-element-97_2670 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2671\"><div class=\"quform-element quform-element-html quform-element-97_2672 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m7serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2673\"><div class=\"quform-element quform-element-html quform-element-97_2674 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2675\"><div class=\"quform-element quform-element-html quform-element-97_2676 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m7amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2677 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2678 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2679 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2680\"><div class=\"quform-element quform-element-html quform-element-97_2681 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2682\"><div class=\"quform-element quform-element-html quform-element-97_2683 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m8name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2684\"><div class=\"quform-element quform-element-html quform-element-97_2685 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2686\"><div class=\"quform-element quform-element-html quform-element-97_2687 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m8sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2688 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2689\"><div class=\"quform-element quform-element-html quform-element-97_2690 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2691\"><div class=\"quform-element quform-element-html quform-element-97_2692 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m8rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2693\"><div class=\"quform-element quform-element-html quform-element-97_2694 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2695\"><div class=\"quform-element quform-element-html quform-element-97_2696 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m8tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2697 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2698\"><div class=\"quform-element quform-element-html quform-element-97_2699 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2700\"><div class=\"quform-element quform-element-html quform-element-97_2701 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m8idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2702\"><div class=\"quform-element quform-element-html quform-element-97_2703 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2704\"><div class=\"quform-element quform-element-html quform-element-97_2705 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m8dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2706 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2707\"><div class=\"quform-element quform-element-html quform-element-97_2708 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2709\"><div class=\"quform-element quform-element-html quform-element-97_2710 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m8serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2711\"><div class=\"quform-element quform-element-html quform-element-97_2712 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2713\"><div class=\"quform-element quform-element-html quform-element-97_2714 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m8amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2715 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2716 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2717 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2718\"><div class=\"quform-element quform-element-html quform-element-97_2719 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2720\"><div class=\"quform-element quform-element-html quform-element-97_2721 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m9name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2722\"><div class=\"quform-element quform-element-html quform-element-97_2723 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2724\"><div class=\"quform-element quform-element-html quform-element-97_2725 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m9sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2726 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2727\"><div class=\"quform-element quform-element-html quform-element-97_2728 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2729\"><div class=\"quform-element quform-element-html quform-element-97_2730 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m9rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2731\"><div class=\"quform-element quform-element-html quform-element-97_2732 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2733\"><div class=\"quform-element quform-element-html quform-element-97_2734 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m9tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2735 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2736\"><div class=\"quform-element quform-element-html quform-element-97_2737 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2738\"><div class=\"quform-element quform-element-html quform-element-97_2739 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m9idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2740\"><div class=\"quform-element quform-element-html quform-element-97_2741 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2742\"><div class=\"quform-element quform-element-html quform-element-97_2743 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m9dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2744 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2745\"><div class=\"quform-element quform-element-html quform-element-97_2746 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2747\"><div class=\"quform-element quform-element-html quform-element-97_2748 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m9serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2749\"><div class=\"quform-element quform-element-html quform-element-97_2750 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2751\"><div class=\"quform-element quform-element-html quform-element-97_2752 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m9amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2753 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2754 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2755 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2756\"><div class=\"quform-element quform-element-html quform-element-97_2757 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2758\"><div class=\"quform-element quform-element-html quform-element-97_2759 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m10name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2760\"><div class=\"quform-element quform-element-html quform-element-97_2761 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2762\"><div class=\"quform-element quform-element-html quform-element-97_2763 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m10sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2764 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2765\"><div class=\"quform-element quform-element-html quform-element-97_2766 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2767\"><div class=\"quform-element quform-element-html quform-element-97_2768 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m10rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2769\"><div class=\"quform-element quform-element-html quform-element-97_2770 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2771\"><div class=\"quform-element quform-element-html quform-element-97_2772 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m10tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2773 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2774\"><div class=\"quform-element quform-element-html quform-element-97_2775 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2776\"><div class=\"quform-element quform-element-html quform-element-97_2777 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m10idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2778\"><div class=\"quform-element quform-element-html quform-element-97_2779 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2780\"><div class=\"quform-element quform-element-html quform-element-97_2781 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m10dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2782 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2783\"><div class=\"quform-element quform-element-html quform-element-97_2784 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2785\"><div class=\"quform-element quform-element-html quform-element-97_2786 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m10serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2787\"><div class=\"quform-element quform-element-html quform-element-97_2788 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2789\"><div class=\"quform-element quform-element-html quform-element-97_2790 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m10amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2791 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2792 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2793 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2794\"><div class=\"quform-element quform-element-html quform-element-97_2795 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2796\"><div class=\"quform-element quform-element-html quform-element-97_2797 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m11name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2798\"><div class=\"quform-element quform-element-html quform-element-97_2799 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2800\"><div class=\"quform-element quform-element-html quform-element-97_2801 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m11sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2802 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2803\"><div class=\"quform-element quform-element-html quform-element-97_2804 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2805\"><div class=\"quform-element quform-element-html quform-element-97_2806 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m11rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2807\"><div class=\"quform-element quform-element-html quform-element-97_2808 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2809\"><div class=\"quform-element quform-element-html quform-element-97_2810 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m11tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2811 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2812\"><div class=\"quform-element quform-element-html quform-element-97_2813 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2814\"><div class=\"quform-element quform-element-html quform-element-97_2815 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m11idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2816\"><div class=\"quform-element quform-element-html quform-element-97_2817 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2818\"><div class=\"quform-element quform-element-html quform-element-97_2819 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m11dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2820 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2821\"><div class=\"quform-element quform-element-html quform-element-97_2822 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2823\"><div class=\"quform-element quform-element-html quform-element-97_2824 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m11serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2825\"><div class=\"quform-element quform-element-html quform-element-97_2826 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2827\"><div class=\"quform-element quform-element-html quform-element-97_2828 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m11amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2829 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_3096 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_3097 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3098\"><div class=\"quform-element quform-element-html quform-element-97_3099 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3100\"><div class=\"quform-element quform-element-html quform-element-97_3101 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m12name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3102\"><div class=\"quform-element quform-element-html quform-element-97_3103 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3104\"><div class=\"quform-element quform-element-html quform-element-97_3105 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m12sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3106 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3107\"><div class=\"quform-element quform-element-html quform-element-97_3108 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3109\"><div class=\"quform-element quform-element-html quform-element-97_3110 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m12rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3111\"><div class=\"quform-element quform-element-html quform-element-97_3112 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3113\"><div class=\"quform-element quform-element-html quform-element-97_3114 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m12tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3115 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3116\"><div class=\"quform-element quform-element-html quform-element-97_3117 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3118\"><div class=\"quform-element quform-element-html quform-element-97_3119 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m12idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3120\"><div class=\"quform-element quform-element-html quform-element-97_3121 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3122\"><div class=\"quform-element quform-element-html quform-element-97_3123 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m12dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3124 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3125\"><div class=\"quform-element quform-element-html quform-element-97_3126 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3127\"><div class=\"quform-element quform-element-html quform-element-97_3128 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m12serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3129\"><div class=\"quform-element quform-element-html quform-element-97_3130 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3131\"><div class=\"quform-element quform-element-html quform-element-97_3132 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m12amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3133 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_3058 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_3059 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3060\"><div class=\"quform-element quform-element-html quform-element-97_3061 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3062\"><div class=\"quform-element quform-element-html quform-element-97_3063 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m13name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3064\"><div class=\"quform-element quform-element-html quform-element-97_3065 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3066\"><div class=\"quform-element quform-element-html quform-element-97_3067 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m13sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3068 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3069\"><div class=\"quform-element quform-element-html quform-element-97_3070 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3071\"><div class=\"quform-element quform-element-html quform-element-97_3072 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m13rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3073\"><div class=\"quform-element quform-element-html quform-element-97_3074 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3075\"><div class=\"quform-element quform-element-html quform-element-97_3076 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m13tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3077 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3078\"><div class=\"quform-element quform-element-html quform-element-97_3079 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3080\"><div class=\"quform-element quform-element-html quform-element-97_3081 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m13idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3082\"><div class=\"quform-element quform-element-html quform-element-97_3083 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3084\"><div class=\"quform-element quform-element-html quform-element-97_3085 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m13dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3086 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3087\"><div class=\"quform-element quform-element-html quform-element-97_3088 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3089\"><div class=\"quform-element quform-element-html quform-element-97_3090 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m13serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3091\"><div class=\"quform-element quform-element-html quform-element-97_3092 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3093\"><div class=\"quform-element quform-element-html quform-element-97_3094 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m13amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3095 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_3020 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_3021 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3022\"><div class=\"quform-element quform-element-html quform-element-97_3023 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3024\"><div class=\"quform-element quform-element-html quform-element-97_3025 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m14name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3026\"><div class=\"quform-element quform-element-html quform-element-97_3027 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3028\"><div class=\"quform-element quform-element-html quform-element-97_3029 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m14sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3030 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3031\"><div class=\"quform-element quform-element-html quform-element-97_3032 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3033\"><div class=\"quform-element quform-element-html quform-element-97_3034 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m14rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3035\"><div class=\"quform-element quform-element-html quform-element-97_3036 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3037\"><div class=\"quform-element quform-element-html quform-element-97_3038 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m14tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3039 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3040\"><div class=\"quform-element quform-element-html quform-element-97_3041 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3042\"><div class=\"quform-element quform-element-html quform-element-97_3043 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m14idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3044\"><div class=\"quform-element quform-element-html quform-element-97_3045 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3046\"><div class=\"quform-element quform-element-html quform-element-97_3047 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m14dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3048 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3049\"><div class=\"quform-element quform-element-html quform-element-97_3050 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3051\"><div class=\"quform-element quform-element-html quform-element-97_3052 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m14serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3053\"><div class=\"quform-element quform-element-html quform-element-97_3054 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3055\"><div class=\"quform-element quform-element-html quform-element-97_3056 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m14amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3057 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2982 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2983 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2984\"><div class=\"quform-element quform-element-html quform-element-97_2985 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2986\"><div class=\"quform-element quform-element-html quform-element-97_2987 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m15name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2988\"><div class=\"quform-element quform-element-html quform-element-97_2989 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2990\"><div class=\"quform-element quform-element-html quform-element-97_2991 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m15sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2992 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2993\"><div class=\"quform-element quform-element-html quform-element-97_2994 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2995\"><div class=\"quform-element quform-element-html quform-element-97_2996 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m15rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2997\"><div class=\"quform-element quform-element-html quform-element-97_2998 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2999\"><div class=\"quform-element quform-element-html quform-element-97_3000 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m15tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3001 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3002\"><div class=\"quform-element quform-element-html quform-element-97_3003 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3004\"><div class=\"quform-element quform-element-html quform-element-97_3005 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m15idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3006\"><div class=\"quform-element quform-element-html quform-element-97_3007 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3008\"><div class=\"quform-element quform-element-html quform-element-97_3009 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m15dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3010 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3011\"><div class=\"quform-element quform-element-html quform-element-97_3012 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3013\"><div class=\"quform-element quform-element-html quform-element-97_3014 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m15serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3015\"><div class=\"quform-element quform-element-html quform-element-97_3016 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3017\"><div class=\"quform-element quform-element-html quform-element-97_3018 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m15amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3019 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2944 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2945 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2946\"><div class=\"quform-element quform-element-html quform-element-97_2947 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2948\"><div class=\"quform-element quform-element-html quform-element-97_2949 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m16name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2950\"><div class=\"quform-element quform-element-html quform-element-97_2951 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2952\"><div class=\"quform-element quform-element-html quform-element-97_2953 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m16sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2954 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2955\"><div class=\"quform-element quform-element-html quform-element-97_2956 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2957\"><div class=\"quform-element quform-element-html quform-element-97_2958 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m16rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2959\"><div class=\"quform-element quform-element-html quform-element-97_2960 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2961\"><div class=\"quform-element quform-element-html quform-element-97_2962 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m16tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2963 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2964\"><div class=\"quform-element quform-element-html quform-element-97_2965 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2966\"><div class=\"quform-element quform-element-html quform-element-97_2967 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m16idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2968\"><div class=\"quform-element quform-element-html quform-element-97_2969 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2970\"><div class=\"quform-element quform-element-html quform-element-97_2971 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m16dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2972 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2973\"><div class=\"quform-element quform-element-html quform-element-97_2974 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2975\"><div class=\"quform-element quform-element-html quform-element-97_2976 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m16serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2977\"><div class=\"quform-element quform-element-html quform-element-97_2978 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2979\"><div class=\"quform-element quform-element-html quform-element-97_2980 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m16amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2981 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2906 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2907 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2908\"><div class=\"quform-element quform-element-html quform-element-97_2909 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2910\"><div class=\"quform-element quform-element-html quform-element-97_2911 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m17name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2912\"><div class=\"quform-element quform-element-html quform-element-97_2913 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2914\"><div class=\"quform-element quform-element-html quform-element-97_2915 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m17sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2916 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2917\"><div class=\"quform-element quform-element-html quform-element-97_2918 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2919\"><div class=\"quform-element quform-element-html quform-element-97_2920 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m17rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2921\"><div class=\"quform-element quform-element-html quform-element-97_2922 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2923\"><div class=\"quform-element quform-element-html quform-element-97_2924 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m17tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2925 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2926\"><div class=\"quform-element quform-element-html quform-element-97_2927 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2928\"><div class=\"quform-element quform-element-html quform-element-97_2929 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m17idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2930\"><div class=\"quform-element quform-element-html quform-element-97_2931 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2932\"><div class=\"quform-element quform-element-html quform-element-97_2933 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m17dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2934 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2935\"><div class=\"quform-element quform-element-html quform-element-97_2936 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2937\"><div class=\"quform-element quform-element-html quform-element-97_2938 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m17serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2939\"><div class=\"quform-element quform-element-html quform-element-97_2940 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2941\"><div class=\"quform-element quform-element-html quform-element-97_2942 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m17amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2943 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2868 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2869 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2870\"><div class=\"quform-element quform-element-html quform-element-97_2871 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2872\"><div class=\"quform-element quform-element-html quform-element-97_2873 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m18name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2874\"><div class=\"quform-element quform-element-html quform-element-97_2875 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2876\"><div class=\"quform-element quform-element-html quform-element-97_2877 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m18sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2878 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2879\"><div class=\"quform-element quform-element-html quform-element-97_2880 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2881\"><div class=\"quform-element quform-element-html quform-element-97_2882 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m18rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2883\"><div class=\"quform-element quform-element-html quform-element-97_2884 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2885\"><div class=\"quform-element quform-element-html quform-element-97_2886 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m18tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2887 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2888\"><div class=\"quform-element quform-element-html quform-element-97_2889 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2890\"><div class=\"quform-element quform-element-html quform-element-97_2891 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m18idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2892\"><div class=\"quform-element quform-element-html quform-element-97_2893 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2894\"><div class=\"quform-element quform-element-html quform-element-97_2895 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m18dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2896 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2897\"><div class=\"quform-element quform-element-html quform-element-97_2898 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2899\"><div class=\"quform-element quform-element-html quform-element-97_2900 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m18serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2901\"><div class=\"quform-element quform-element-html quform-element-97_2902 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2903\"><div class=\"quform-element quform-element-html quform-element-97_2904 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m18amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2905 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_2830 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_2831 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2832\"><div class=\"quform-element quform-element-html quform-element-97_2833 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2834\"><div class=\"quform-element quform-element-html quform-element-97_2835 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m19name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2836\"><div class=\"quform-element quform-element-html quform-element-97_2837 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2838\"><div class=\"quform-element quform-element-html quform-element-97_2839 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m19sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2840 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2841\"><div class=\"quform-element quform-element-html quform-element-97_2842 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2843\"><div class=\"quform-element quform-element-html quform-element-97_2844 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m19rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2845\"><div class=\"quform-element quform-element-html quform-element-97_2846 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2847\"><div class=\"quform-element quform-element-html quform-element-97_2848 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m19tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2849 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2850\"><div class=\"quform-element quform-element-html quform-element-97_2851 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2852\"><div class=\"quform-element quform-element-html quform-element-97_2853 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m19idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2854\"><div class=\"quform-element quform-element-html quform-element-97_2855 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2856\"><div class=\"quform-element quform-element-html quform-element-97_2857 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m19dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2858 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_2859\"><div class=\"quform-element quform-element-html quform-element-97_2860 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2861\"><div class=\"quform-element quform-element-html quform-element-97_2862 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m19serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2863\"><div class=\"quform-element quform-element-html quform-element-97_2864 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2865\"><div class=\"quform-element quform-element-html quform-element-97_2866 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m19amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2867 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_3134 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_3135 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3136\"><div class=\"quform-element quform-element-html quform-element-97_3137 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3138\"><div class=\"quform-element quform-element-html quform-element-97_3139 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m20name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3140\"><div class=\"quform-element quform-element-html quform-element-97_3141 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3142\"><div class=\"quform-element quform-element-html quform-element-97_3143 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m20sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3144 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3145\"><div class=\"quform-element quform-element-html quform-element-97_3146 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3147\"><div class=\"quform-element quform-element-html quform-element-97_3148 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m20rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3149\"><div class=\"quform-element quform-element-html quform-element-97_3150 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3151\"><div class=\"quform-element quform-element-html quform-element-97_3152 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m20tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3153 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3154\"><div class=\"quform-element quform-element-html quform-element-97_3155 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3156\"><div class=\"quform-element quform-element-html quform-element-97_3157 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m20idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3158\"><div class=\"quform-element quform-element-html quform-element-97_3159 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3160\"><div class=\"quform-element quform-element-html quform-element-97_3161 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m20dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3162 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3163\"><div class=\"quform-element quform-element-html quform-element-97_3164 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3165\"><div class=\"quform-element quform-element-html quform-element-97_3166 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m20serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3167\"><div class=\"quform-element quform-element-html quform-element-97_3168 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3169\"><div class=\"quform-element quform-element-html quform-element-97_3170 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m20amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3171 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_3172 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_3173 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3174\"><div class=\"quform-element quform-element-html quform-element-97_3175 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3176\"><div class=\"quform-element quform-element-html quform-element-97_3177 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m21name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3178\"><div class=\"quform-element quform-element-html quform-element-97_3179 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3180\"><div class=\"quform-element quform-element-html quform-element-97_3181 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m21sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3182 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3183\"><div class=\"quform-element quform-element-html quform-element-97_3184 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3185\"><div class=\"quform-element quform-element-html quform-element-97_3186 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m21rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3187\"><div class=\"quform-element quform-element-html quform-element-97_3188 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3189\"><div class=\"quform-element quform-element-html quform-element-97_3190 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m21tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3191 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3192\"><div class=\"quform-element quform-element-html quform-element-97_3193 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3194\"><div class=\"quform-element quform-element-html quform-element-97_3195 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m21idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3196\"><div class=\"quform-element quform-element-html quform-element-97_3197 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3198\"><div class=\"quform-element quform-element-html quform-element-97_3199 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m21dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3200 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3201\"><div class=\"quform-element quform-element-html quform-element-97_3202 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3203\"><div class=\"quform-element quform-element-html quform-element-97_3204 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m21serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3205\"><div class=\"quform-element quform-element-html quform-element-97_3206 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3207\"><div class=\"quform-element quform-element-html quform-element-97_3208 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m21amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3209 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_3210 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_3211 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3212\"><div class=\"quform-element quform-element-html quform-element-97_3213 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3214\"><div class=\"quform-element quform-element-html quform-element-97_3215 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m22name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3216\"><div class=\"quform-element quform-element-html quform-element-97_3217 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3218\"><div class=\"quform-element quform-element-html quform-element-97_3219 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m22sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3220 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3221\"><div class=\"quform-element quform-element-html quform-element-97_3222 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3223\"><div class=\"quform-element quform-element-html quform-element-97_3224 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m22rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3225\"><div class=\"quform-element quform-element-html quform-element-97_3226 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3227\"><div class=\"quform-element quform-element-html quform-element-97_3228 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m22tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3229 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3230\"><div class=\"quform-element quform-element-html quform-element-97_3231 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3232\"><div class=\"quform-element quform-element-html quform-element-97_3233 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m22idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3234\"><div class=\"quform-element quform-element-html quform-element-97_3235 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3236\"><div class=\"quform-element quform-element-html quform-element-97_3237 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m22dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3238 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3239\"><div class=\"quform-element quform-element-html quform-element-97_3240 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3241\"><div class=\"quform-element quform-element-html quform-element-97_3242 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m22serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3243\"><div class=\"quform-element quform-element-html quform-element-97_3244 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3245\"><div class=\"quform-element quform-element-html quform-element-97_3246 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m22amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3247 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_3476 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_3477 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3478\"><div class=\"quform-element quform-element-html quform-element-97_3479 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3480\"><div class=\"quform-element quform-element-html quform-element-97_3481 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m23name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3482\"><div class=\"quform-element quform-element-html quform-element-97_3483 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3484\"><div class=\"quform-element quform-element-html quform-element-97_3485 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m23sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3486 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3487\"><div class=\"quform-element quform-element-html quform-element-97_3488 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3489\"><div class=\"quform-element quform-element-html quform-element-97_3490 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m23rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3491\"><div class=\"quform-element quform-element-html quform-element-97_3492 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3493\"><div class=\"quform-element quform-element-html quform-element-97_3494 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m23tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3495 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3496\"><div class=\"quform-element quform-element-html quform-element-97_3497 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3498\"><div class=\"quform-element quform-element-html quform-element-97_3499 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m23idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3500\"><div class=\"quform-element quform-element-html quform-element-97_3501 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3502\"><div class=\"quform-element quform-element-html quform-element-97_3503 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m23dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3504 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3505\"><div class=\"quform-element quform-element-html quform-element-97_3506 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3507\"><div class=\"quform-element quform-element-html quform-element-97_3508 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m23serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3509\"><div class=\"quform-element quform-element-html quform-element-97_3510 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3511\"><div class=\"quform-element quform-element-html quform-element-97_3512 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m23amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3513 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_3438 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_3439 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3440\"><div class=\"quform-element quform-element-html quform-element-97_3441 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3442\"><div class=\"quform-element quform-element-html quform-element-97_3443 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m24name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3444\"><div class=\"quform-element quform-element-html quform-element-97_3445 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3446\"><div class=\"quform-element quform-element-html quform-element-97_3447 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m24sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3448 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3449\"><div class=\"quform-element quform-element-html quform-element-97_3450 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3451\"><div class=\"quform-element quform-element-html quform-element-97_3452 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m24rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3453\"><div class=\"quform-element quform-element-html quform-element-97_3454 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3455\"><div class=\"quform-element quform-element-html quform-element-97_3456 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m24tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3457 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3458\"><div class=\"quform-element quform-element-html quform-element-97_3459 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3460\"><div class=\"quform-element quform-element-html quform-element-97_3461 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m24idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3462\"><div class=\"quform-element quform-element-html quform-element-97_3463 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3464\"><div class=\"quform-element quform-element-html quform-element-97_3465 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m24dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3466 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3467\"><div class=\"quform-element quform-element-html quform-element-97_3468 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3469\"><div class=\"quform-element quform-element-html quform-element-97_3470 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m24serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3471\"><div class=\"quform-element quform-element-html quform-element-97_3472 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3473\"><div class=\"quform-element quform-element-html quform-element-97_3474 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m24amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3475 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_3400 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_3401 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3402\"><div class=\"quform-element quform-element-html quform-element-97_3403 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3404\"><div class=\"quform-element quform-element-html quform-element-97_3405 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m25name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3406\"><div class=\"quform-element quform-element-html quform-element-97_3407 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3408\"><div class=\"quform-element quform-element-html quform-element-97_3409 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m25sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3410 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3411\"><div class=\"quform-element quform-element-html quform-element-97_3412 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3413\"><div class=\"quform-element quform-element-html quform-element-97_3414 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m25rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3415\"><div class=\"quform-element quform-element-html quform-element-97_3416 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3417\"><div class=\"quform-element quform-element-html quform-element-97_3418 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m25tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3419 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3420\"><div class=\"quform-element quform-element-html quform-element-97_3421 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3422\"><div class=\"quform-element quform-element-html quform-element-97_3423 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m25idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3424\"><div class=\"quform-element quform-element-html quform-element-97_3425 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3426\"><div class=\"quform-element quform-element-html quform-element-97_3427 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m25dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3428 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3429\"><div class=\"quform-element quform-element-html quform-element-97_3430 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3431\"><div class=\"quform-element quform-element-html quform-element-97_3432 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m25serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3433\"><div class=\"quform-element quform-element-html quform-element-97_3434 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3435\"><div class=\"quform-element quform-element-html quform-element-97_3436 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m25amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3437 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_3362 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_3363 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3364\"><div class=\"quform-element quform-element-html quform-element-97_3365 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3366\"><div class=\"quform-element quform-element-html quform-element-97_3367 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m26name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3368\"><div class=\"quform-element quform-element-html quform-element-97_3369 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3370\"><div class=\"quform-element quform-element-html quform-element-97_3371 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m26sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3372 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3373\"><div class=\"quform-element quform-element-html quform-element-97_3374 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3375\"><div class=\"quform-element quform-element-html quform-element-97_3376 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m26rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3377\"><div class=\"quform-element quform-element-html quform-element-97_3378 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3379\"><div class=\"quform-element quform-element-html quform-element-97_3380 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m26tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3381 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3382\"><div class=\"quform-element quform-element-html quform-element-97_3383 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3384\"><div class=\"quform-element quform-element-html quform-element-97_3385 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m26idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3386\"><div class=\"quform-element quform-element-html quform-element-97_3387 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3388\"><div class=\"quform-element quform-element-html quform-element-97_3389 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m26dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3390 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3391\"><div class=\"quform-element quform-element-html quform-element-97_3392 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3393\"><div class=\"quform-element quform-element-html quform-element-97_3394 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m26serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3395\"><div class=\"quform-element quform-element-html quform-element-97_3396 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3397\"><div class=\"quform-element quform-element-html quform-element-97_3398 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m26amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3399 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_3324 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_3325 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3326\"><div class=\"quform-element quform-element-html quform-element-97_3327 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3328\"><div class=\"quform-element quform-element-html quform-element-97_3329 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m27name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3330\"><div class=\"quform-element quform-element-html quform-element-97_3331 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3332\"><div class=\"quform-element quform-element-html quform-element-97_3333 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m27sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3334 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3335\"><div class=\"quform-element quform-element-html quform-element-97_3336 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3337\"><div class=\"quform-element quform-element-html quform-element-97_3338 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m27rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3339\"><div class=\"quform-element quform-element-html quform-element-97_3340 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3341\"><div class=\"quform-element quform-element-html quform-element-97_3342 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m27tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3343 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3344\"><div class=\"quform-element quform-element-html quform-element-97_3345 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3346\"><div class=\"quform-element quform-element-html quform-element-97_3347 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m27idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3348\"><div class=\"quform-element quform-element-html quform-element-97_3349 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3350\"><div class=\"quform-element quform-element-html quform-element-97_3351 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m27dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3352 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3353\"><div class=\"quform-element quform-element-html quform-element-97_3354 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3355\"><div class=\"quform-element quform-element-html quform-element-97_3356 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m27serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3357\"><div class=\"quform-element quform-element-html quform-element-97_3358 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3359\"><div class=\"quform-element quform-element-html quform-element-97_3360 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m27amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3361 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_3286 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_3287 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3288\"><div class=\"quform-element quform-element-html quform-element-97_3289 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3290\"><div class=\"quform-element quform-element-html quform-element-97_3291 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m28name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3292\"><div class=\"quform-element quform-element-html quform-element-97_3293 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3294\"><div class=\"quform-element quform-element-html quform-element-97_3295 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m28sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3296 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3297\"><div class=\"quform-element quform-element-html quform-element-97_3298 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3299\"><div class=\"quform-element quform-element-html quform-element-97_3300 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m28rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3301\"><div class=\"quform-element quform-element-html quform-element-97_3302 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3303\"><div class=\"quform-element quform-element-html quform-element-97_3304 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m28tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3305 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3306\"><div class=\"quform-element quform-element-html quform-element-97_3307 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3308\"><div class=\"quform-element quform-element-html quform-element-97_3309 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m28idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3310\"><div class=\"quform-element quform-element-html quform-element-97_3311 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3312\"><div class=\"quform-element quform-element-html quform-element-97_3313 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m28dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3314 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3315\"><div class=\"quform-element quform-element-html quform-element-97_3316 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3317\"><div class=\"quform-element quform-element-html quform-element-97_3318 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m28serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3319\"><div class=\"quform-element quform-element-html quform-element-97_3320 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3321\"><div class=\"quform-element quform-element-html quform-element-97_3322 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m28amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3323 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_3248 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_3249 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3250\"><div class=\"quform-element quform-element-html quform-element-97_3251 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3252\"><div class=\"quform-element quform-element-html quform-element-97_3253 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m29name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3254\"><div class=\"quform-element quform-element-html quform-element-97_3255 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3256\"><div class=\"quform-element quform-element-html quform-element-97_3257 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m29sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3258 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3259\"><div class=\"quform-element quform-element-html quform-element-97_3260 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3261\"><div class=\"quform-element quform-element-html quform-element-97_3262 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m29rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3263\"><div class=\"quform-element quform-element-html quform-element-97_3264 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3265\"><div class=\"quform-element quform-element-html quform-element-97_3266 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m29tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3267 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3268\"><div class=\"quform-element quform-element-html quform-element-97_3269 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3270\"><div class=\"quform-element quform-element-html quform-element-97_3271 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m29idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3272\"><div class=\"quform-element quform-element-html quform-element-97_3273 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3274\"><div class=\"quform-element quform-element-html quform-element-97_3275 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m29dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3276 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3277\"><div class=\"quform-element quform-element-html quform-element-97_3278 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3279\"><div class=\"quform-element quform-element-html quform-element-97_3280 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m29serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3281\"><div class=\"quform-element quform-element-html quform-element-97_3282 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3283\"><div class=\"quform-element quform-element-html quform-element-97_3284 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m29amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3285 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-group quform-element-97_3514 quform-cf quform-group-style-plain\"><div class=\"quform-spacer\"><div class=\"quform-child-elements\"><div class=\"quform-element quform-element-row quform-element-row-97_3515 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3516\"><div class=\"quform-element quform-element-html quform-element-97_3517 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u59d3\u540d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3518\"><div class=\"quform-element quform-element-html quform-element-97_3519 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m30name\">\u59d3\u540d (Name)<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3520\"><div class=\"quform-element quform-element-html quform-element-97_3521 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u6027\u5225<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3522\"><div class=\"quform-element quform-element-html quform-element-97_3523 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m30sex\";>\u6027\u5225<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3524 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3525\"><div class=\"quform-element quform-element-html quform-element-97_3526 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3527\"><div class=\"quform-element quform-element-html quform-element-97_3528 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m30rel\";>\u95dc\u4fc2<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3529\"><div class=\"quform-element quform-element-html quform-element-97_3530 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u96fb\u8a71<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3531\"><div class=\"quform-element quform-element-html quform-element-97_3532 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m30tel\";>\u96fb\u8a71\u865f\u78bc<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3533 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3534\"><div class=\"quform-element quform-element-html quform-element-97_3535 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u8a3c\u4ef6<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3536\"><div class=\"quform-element quform-element-html quform-element-97_3537 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m30idno\";>\u8a3c\u4ef6\u865f\u78bc<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3538\"><div class=\"quform-element quform-element-html quform-element-97_3539 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u751f\u65e5<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3540\"><div class=\"quform-element quform-element-html quform-element-97_3541 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m30dob\";>\u51fa\u751f\u65e5\u671f<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_3542 quform-4-columns quform-element-row-size-fixed\"><div class=\"quform-element quform-element-column quform-element-97_3543\"><div class=\"quform-element quform-element-html quform-element-97_3544 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3545\"><div class=\"quform-element quform-element-html quform-element-97_3546 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m30serv\";>\u670d\u52d9<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3547\"><div class=\"quform-element quform-element-html quform-element-97_3548 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\">\u91d1\u984d<\/div>\n<\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_3549\"><div class=\"quform-element quform-element-html quform-element-97_3550 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.1rem;\" id=\"m30amt\";>\u91d1\u984d<\/div>\n<\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3551 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3553 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: center; font-family: kaiti; font-size: 1.2rem;\" id=\"totalamount\";>\u91d1\u984d<\/div>\n<\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3554 quform-cf\"><div class=\"quform-spacer\"><div style=\"font-size: 3px;background: grey;border-bottom: solid 3px bisque;\" class=\"candidate_ref\"> <\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3552 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: center; font-family: kaiti; font-size: 1.2rem;\" id=\"promotion\";>\u670d\u52d9<\/div>\n<\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3556 quform-cf\"><div class=\"quform-spacer\"><div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\">\u8acb\u7d30\u5fc3\u67e5\u6838\u6240\u63d0\u4ea4\u7684\u8cc7\u6599\uff0c\u82e5\u6709\u932f\u8aa4\u6216\u907a\u7559\u800c\u5c0e\u81f4\u670d\u52d9\u6709\u6240\u5ef6\u8aa4\u6216\u672a\u80fd\u6309\u6642\u4eab\u7528\u6240\u9078\u4e4b\u4fdd\u969c\u8a08\u5283\uff0c\u672c\u516c\u53f8\u5c07\u4e0d\u6703\u8ca0\u4e0a\u4efb\u4f55\u8cac\u4efb\u3002\u82e5\u56e0\u4ee5\u4e0a\u60c5\u6cc1\u800c\u5f15\u81f4\u4efb\u4f55\u884c\u653f\u8cbb\u7528\u7684\u7522\u751f\uff0c\u5747\u7531\u7533\u8acb\u4eba\u627f\u64d4\u3002\u53e6\u5916\uff0c\u82e5\u9700\u7533\u8acb\u91cd\u767c\u6703\u54e1\u54ad\uff0c\u8cbb\u7528HKD50.00\u3002<\/div><br \/>\n<div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\"><strong>\u500b\u4eba\u8cc7\u6599\u6536\u96c6\u8072\u660e\ufe30<\/strong><br \/>\u6839\u64da\u300a\u500b\u4eba\u8cc7\u6599(\u79c1\u96b1)\u689d\u4f8b\u300b\uff0c\u95a3\u4e0b\u5728\u672c\u8868\u683c\u5167\u6240\u63d0\u4f9b\u4e88\u672c\u516c\u53f8\u7684\u8cc7\u6599\u53ea\u6703\u7528\u65bc\u6295\u4fdd\u53ca\u65e5\u5f8c\u5e02\u5834\u63a8\u5ee3\u4e4b\u7528\u3002 \u5982\u95a3\u4e0b\u65e5\u5f8c\u4e0d\u6b32\u6536\u53d6\u6b64\u7b49\u8cc7\u8a0a\uff0c\u8acb\u81f4\u96fb6255 3289\u806f\u7d61\u672c\u516c\u53f8\u3002<\/div><br \/>\n<div style=\"text-align: left; font-family: kaiti; font-size: 1.2rem;\"><strong>\u6ce8\u610f\u4e8b\u9805\ufe30<\/strong><br \/>** \u8a08\u5283\u4e00\u7d93\u751f\u6548\uff0c\u53ea\u80fd\u5920\u5728\u9031\u5e74\u5f8c\uff0c\u65bc\u7e8c\u4fdd\u6642\u66f4\u6539\u8a08\u5283\uff0c\u6240\u6709\u7533\u8acb\u53ca\u7e8c\u4fdd\u5747\u7531\u5065\u9053\u570b\u969b\/\u52c7\u6377\u9867\u554f\u6709\u9650\u516c\u53f8\u4fdd\u7559\u6700\u7d42\u6c7a\u5b9a\u6b0a\u3002<\/div><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_2249 quform-cf\"><div class=\"quform-spacer\"><script>\n    jQuery(document).ready(function ($) {                    \n\t\t$('.quform-next').click(function () {\n\t\t check_coupon_code();\n\t\t});\n\t\t$(\".quform-back\").click(function () {\n\t\t\tvar member_number = $(\".members_number\").val();\n\t\t\t\/\/ close all expanded family info when clicking the go back button\n\t\t\tif(member_number > 0) {\n\t\t\t\t$(\".m1-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m1-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m1-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 1) {\n\t\t\t\t$(\".m2-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m2-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m2-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 2) {\n\t\t\t\t$(\".m3-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m3-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m3-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 3) {\n\t\t\t\t$(\".m4-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m4-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m4-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 4) {\n\t\t\t\t$(\".m5-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m5-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m5-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 5) {\n\t\t\t\t$(\".m6-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m6-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m6-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 6) {\n\t\t\t\t$(\".m7-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m7-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m7-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 7) {\n\t\t\t\t$(\".m8-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m8-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m8-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 8) {\n\t\t\t\t$(\".m9-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m9-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m9-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 9) {\n\t\t\t\t$(\".m10-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m10-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m10-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 10) {\n\t\t\t\t$(\".m11-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m11-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m11-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 11) {\n\t\t\t\t$(\".m12-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m12-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m12-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 12) {\n\t\t\t\t$(\".m13-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m13-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m13-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 13) {\n\t\t\t\t$(\".m14-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m14-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m14-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 14) {\n\t\t\t\t$(\".m15-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m15-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m15-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 15) {\n\t\t\t\t$(\".m16-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m16-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m16-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 16) {\n\t\t\t\t$(\".m17-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m17-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m17-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 17) {\n\t\t\t\t$(\".m18-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m18-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m18-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 18) {\n\t\t\t\t$(\".m19-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m19-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m19-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 19) {\n\t\t\t\t$(\".m20-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m20-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m20-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 20) {\n\t\t\t\t$(\".m21-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m21-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m21-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 21) {\n\t\t\t\t$(\".m22-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m22-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m22-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 22) {\n\t\t\t\t$(\".m23-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m23-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m23-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 23) {\n\t\t\t\t$(\".m24-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m24-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m24-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 24) {\n\t\t\t\t$(\".m25-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m25-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m25-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 25) {\n\t\t\t\t$(\".m26-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m26-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m26-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 26) {\n\t\t\t\t$(\".m27-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m27-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m27-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 27) {\n\t\t\t\t$(\".m28-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m28-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m28-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 28) {\n\t\t\t\t$(\".m29-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m29-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m29-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t\tif(member_number > 29) {\n\t\t\t\t$(\".m30-save\").filter('[value=\"save\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$(\".m30-sname\").closest('.quform-element-group').hide();\n\t\t\t\t$(\"#m30-label\").closest('.quform-element-html').show();\n\t\t\t}\n\t\t});\n\t});  \/\/end document ready\n<\/script><\/div><\/div><div class=\"quform-element quform-element-html quform-element-97_3616 quform-cf\"><div class=\"quform-spacer\">\n<script>\n \nvar update_price_sucess = function(data, textStatus, jqXHR){\n    $jq('.xcount').val(data);\n\/\/display data for checking\n\t\t\tvar formtype = $jq('.aformtype').val().toUpperCase();\n\t\t\tvar applicant_sname = $jq('.a-sname').val().toUpperCase();\n\t\t\tvar applicant_gname = $jq('.a-gname').val().toUpperCase();\n\t\t\t$jq('#appname').html(\"<b>\"+applicant_sname+\" \"+applicant_gname+\"<\/b>\");\n\t\t\tvar applicant_sex = $jq('.a-sex').val();\n\t\t\t$jq('#appsex').html(\"<b>\"+applicant_sex+\"<\/b>\");\n\t\t\tvar applicant_mtype = $jq('.a-mtype').val();\n\t\t\tvar applicant_mno = $jq('.a-mno').val();\n\t\t\t$jq('#appmemid').html(\"<b>\"+applicant_mno+\" (\"+applicant_mtype+\")<\/b>\");\n\t\t\tvar applicant_hkid = $jq('.a-hkid').val().toUpperCase();\n\t\t\t$jq('#apphkid').html(\"<b>\"+applicant_hkid+\"<\/b>\");\n\t\t\tvar applicant_dob = $jq('.a-dob').val();\n\t\t\t$jq('#appdob').html(\"<b>\"+applicant_dob+\"<\/b>\");\n\t\t\tvar applicant_add = $jq('.a-add').val().toUpperCase();\n\t\t\t$jq('#appadd').html(\"<b>\"+applicant_add+\"<\/b>\");\n\t\t\tvar applicant_tel = $jq('.a-tel').val();\n\t\t\t$jq('#apptel').html(\"<b>\"+applicant_tel+\"<\/b>\");\n\t\t\tvar applicant_email = $jq('.a-email').val();\n\t\t\t$jq('#appemail').html(\"<b>\"+applicant_email+\"<\/b>\");\n\t\t\tvar applicant_district = $jq('.a-district').val().toUpperCase();\n\t\t\t$jq('#appdistrict').html(\"<b>\"+applicant_district+\"<\/b>\");\n\t\t\tvar applicant_agent = $jq('.a-agent').val().toUpperCase();\n\t\t\t$jq('#appagent').html(\"<b>\"+applicant_agent+\"<\/b>\");\n\t\t\t$jq('#promotion').html(\"<b>\u672c\u4eba\u9858\u610f\u65e5\u5f8c\u63a5\u6536\u76f8\u95dc\u7522\u54c1\u63a8\u5ee3<\/b>\");\n\t\t\t\/\/ display card info\n\t\t\tvar xctn = Number($jq('.xcount').val());\n\t\t\tif (xctn > 200) {\n\t\t\t\t$jq('.xcount').val('200');\n\t\t\t\t$jq('.MediCardAmt').val('1413');\n\t\t\t\t$jq('.DentalSureAmt').val('490');\n\t\t\t\t$jq('.CheckUpAmt').val('490');\n\t\t\t\txctn = 200;\t\t\t\t\n\t\t\t}\n\t\t\tvar healthcareamt = Number($jq('.HealthCareAmt').val());\n\t\t\tvar goldamt = Number($jq('.MediCardAmt').val());\n\t\t\tvar dentalamt = Number($jq('.DentalSureAmt').val());\n\t\t\tvar checkupamt = Number($jq('.CheckUpAmt').val());\n\t\t\tvar paidamt = Number($jq('.PaidAmt').val());\n\n\t\t\tif (paidamt>0) {\n\t\t\t\thealthcareamt = 0;\n\t\t\t\txctn = 0;\n\t\t\t}\n\t\t\t\n            if ($jq('.isValidForEdit').val()=='Y') {\n\t\t\t\thealthcareamt = 0;\n\t\t\t\txctn = 0;\n\t\t\t}\n\t\t\t\n\t\t\tvar result = $jq('input[type=\"checkbox\"]:checked');\n\t\t\tvar member_number = Number($jq(\".members_number\").val());\n\t\t\tvar resultAmt = healthcareamt ;\n\t\t\tvar totalamt = healthcareamt ;\n\t\t\tvar resultString = \"HealthCare<br \/>\";\n\t\t\tvar resultString1 = \"HealthCare\";\n\t\t\tvar resultAmt1 = 0 ;\n\t\t\tvar resultString2 = \"HealthCare\";\n\t\t\tvar resultAmt2 = 0 ;\n\t\t\tvar resultString3 = \"HealthCare\";\n\t\t\tvar resultAmt3 = 0 ;\n\t\t\tvar resultString4 = \"HealthCare\";\n\t\t\tvar resultAmt4 = 0 ;\n\t\t\tvar resultString5 = \"HealthCare\";\n\t\t\tvar resultAmt5 = 0 ;\n\t\t\tvar resultString6 = \"HealthCare\";\n\t\t\tvar resultAmt6 = 0 ;\n\t\t\tvar resultString7 = \"HealthCare\";\n\t\t\tvar resultAmt7 = 0 ;\n\t\t\tvar resultString8 = \"HealthCare\";\n\t\t\tvar resultAmt8 = 0 ;\n\t\t\tvar resultString9 = \"HealthCare\";\n\t\t\tvar resultAmt9 = 0 ;\n\t\t\tvar resultString10 = \"HealthCare\";\n\t\t\tvar resultAmt10 = 0 ;\n\t\t\tvar resultString11 = \"HealthCare\";\n\t\t\tvar resultAmt11 = 0 ;\n\t\t\tvar resultString12 = \"HealthCare\";\n\t\t\tvar resultAmt12 = 0 ;\n\t\t\tvar resultString13 = \"HealthCare\";\n\t\t\tvar resultAmt13 = 0 ;\n\t\t\tvar resultString14 = \"HealthCare\";\n\t\t\tvar resultAmt14 = 0 ;\n\t\t\tvar resultString15 = \"HealthCare\";\n\t\t\tvar resultAmt15 = 0 ;\n\t\t\tvar resultString16 = \"HealthCare\";\n\t\t\tvar resultAmt16 = 0 ;\n\t\t\tvar resultString17 = \"HealthCare\";\n\t\t\tvar resultAmt17 = 0 ;\n\t\t\tvar resultString18 = \"HealthCare\";\n\t\t\tvar resultAmt18 = 0 ;\n\t\t\tvar resultString19 = \"HealthCare\";\n\t\t\tvar resultAmt19 = 0 ;\n\t\t\tvar resultString20 = \"HealthCare\";\n\t\t\tvar resultAmt20 = 0 ;\n\t\t\tvar resultString21 = \"HealthCare\";\n\t\t\tvar resultAmt21 = 0 ;\n\t\t\tvar resultString22 = \"HealthCare\";\n\t\t\tvar resultAmt22 = 0 ;\n\t\t\tvar resultString23 = \"HealthCare\";\n\t\t\tvar resultAmt23 = 0 ;\n\t\t\tvar resultString24 = \"HealthCare\";\n\t\t\tvar resultAmt24 = 0 ;\n\t\t\tvar resultString25 = \"HealthCare\";\n\t\t\tvar resultAmt25 = 0 ;\n\t\t\tvar resultString26 = \"HealthCare\";\n\t\t\tvar resultAmt26 = 0 ;\n\t\t\tvar resultString27 = \"HealthCare\";\n\t\t\tvar resultAmt27 = 0 ;\n\t\t\tvar resultString28 = \"HealthCare\";\n\t\t\tvar resultAmt28 = 0 ;\n\t\t\tvar resultString29 = \"HealthCare\";\n\t\t\tvar resultAmt29 = 0 ;\n\t\t\tvar resultString30 = \"HealthCare\";\n\t\t\tvar resultAmt30 = 0 ;\n\t\t\tif (result.length > 0) {\n\t\t\t\tresult.each(function () {\n\t\t\t\t\tif($jq(this).val()==\"gold\") {\n\t\t\t\t\t\tresultString += \"MediCard (\u91d1\u54ad)<br \/>\";\n\t\t\t\t\t\tresultAmt += goldamt;\n\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t}\n\t\t\t\t\tif($jq(this).val()==\"dental\") {\n\t\t\t\t\t\tresultString += \"DentalSure<br \/>\";\n\t\t\t\t\t\tresultAmt += dentalamt;\n\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t}\n\t\t\t\t\tif($jq(this).val()==\"checkup\") {\n\t\t\t\t\tresultString += \"Medical Checkcup<br \/>\";\n\t\t\t\t\t\tresultAmt += checkupamt;\n\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m1-del').is(':checked')) && member_number > 0) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold1\") {\n\t\t\t\t\t\t\tresultString1 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt1 += goldamt;\n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental1\") {\n\t\t\t\t\t\t\tresultString1 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt1 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup1\") {\n\t\t\t\t\t\t\tresultString1 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt1 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m2-del').is(':checked')) && member_number > 1) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold2\") {\n\t\t\t\t\t\t\tresultString2 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt2 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental2\") {\n\t\t\t\t\t\t\tresultString2 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt2 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup2\") {\n\t\t\t\t\t\t\tresultString2 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt2 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m3-del').is(':checked')) && member_number > 2) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold3\") {\n\t\t\t\t\t\t\tresultString3 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt3 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental3\") {\n\t\t\t\t\t\t\tresultString3 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt3 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup3\") {\n\t\t\t\t\t\t\tresultString3 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt3 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m4-del').is(':checked')) && member_number > 3) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold4\") {\n\t\t\t\t\t\t\tresultString4 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt4 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental4\") {\n\t\t\t\t\t\t\tresultString4 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt4 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup4\") {\n\t\t\t\t\t\t\tresultString4 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt4 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m5-del').is(':checked')) && member_number > 4) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold5\") {\n\t\t\t\t\t\t\tresultString5 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt5 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental5\") {\n\t\t\t\t\t\t\tresultString5 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt5 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup5\") {\n\t\t\t\t\t\t\tresultString5 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt5 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m6-del').is(':checked')) && member_number > 5) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold6\") {\n\t\t\t\t\t\t\tresultString6 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt6 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental6\") {\n\t\t\t\t\t\t\tresultString6 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt6 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup6\") {\n\t\t\t\t\t\t\tresultString6 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt6 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m7-del').is(':checked')) && member_number > 6) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold7\") {\n\t\t\t\t\t\t\tresultString7 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt7 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental7\") {\n\t\t\t\t\t\t\tresultString7 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt7 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup7\") {\n\t\t\t\t\t\t\tresultString7 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt7 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m8-del').is(':checked')) && member_number > 7) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold8\") {\n\t\t\t\t\t\t\tresultString8 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt8 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental8\") {\n\t\t\t\t\t\t\tresultString8 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt8 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup8\") {\n\t\t\t\t\t\t\tresultString8 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt8 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m9-del').is(':checked')) && member_number > 8) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold9\") {\n\t\t\t\t\t\t\tresultString9 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt9 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental9\") {\n\t\t\t\t\t\t\tresultString9 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt9 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup9\") {\n\t\t\t\t\t\t\tresultString9 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt9 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m10-del').is(':checked')) && member_number > 9) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold10\") {\n\t\t\t\t\t\t\tresultString10 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt10 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental10\") {\n\t\t\t\t\t\t\tresultString10 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt10 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup10\") {\n\t\t\t\t\t\t\tresultString10 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt10 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m11-del').is(':checked')) && member_number > 10) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold11\") {\n\t\t\t\t\t\t\tresultString11 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt11 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental11\") {\n\t\t\t\t\t\t\tresultString11 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt11 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup11\") {\n\t\t\t\t\t\t\tresultString11 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt11 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m12-del').is(':checked')) && member_number > 11) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold12\") {\n\t\t\t\t\t\t\tresultString12 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt12 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental12\") {\n\t\t\t\t\t\t\tresultString12 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt12 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup12\") {\n\t\t\t\t\t\t\tresultString12 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt12 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m13-del').is(':checked')) && member_number > 12) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold13\") {\n\t\t\t\t\t\t\tresultString13 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt13 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental13\") {\n\t\t\t\t\t\t\tresultString13 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt13 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup13\") {\n\t\t\t\t\t\t\tresultString13 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt13 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m14-del').is(':checked')) && member_number > 13) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold14\") {\n\t\t\t\t\t\t\tresultString14 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt14 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental14\") {\n\t\t\t\t\t\t\tresultString14 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt14 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup14\") {\n\t\t\t\t\t\t\tresultString14 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt14 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m15-del').is(':checked')) && member_number > 14) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold15\") {\n\t\t\t\t\t\t\tresultString15 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt15 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental15\") {\n\t\t\t\t\t\t\tresultString15 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt15 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup15\") {\n\t\t\t\t\t\t\tresultString15 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt15 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m16-del').is(':checked')) && member_number > 15) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold16\") {\n\t\t\t\t\t\t\tresultString16 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt16 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental16\") {\n\t\t\t\t\t\t\tresultString16 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt16 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup16\") {\n\t\t\t\t\t\t\tresultString16 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt16 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m17-del').is(':checked')) && member_number > 16) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold17\") {\n\t\t\t\t\t\t\tresultString17 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt17 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental17\") {\n\t\t\t\t\t\t\tresultString17 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt17 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup17\") {\n\t\t\t\t\t\t\tresultString17 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt17 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m18-del').is(':checked')) && member_number > 17) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold18\") {\n\t\t\t\t\t\t\tresultString18 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt18 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental18\") {\n\t\t\t\t\t\t\tresultString18 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt18 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup18\") {\n\t\t\t\t\t\t\tresultString18 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt18 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m19-del').is(':checked')) && member_number > 18) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold19\") {\n\t\t\t\t\t\t\tresultString19 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt19 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental19\") {\n\t\t\t\t\t\t\tresultString19 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt19 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup19\") {\n\t\t\t\t\t\t\tresultString19 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt19 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m20-del').is(':checked')) && member_number > 19) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold20\") {\n\t\t\t\t\t\t\tresultString20 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt20 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental20\") {\n\t\t\t\t\t\t\tresultString20 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt20 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup20\") {\n\t\t\t\t\t\t\tresultString20 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt20 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\t\t\t\t\n\t\t\t\t\tif(!($jq('.m21-del').is(':checked')) && member_number > 20) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold21\") {\n\t\t\t\t\t\t\tresultString21 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt21 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental21\") {\n\t\t\t\t\t\t\tresultString21 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt21 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup21\") {\n\t\t\t\t\t\t\tresultString21 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt21 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m22-del').is(':checked')) && member_number > 21) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold22\") {\n\t\t\t\t\t\t\tresultString22 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt22 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental22\") {\n\t\t\t\t\t\t\tresultString22 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt22 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup22\") {\n\t\t\t\t\t\t\tresultString22 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt22 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m23-del').is(':checked')) && member_number > 22) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold23\") {\n\t\t\t\t\t\t\tresultString23 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt23 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental23\") {\n\t\t\t\t\t\t\tresultString23 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt23 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup23\") {\n\t\t\t\t\t\t\tresultString23 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt23 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m24-del').is(':checked')) && member_number > 23) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold24\") {\n\t\t\t\t\t\t\tresultString24 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt24 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental24\") {\n\t\t\t\t\t\t\tresultString24 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt24 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup24\") {\n\t\t\t\t\t\t\tresultString24 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt24 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m25-del').is(':checked')) && member_number > 24) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold25\") {\n\t\t\t\t\t\t\tresultString25 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt25 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental25\") {\n\t\t\t\t\t\t\tresultString25 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt25 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup25\") {\n\t\t\t\t\t\t\tresultString25 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt25 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m26-del').is(':checked')) && member_number > 25) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold26\") {\n\t\t\t\t\t\t\tresultString26 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt26 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental26\") {\n\t\t\t\t\t\t\tresultString26 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt26 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup26\") {\n\t\t\t\t\t\t\tresultString26 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt26 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m27-del').is(':checked')) && member_number > 26) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold27\") {\n\t\t\t\t\t\t\tresultString27 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt27 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental27\") {\n\t\t\t\t\t\t\tresultString27 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt27 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup27\") {\n\t\t\t\t\t\t\tresultString27 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt27 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m28-del').is(':checked')) && member_number > 27) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold28\") {\n\t\t\t\t\t\t\tresultString28 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt28 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental28\") {\n\t\t\t\t\t\t\tresultString28 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt28 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup28\") {\n\t\t\t\t\t\t\tresultString28 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt28 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m29-del').is(':checked')) && member_number > 28) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold29\") {\n\t\t\t\t\t\t\tresultString29 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt29 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental29\") {\n\t\t\t\t\t\t\tresultString29 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt29 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup29\") {\n\t\t\t\t\t\t\tresultString29 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt29 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif(!($jq('.m30-del').is(':checked')) && member_number > 29) {\n\t\t\t\t\t\tif($jq(this).val()==\"gold30\") {\n\t\t\t\t\t\t\tresultString30 += \" \/ MediCard\";\n\t\t\t\t\t\t\tresultAmt30 += goldamt; \n\t\t\t\t\t\t\ttotalamt += goldamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"dental30\") {\n\t\t\t\t\t\t\tresultString30 += \" \/ DentalSure\";\n\t\t\t\t\t\t\tresultAmt30 += dentalamt; \n\t\t\t\t\t\t\ttotalamt += dentalamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t\tif($jq(this).val()==\"checkup30\") {\n\t\t\t\t\t\t\tresultString30 += \" \/ Checkup\";\n\t\t\t\t\t\t\tresultAmt30 += checkupamt; \n\t\t\t\t\t\t\ttotalamt += checkupamt;\n\t\t\t\t\t\t}\n\t\t\t\t\t}\n\t\t\t\t\tif($jq(this).val()==\"nonpromote\") {\n\t\t\t\t\t\t$jq('#promotion').html(\"<b>\u672c\u4eba\u4e0d\u9858\u610f\u65e5\u5f8c\u63a5\u6536\u76f8\u95dc\u7522\u54c1\u63a8\u5ee3<\/b>\");\n\t\t\t\t\t}\n\t\t\t\t});\n\t\t\t\tif (formtype=='HWED') {\n\t\t\t\t\tif (totalamt>healthcareamt) {\n\t\t\t\t\t\tresultAmt = resultAmt - healthcareamt;\n\t\t\t\t\t\ttotalamt = totalamt - healthcareamt;\n\t\t\t\t\t} else {\n\t\t\t\t\t\tresultAmt = resultAmt - xctn;\n\t\t\t\t\t\ttotalamt = totalamt - xctn;\n\t\t\t\t\t}\n\t\t\t\t} else {\n\t\t\t\t\tresultAmt = resultAmt - xctn;\n\t\t\t\t\ttotalamt = totalamt - xctn;\n\t\t\t\t}\n\t\t\t\t$jq('#appcard').html(\"<b>\"+resultString+\"<br \/>\u7533\u8acb\u4eba\u91d1\u984d : HKD \"+resultAmt+\"<\/b>\");\n\t\t\t\tif (paidamt > 0){\n\t\t\t\t\ttotalamt = totalamt - paidamt;\n\t\t\t\t\t$jq('#totalamount').html(\"<b>\u6263\u9664\u5df2\u4ed8\u91d1\u984d \uff1a \"+paidamt+\"<br\/>\u73fe\u61c9\u4ed8\u7e3d\u91d1\u984d : HKD \"+totalamt+\"<\/b>\");\n\t\t\t\t} else {\n\t\t\t\t\t$jq('#totalamount').html(\"<b>\u7e3d\u91d1\u984d : HKD \"+totalamt+\"<\/b>\");\n\t\t\t\t}\n\t\t\t}\n\t\t\telse {\n\t\t\t\tif (formtype=='HWED') {\n\t\t\t\t\tif (totalamt>healthcareamt) {\n\t\t\t\t\t\tresultAmt = resultAmt - healthcareamt;\n\t\t\t\t\t\ttotalamt = totalamt - healthcareamt;\n\t\t\t\t\t} else {\n\t\t\t\t\t\tresultAmt = resultAmt - xctn;\n\t\t\t\t\t\ttotalamt = totalamt - xctn;\n\t\t\t\t\t}\n\t\t\t\t} else {\n\t\t\t\t\tresultAmt = resultAmt - xctn;\n\t\t\t\t\ttotalamt = totalamt - xctn;\n\t\t\t\t}\n\t\t\t\t$jq('#appcard').html(\"<b>HealthCare<br \/>\u7533\u8acb\u4eba\u91d1\u984d : HKD \"+resultAmt+\"<\/b>\");\n\t\t\t\tif (paidamt > 0){\n\t\t\t\t\ttotalamt = totalamt - paidamt;\n\t\t\t\t\t$jq('#totalamount').html(\"<b>\u6263\u9664\u5df2\u4ed8\u91d1\u984d \uff1a HKD \"+paidamt+\"<br\/>\u73fe\u61c9\u4ed8\u7e3d\u91d1\u984d : HKD \"+totalamt+\"<\/b>\");\n\t\t\t\t} else {\n\t\t\t\t\t$jq('#totalamount').html(\"<b>\u7e3d\u91d1\u984d : HKD \"+totalamt+\"<\/b>\");\n\t\t\t\t}\n\t\t\t}\n\t\t\t\n\t\t\t\/\/ expand family member info for validation\n\t\t\t\n\t\t\tif(member_number > 0) {\n\n\t\t\t\tvar m_sname = $jq('.m1-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m1-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m1-del').is(':checked')) {\n\t\t\t\t\t$jq('#m1name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m1name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m1-sex').val();\n\t\t\t\t$jq('#m1sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m1-rel').val();\n\t\t\t\t$jq('#m1rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m1-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m1-idno').val().toUpperCase();\n\t\t\t\t$jq('#m1idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m1-dob').val();\n\t\t\t\t$jq('#m1dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m1-tel').val();\n\t\t\t\t$jq('#m1tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m1serv').html(\"<b>\"+resultString1+\"<\/b>\");\n\t\t\t\t$jq('#m1amt').html(\"<b>HKD \"+resultAmt1+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 1) {\n\n\t\t\t\tvar m_sname = $jq('.m2-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m2-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m2-del').is(':checked')) {\n\t\t\t\t\t$jq('#m2name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m2name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m2-sex').val();\n\t\t\t\t$jq('#m2sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m2-rel').val();\n\t\t\t\t$jq('#m2rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m2-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m2-idno').val().toUpperCase();\n\t\t\t\t$jq('#m2idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m2-dob').val();\n\t\t\t\t$jq('#m2dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m2-tel').val();\n\t\t\t\t$jq('#m2tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m2serv').html(\"<b>\"+resultString2+\"<\/b>\");\n\t\t\t\t$jq('#m2amt').html(\"<b>HKD \"+resultAmt2+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 2) {\n\n\t\t\t\tvar m_sname = $jq('.m3-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m3-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m3-del').is(':checked')) {\n\t\t\t\t\t$jq('#m3name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m3name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m3-sex').val();\n\t\t\t\t$jq('#m3sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m3-rel').val();\n\t\t\t\t$jq('#m3rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m3-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m3-idno').val().toUpperCase();\n\t\t\t\t$jq('#m3idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m3-dob').val();\n\t\t\t\t$jq('#m3dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m3-tel').val();\n\t\t\t\t$jq('#m3tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m3serv').html(\"<b>\"+resultString3+\"<\/b>\");\n\t\t\t\t$jq('#m3amt').html(\"<b>HKD \"+resultAmt3+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 3) {\n\n\t\t\t\tvar m_sname = $jq('.m4-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m4-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m4-del').is(':checked')) {\n\t\t\t\t\t$jq('#m4name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m4name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m4-sex').val();\n\t\t\t\t$jq('#m4sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m4-rel').val();\n\t\t\t\t$jq('#m4rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m4-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m4-idno').val().toUpperCase();\n\t\t\t\t$jq('#m4idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m4-dob').val();\n\t\t\t\t$jq('#m4dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m4-tel').val();\n\t\t\t\t$jq('#m4tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m4serv').html(\"<b>\"+resultString4+\"<\/b>\");\n\t\t\t\t$jq('#m4amt').html(\"<b>HKD \"+resultAmt4+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 4) {\n\n\t\t\t\tvar m_sname = $jq('.m5-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m5-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m5-del').is(':checked')) {\n\t\t\t\t\t$jq('#m5name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m5name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m5-sex').val();\n\t\t\t\t$jq('#m5sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m5-rel').val();\n\t\t\t\t$jq('#m5rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m5-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m5-idno').val().toUpperCase();\n\t\t\t\t$jq('#m5idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m5-dob').val();\n\t\t\t\t$jq('#m5dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m5-tel').val();\n\t\t\t\t$jq('#m5tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m5serv').html(\"<b>\"+resultString5+\"<\/b>\");\n\t\t\t\t$jq('#m5amt').html(\"<b>HKD \"+resultAmt5+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 5) {\n\n\t\t\t\tvar m_sname = $jq('.m6-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m6-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m6-del').is(':checked')) {\n\t\t\t\t\t$jq('#m6name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m6name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m6-sex').val();\n\t\t\t\t$jq('#m6sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m6-rel').val();\n\t\t\t\t$jq('#m6rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m6-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m6-idno').val().toUpperCase();\n\t\t\t\t$jq('#m6idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m6-dob').val();\n\t\t\t\t$jq('#m6dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m6-tel').val();\n\t\t\t\t$jq('#m6tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m6serv').html(\"<b>\"+resultString6+\"<\/b>\");\n\t\t\t\t$jq('#m6amt').html(\"<b>HKD \"+resultAmt6+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 6) {\n\n\t\t\t\tvar m_sname = $jq('.m7-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m7-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m7-del').is(':checked')) {\n\t\t\t\t\t$jq('#m7name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m7name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m7-sex').val();\n\t\t\t\t$jq('#m7sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m7-rel').val();\n\t\t\t\t$jq('#m7rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m7-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m7-idno').val().toUpperCase();\n\t\t\t\t$jq('#m7idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m7-dob').val();\n\t\t\t\t$jq('#m7dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m7-tel').val();\n\t\t\t\t$jq('#m7tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m7serv').html(\"<b>\"+resultString7+\"<\/b>\");\n\t\t\t\t$jq('#m7amt').html(\"<b>HKD \"+resultAmt7+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 7) {\n\n\t\t\t\tvar m_sname = $jq('.m8-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m8-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m8-del').is(':checked')) {\n\t\t\t\t\t$jq('#m8name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m8name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m8-sex').val();\n\t\t\t\t$jq('#m8sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m8-rel').val();\n\t\t\t\t$jq('#m8rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m8-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m8-idno').val().toUpperCase();\n\t\t\t\t$jq('#m8idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m8-dob').val();\n\t\t\t\t$jq('#m8dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m8-tel').val();\n\t\t\t\t$jq('#m8tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m8serv').html(\"<b>\"+resultString8+\"<\/b>\");\n\t\t\t\t$jq('#m8amt').html(\"<b>HKD \"+resultAmt8+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 8) {\n\n\t\t\t\tvar m_sname = $jq('.m9-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m9-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m9-del').is(':checked')) {\n\t\t\t\t\t$jq('#m9name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m9name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m9-sex').val();\n\t\t\t\t$jq('#m9sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m9-rel').val();\n\t\t\t\t$jq('#m9rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m9-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m9-idno').val().toUpperCase();\n\t\t\t\t$jq('#m9idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m9-dob').val();\n\t\t\t\t$jq('#m9dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m9-tel').val();\n\t\t\t\t$jq('#m9tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m9serv').html(\"<b>\"+resultString9+\"<\/b>\");\n\t\t\t\t$jq('#m9amt').html(\"<b>HKD \"+resultAmt9+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 9) {\n\n\t\t\t\tvar m_sname = $jq('.m10-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m10-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m10-del').is(':checked')) {\n\t\t\t\t\t$jq('#m10name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m10name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m10-sex').val();\n\t\t\t\t$jq('#m10sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m10-rel').val();\n\t\t\t\t$jq('#m10rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m10-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m10-idno').val().toUpperCase();\n\t\t\t\t$jq('#m10idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m10-dob').val();\n\t\t\t\t$jq('#m10dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m10-tel').val();\n\t\t\t\t$jq('#m10tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m10serv').html(\"<b>\"+resultString10+\"<\/b>\");\n\t\t\t\t$jq('#m10amt').html(\"<b>HKD \"+resultAmt10+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 10) {\n\n\t\t\t\tvar m_sname = $jq('.m11-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m11-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m11-del').is(':checked')) {\n\t\t\t\t\t$jq('#m11name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m11name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m11-sex').val();\n\t\t\t\t$jq('#m11sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m11-rel').val();\n\t\t\t\t$jq('#m11rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m11-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m11-idno').val().toUpperCase();\n\t\t\t\t$jq('#m11idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m11-dob').val();\n\t\t\t\t$jq('#m11dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m11-tel').val();\n\t\t\t\t$jq('#m11tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m11serv').html(\"<b>\"+resultString11+\"<\/b>\");\n\t\t\t\t$jq('#m11amt').html(\"<b>HKD \"+resultAmt11+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 11) {\n\n\t\t\t\tvar m_sname = $jq('.m12-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m12-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m12-del').is(':checked')) {\n\t\t\t\t\t$jq('#m12name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m12name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m12-sex').val();\n\t\t\t\t$jq('#m12sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m12-rel').val();\n\t\t\t\t$jq('#m12rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m12-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m12-idno').val().toUpperCase();\n\t\t\t\t$jq('#m12idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m12-dob').val();\n\t\t\t\t$jq('#m12dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m12-tel').val();\n\t\t\t\t$jq('#m12tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m12serv').html(\"<b>\"+resultString12+\"<\/b>\");\n\t\t\t\t$jq('#m12amt').html(\"<b>HKD \"+resultAmt12+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 12) {\n\n\t\t\t\tvar m_sname = $jq('.m13-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m13-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m13-del').is(':checked')) {\n\t\t\t\t\t$jq('#m13name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m13name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m13-sex').val();\n\t\t\t\t$jq('#m13sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m13-rel').val();\n\t\t\t\t$jq('#m13rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m13-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m13-idno').val().toUpperCase();\n\t\t\t\t$jq('#m13idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m13-dob').val();\n\t\t\t\t$jq('#m13dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m13-tel').val();\n\t\t\t\t$jq('#m13tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m13serv').html(\"<b>\"+resultString13+\"<\/b>\");\n\t\t\t\t$jq('#m13amt').html(\"<b>HKD \"+resultAmt13+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 13) {\n\n\t\t\t\tvar m_sname = $jq('.m14-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m14-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m14-del').is(':checked')) {\n\t\t\t\t\t$jq('#m14name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m14name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m14-sex').val();\n\t\t\t\t$jq('#m14sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m14-rel').val();\n\t\t\t\t$jq('#m14rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m14-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m14-idno').val().toUpperCase();\n\t\t\t\t$jq('#m14idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m14-dob').val();\n\t\t\t\t$jq('#m14dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m14-tel').val();\n\t\t\t\t$jq('#m14tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m14serv').html(\"<b>\"+resultString14+\"<\/b>\");\n\t\t\t\t$jq('#m14amt').html(\"<b>HKD \"+resultAmt14+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 14) {\n\n\t\t\t\tvar m_sname = $jq('.m15-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m15-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m15-del').is(':checked')) {\n\t\t\t\t\t$jq('#m15name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m15name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m15-sex').val();\n\t\t\t\t$jq('#m15sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m15-rel').val();\n\t\t\t\t$jq('#m15rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m15-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m15-idno').val().toUpperCase();\n\t\t\t\t$jq('#m15idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m15-dob').val();\n\t\t\t\t$jq('#m15dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m15-tel').val();\n\t\t\t\t$jq('#m15tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m15serv').html(\"<b>\"+resultString15+\"<\/b>\");\n\t\t\t\t$jq('#m15amt').html(\"<b>HKD \"+resultAmt15+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 15) {\n\n\t\t\t\tvar m_sname = $jq('.m16-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m16-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m16-del').is(':checked')) {\n\t\t\t\t\t$jq('#m16name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m16name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m16-sex').val();\n\t\t\t\t$jq('#m16sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m16-rel').val();\n\t\t\t\t$jq('#m16rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m16-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m16-idno').val().toUpperCase();\n\t\t\t\t$jq('#m16idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m16-dob').val();\n\t\t\t\t$jq('#m16dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m16-tel').val();\n\t\t\t\t$jq('#m16tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m16serv').html(\"<b>\"+resultString16+\"<\/b>\");\n\t\t\t\t$jq('#m16amt').html(\"<b>HKD \"+resultAmt16+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 16) {\n\n\t\t\t\tvar m_sname = $jq('.m17-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m17-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m17-del').is(':checked')) {\n\t\t\t\t\t$jq('#m17name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m17name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m17-sex').val();\n\t\t\t\t$jq('#m17sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m17-rel').val();\n\t\t\t\t$jq('#m17rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m17-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m17-idno').val().toUpperCase();\n\t\t\t\t$jq('#m17idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m17-dob').val();\n\t\t\t\t$jq('#m17dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m17-tel').val();\n\t\t\t\t$jq('#m17tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m17serv').html(\"<b>\"+resultString17+\"<\/b>\");\n\t\t\t\t$jq('#m17amt').html(\"<b>HKD \"+resultAmt17+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 17) {\n\n\t\t\t\tvar m_sname = $jq('.m18-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m18-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m18-del').is(':checked')) {\n\t\t\t\t\t$jq('#m18name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m18name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m18-sex').val();\n\t\t\t\t$jq('#m18sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m18-rel').val();\n\t\t\t\t$jq('#m18rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m18-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m18-idno').val().toUpperCase();\n\t\t\t\t$jq('#m18idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m18-dob').val();\n\t\t\t\t$jq('#m18dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m18-tel').val();\n\t\t\t\t$jq('#m18tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m18serv').html(\"<b>\"+resultString18+\"<\/b>\");\n\t\t\t\t$jq('#m18amt').html(\"<b>HKD \"+resultAmt18+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 18) {\n\n\t\t\t\tvar m_sname = $jq('.m19-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m19-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m19-del').is(':checked')) {\n\t\t\t\t\t$jq('#m19name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m19name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m19-sex').val();\n\t\t\t\t$jq('#m19sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m19-rel').val();\n\t\t\t\t$jq('#m19rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m19-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m19-idno').val().toUpperCase();\n\t\t\t\t$jq('#m19idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m19-dob').val();\n\t\t\t\t$jq('#m19dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m19-tel').val();\n\t\t\t\t$jq('#m19tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m19serv').html(\"<b>\"+resultString19+\"<\/b>\");\n\t\t\t\t$jq('#m19amt').html(\"<b>HKD \"+resultAmt19+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 19) {\n\n\t\t\t\tvar m_sname = $jq('.m20-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m20-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m20-del').is(':checked')) {\n\t\t\t\t\t$jq('#m20name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m20name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m20-sex').val();\n\t\t\t\t$jq('#m20sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m20-rel').val();\n\t\t\t\t$jq('#m20rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m20-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m20-idno').val().toUpperCase();\n\t\t\t\t$jq('#m20idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m20-dob').val();\n\t\t\t\t$jq('#m20dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m20-tel').val();\n\t\t\t\t$jq('#m20tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m20serv').html(\"<b>\"+resultString20+\"<\/b>\");\n\t\t\t\t$jq('#m20amt').html(\"<b>HKD \"+resultAmt20+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 20) {\n\n\t\t\t\tvar m_sname = $jq('.m21-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m21-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m21-del').is(':checked')) {\n\t\t\t\t\t$jq('#m21name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m21name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m21-sex').val();\n\t\t\t\t$jq('#m21sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m21-rel').val();\n\t\t\t\t$jq('#m21rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m21-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m21-idno').val().toUpperCase();\n\t\t\t\t$jq('#m21idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m21-dob').val();\n\t\t\t\t$jq('#m21dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m21-tel').val();\n\t\t\t\t$jq('#m21tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m21serv').html(\"<b>\"+resultString21+\"<\/b>\");\n\t\t\t\t$jq('#m21amt').html(\"<b>HKD \"+resultAmt21+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 21) {\n\n\t\t\t\tvar m_sname = $jq('.m22-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m22-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m22-del').is(':checked')) {\n\t\t\t\t\t$jq('#m22name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m22name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m22-sex').val();\n\t\t\t\t$jq('#m22sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m22-rel').val();\n\t\t\t\t$jq('#m22rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m22-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m22-idno').val().toUpperCase();\n\t\t\t\t$jq('#m22idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m22-dob').val();\n\t\t\t\t$jq('#m22dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m22-tel').val();\n\t\t\t\t$jq('#m22tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m22serv').html(\"<b>\"+resultString22+\"<\/b>\");\n\t\t\t\t$jq('#m22amt').html(\"<b>HKD \"+resultAmt22+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 22) {\n\n\t\t\t\tvar m_sname = $jq('.m23-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m23-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m23-del').is(':checked')) {\n\t\t\t\t\t$jq('#m23name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m23name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m23-sex').val();\n\t\t\t\t$jq('#m23sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m23-rel').val();\n\t\t\t\t$jq('#m23rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m23-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m23-idno').val().toUpperCase();\n\t\t\t\t$jq('#m23idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m23-dob').val();\n\t\t\t\t$jq('#m23dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m23-tel').val();\n\t\t\t\t$jq('#m23tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m23serv').html(\"<b>\"+resultString23+\"<\/b>\");\n\t\t\t\t$jq('#m23amt').html(\"<b>HKD \"+resultAmt23+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 23) {\n\n\t\t\t\tvar m_sname = $jq('.m24-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m24-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m24-del').is(':checked')) {\n\t\t\t\t\t$jq('#m24name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m24name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m24-sex').val();\n\t\t\t\t$jq('#m24sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m24-rel').val();\n\t\t\t\t$jq('#m24rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m24-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m24-idno').val().toUpperCase();\n\t\t\t\t$jq('#m24idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m24-dob').val();\n\t\t\t\t$jq('#m24dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m24-tel').val();\n\t\t\t\t$jq('#m24tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m24serv').html(\"<b>\"+resultString24+\"<\/b>\");\n\t\t\t\t$jq('#m24amt').html(\"<b>HKD \"+resultAmt24+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 24) {\n\n\t\t\t\tvar m_sname = $jq('.m25-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m25-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m25-del').is(':checked')) {\n\t\t\t\t\t$jq('#m25name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m25name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m25-sex').val();\n\t\t\t\t$jq('#m25sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m25-rel').val();\n\t\t\t\t$jq('#m25rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m25-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m25-idno').val().toUpperCase();\n\t\t\t\t$jq('#m25idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m25-dob').val();\n\t\t\t\t$jq('#m25dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m25-tel').val();\n\t\t\t\t$jq('#m25tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m25serv').html(\"<b>\"+resultString25+\"<\/b>\");\n\t\t\t\t$jq('#m25amt').html(\"<b>HKD \"+resultAmt25+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 25) {\n\n\t\t\t\tvar m_sname = $jq('.m26-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m26-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m26-del').is(':checked')) {\n\t\t\t\t\t$jq('#m26name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m26name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m26-sex').val();\n\t\t\t\t$jq('#m26sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m26-rel').val();\n\t\t\t\t$jq('#m26rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m26-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m26-idno').val().toUpperCase();\n\t\t\t\t$jq('#m26idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m26-dob').val();\n\t\t\t\t$jq('#m26dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m26-tel').val();\n\t\t\t\t$jq('#m26tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m26serv').html(\"<b>\"+resultString26+\"<\/b>\");\n\t\t\t\t$jq('#m26amt').html(\"<b>HKD \"+resultAmt26+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 26) {\n\n\t\t\t\tvar m_sname = $jq('.m27-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m27-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m27-del').is(':checked')) {\n\t\t\t\t\t$jq('#m27name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m27name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m27-sex').val();\n\t\t\t\t$jq('#m27sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m27-rel').val();\n\t\t\t\t$jq('#m27rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m27-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m27-idno').val().toUpperCase();\n\t\t\t\t$jq('#m27idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m27-dob').val();\n\t\t\t\t$jq('#m27dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m27-tel').val();\n\t\t\t\t$jq('#m27tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m27serv').html(\"<b>\"+resultString27+\"<\/b>\");\n\t\t\t\t$jq('#m27amt').html(\"<b>HKD \"+resultAmt27+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 27) {\n\n\t\t\t\tvar m_sname = $jq('.m28-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m28-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m28-del').is(':checked')) {\n\t\t\t\t\t$jq('#m28name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m28name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m28-sex').val();\n\t\t\t\t$jq('#m28sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m28-rel').val();\n\t\t\t\t$jq('#m28rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m28-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m28-idno').val().toUpperCase();\n\t\t\t\t$jq('#m28idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m28-dob').val();\n\t\t\t\t$jq('#m28dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m28-tel').val();\n\t\t\t\t$jq('#m28tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m28serv').html(\"<b>\"+resultString28+\"<\/b>\");\n\t\t\t\t$jq('#m28amt').html(\"<b>HKD \"+resultAmt28+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 28) {\n\n\t\t\t\tvar m_sname = $jq('.m29-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m29-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m29-del').is(':checked')) {\n\t\t\t\t\t$jq('#m29name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m29name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m29-sex').val();\n\t\t\t\t$jq('#m29sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m29-rel').val();\n\t\t\t\t$jq('#m29rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m29-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m29-idno').val().toUpperCase();\n\t\t\t\t$jq('#m29idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m29-dob').val();\n\t\t\t\t$jq('#m29dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m29-tel').val();\n\t\t\t\t$jq('#m29tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m29serv').html(\"<b>\"+resultString29+\"<\/b>\");\n\t\t\t\t$jq('#m29amt').html(\"<b>HKD \"+resultAmt29+\"<\/b>\");\n\t\t\t}\n\t\t\tif(member_number > 29) {\n\n\t\t\t\tvar m_sname = $jq('.m30-sname').val().toUpperCase();\n\t\t\t\tvar m_gname = $jq('.m30-gname').val().toUpperCase();\n\t\t\t\tif($jq('.m30-del').is(':checked')) {\n\t\t\t\t\t$jq('#m30name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<span style='color:ref;'>- \u522a\u9664 <\/span><\/b>\");\n\t\t\t\t} else {\t\n\t\t\t\t\t$jq('#m30name').html(\"<b>\"+m_sname+\" \"+m_gname+\"<\/b>\");\n\t\t\t\t}\n\t\t\t\tvar m_sex = $jq('.m30-sex').val();\n\t\t\t\t$jq('#m30sex').html(\"<b>\"+m_sex+\"<\/b>\");\n\t\t\t\tvar m_rel = $jq('.m30-rel').val();\n\t\t\t\t$jq('#m30rel').html(\"<b>\"+m_rel+\"<\/b>\");\n\t\t\t\tvar m_idtype = $jq('.m30-idtype').val();\n\t\t\t\tvar m_idno = $jq('.m30-idno').val().toUpperCase();\n\t\t\t\t$jq('#m30idno').html(\"<b>\"+m_idtype+\" \"+m_idno+\"<\/b>\");\n\t\t\t\tvar m_dob = $jq('.m30-dob').val();\n\t\t\t\t$jq('#m30dob').html(\"<b>\"+m_dob+\"<\/b>\");\n\t\t\t\tvar m_tel = $jq('.m30-tel').val();\n\t\t\t\t$jq('#m30tel').html(\"<b>\"+m_tel+\"<\/b>\");\n\t\t\t\t$jq('#m30serv').html(\"<b>\"+resultString30+\"<\/b>\");\n\t\t\t\t$jq('#m30amt').html(\"<b>HKD \"+resultAmt30+\"<\/b>\");\n\t\t\t}\n    \n}\n\nfunction expand_members(){\n\/\/ expand family member info for validation\n\t\t\tvar member_number = Number($jq(\".members_number\").val());\n\t\t\tif(member_number > 0) {\n\t\t\t\t$jq(\".m1-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m1-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m1-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 1) {\n\t\t\t\t$jq(\".m2-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m2-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m2-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 2) {\n\t\t\t\t$jq(\".m3-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m3-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m3-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 3) {\n\t\t\t\t$jq(\".m4-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m4-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m4-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 4) {\n\t\t\t\t$jq(\".m5-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m5-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m5-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 5) {\t\t\t\t\n\t\t\t\t$jq(\".m6-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m6-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m6-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 6) {\t\t\t\t\n\t\t\t\t$jq(\".m7-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m7-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m7-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 7) {\t\t\t\t\n\t\t\t\t$jq(\".m8-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m8-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m8-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 8) {\n\t\t\t\t$jq(\".m9-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m9-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m9-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 9) {\t\t\t\t\n\t\t\t\t$jq(\".m10-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m10-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m10-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 10) {\t\t\t\t\n\t\t\t\t$jq(\".m11-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m11-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m11-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 11) {\n\t\t\t\t$jq(\".m12-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m12-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m12-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 12) {\t\t\t\t\n\t\t\t\t$jq(\".m13-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m13-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m13-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\t\n\t\t\tif(member_number > 13) {\t\t\t\t\n\t\t\t\t$jq(\".m14-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m14-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m14-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 14) {\t\t\t\t\n\t\t\t\t$jq(\".m15-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m15-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m15-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 15) {\t\t\t\t\n\t\t\t\t$jq(\".m16-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m16-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m16-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 16) {\t\t\t\t\n\t\t\t\t$jq(\".m17-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m17-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m17-label\").closest('.quform-element-html').hide();\n\t\t\t}\t\n\t\t\tif(member_number > 17) {\n\t\t\t\t$jq(\".m18-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m18-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m18-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 18) {\t\t\t\t\n\t\t\t\t$jq(\".m19-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m19-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m19-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 19) {\t\t\t\t\n\t\t\t\t$jq(\".m20-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m20-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m20-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 20) {\t\t\t\t\n\t\t\t\t$jq(\".m21-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m21-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m21-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 21) {\t\t\t\t\n\t\t\t\t$jq(\".m22-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m22-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m22-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 22) {\t\t\t\t\n\t\t\t\t$jq(\".m23-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m23-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m23-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 23) {\t\t\t\t\n\t\t\t\t$jq(\".m24-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m24-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m24-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 24) {\t\t\t\t\n\t\t\t\t$jq(\".m25-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m25-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m25-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 25) {\t\t\t\t\n\t\t\t\t$jq(\".m26-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m26-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m26-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 26) {\t\t\t\t\n\t\t\t\t$jq(\".m27-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m27-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m27-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 27) {\t\t\t\t\n\t\t\t\t$jq(\".m28-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m28-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m28-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\tif(member_number > 28) {\t\t\t\t\n\t\t\t\t$jq(\".m29-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m29-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m29-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\t\n\t\t\tif(member_number > 29) {\t\t\t\t\n\t\t\t\t$jq(\".m30-edit\").filter('[value=\"edit\"]').attr('checked', true).trigger('click'); \n\t\t\t\t$jq(\".m30-sname\").closest('.quform-element-group').show();\n\t\t\t\t$jq(\"#m30-label\").closest('.quform-element-html').hide();\n\t\t\t}\n\t\t\t\t\t\t\t\t\n}\n\n\n\n   function check_coupon_code(){\n        var coupon = $jq('.a-discount').val();\n         ajaxInitializer({\n          success: update_price_sucess, \n          beforeSend: expand_members,\n          complete: function(){\n    \n          },\n          \"data\":{\n            \"coupon\" : coupon,\n            \"action\" : wpwa_conf.ajaxActions.check_counpon.action,\n            \"nonce\" : wpwa_conf.ajaxNonce\n          }\n        });\n        \n    }\n\n\n    var update_edit_status = function(data, textStatus, jqXHR){\n    $jq('.isValidForEdit').val(data);\n\n    }\n\tvar member_number = applicant.member_no;\n    ajaxInitializer({\n          success: update_edit_status, \n          complete: function(){\n    \n          },\n          \"data\":{\n            \"member_no\" : member_number,\n            \"action\" : wpwa_conf.ajaxActions.is_valid_for_edit.action,\n            \"nonce\" : wpwa_conf.ajaxNonce\n          }\n        });\n   \n\n\n<\/script><\/div><\/div><div class=\"quform-element quform-element-row quform-element-row-97_2250 quform-3-columns quform-element-row-size-fixed quform-responsive-columns-phone-landscape\"><div class=\"quform-element quform-element-column quform-element-97_2251\"><\/div><div class=\"quform-element quform-element-column quform-element-97_2252\"><div class=\"quform-element quform-element-submit quform-element-97_655 quform-cf quform-button-style-sexy-silver quform-button-size-huge quform-button-width-full\"><div class=\"quform-button-back quform-button-back-default quform-button-back-97_655\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-back\" value=\"back\"><span class=\"quform-button-text quform-button-back-text\">\u8fd4\u56de<\/span><\/button><\/div><div class=\"quform-button-submit quform-button-submit-default quform-button-submit-97_655 quform-button-icon-left\"><button name=\"quform_submit\" type=\"submit\" class=\"quform-submit\" value=\"submit\"><span class=\"quform-button-icon quform-button-submit-icon\"><i class=\"qicon-check\"><\/i><\/span><span class=\"quform-button-text quform-button-submit-text\">\u78ba\u5b9a\u63d0\u4ea4<\/span><\/button><\/div><div class=\"quform-loading quform-loading-position-left quform-loading-type-spinner-1\"><div class=\"quform-loading-inner\"><div class=\"quform-loading-spinner\"><div class=\"quform-loading-spinner-inner\"><\/div><\/div><\/div><\/div><\/div><\/div><div class=\"quform-element quform-element-column quform-element-97_2253\"><\/div><\/div><div class=\"quform-element-tree\"><label for=\"quform_97_0_6e1cb0\">This field should be left blank<\/label><input type=\"text\" id=\"quform_97_0_6e1cb0\" name=\"quform_97_0\" class=\"quform-field quform-field-tree quform-field-97_0\" tabindex=\"-1\" autocomplete=\"off\" \/><\/div><\/div><\/div><\/div><div class=\"quform-upload-progress-wrap\"><div class=\"quform-upload-progress-bar-wrap\"><div class=\"quform-upload-progress-bar\"><\/div><\/div><div class=\"quform-upload-info quform-cf\"><div class=\"quform-upload-filename\"><\/div><\/div><\/div><\/div><\/form><\/div>\n","protected":false},"excerpt":{"rendered":"","protected":false},"author":26,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"page-blank-header.php","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"_links":{"self":[{"href":"https:\/\/www.health-way.org\/isys\/wp-json\/wp\/v2\/pages\/23136"}],"collection":[{"href":"https:\/\/www.health-way.org\/isys\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/www.health-way.org\/isys\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/www.health-way.org\/isys\/wp-json\/wp\/v2\/users\/26"}],"replies":[{"embeddable":true,"href":"https:\/\/www.health-way.org\/isys\/wp-json\/wp\/v2\/comments?post=23136"}],"version-history":[{"count":3,"href":"https:\/\/www.health-way.org\/isys\/wp-json\/wp\/v2\/pages\/23136\/revisions"}],"predecessor-version":[{"id":24596,"href":"https:\/\/www.health-way.org\/isys\/wp-json\/wp\/v2\/pages\/23136\/revisions\/24596"}],"wp:attachment":[{"href":"https:\/\/www.health-way.org\/isys\/wp-json\/wp\/v2\/media?parent=23136"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}