{"id":1539,"date":"2026-08-19T05:55:39","date_gmt":"2026-08-19T05:55:39","guid":{"rendered":"https:\/\/geminia.co.ke\/dev\/?page_id=1539"},"modified":"2026-08-21T09:25:51","modified_gmt":"2026-08-21T09:25:51","slug":"employee-liability-form","status":"publish","type":"page","link":"https:\/\/geminia.co.ke\/dev\/employee-liability-form\/","title":{"rendered":"Employee Liability Form"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-page\" data-elementor-id=\"1539\" class=\"elementor elementor-1539\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3fcd98b e-con-full e-flex e-con e-parent\" data-id=\"3fcd98b\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-55178c7 elementor-widget elementor-widget-html\" data-id=\"55178c7\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t\t<div id=\"gel\"\r\n     data-endpoint=\"https:\/\/script.google.com\/macros\/s\/AKfycbzF2MGQv9CxQ6-Ad4CIn5w4BnBC2ZHMiJQh6kyZsZJ1pne3MnkxMGKc_At2aLXCtP6L\/exec\">\r\n\r\n<style>\r\n\/* ---- Fonts & tokens ------------------------------------------------ *\/\r\n@import url('https:\/\/fonts.googleapis.com\/css2?family=Inter:wght@400;500;600;700&family=Poppins:wght@500;600;700&display=swap');\r\n\r\n#gel{\r\n  --primary:#3fa6dd;\r\n  --accent:#393680;\r\n  --grad:#3fa6dd;\r\n  --bg:#F8F9FB;\r\n  --card:#FFFFFF;\r\n  --ink:#16283D;\r\n  --muted:#65758B;\r\n  --line:#E6EAF0;\r\n  --line-2:#EDF0F5;\r\n  --ok:#16A34A;\r\n  --err:#E5484D;\r\n  --radius:16px;\r\n  --radius-in:12px;\r\n  --shadow-s:0 1px 2px rgba(16,24,40,.05);\r\n  --shadow-m:0 8px 30px rgba(16,24,40,.08);\r\n  --shadow-btn:0 8px 20px rgba(57,54,128,.28);\r\n\r\n  all:initial;\r\n  display:block;\r\n  box-sizing:border-box;\r\n  font-family:'Inter',system-ui,-apple-system,Segoe UI,Roboto,sans-serif;\r\n  color:var(--ink);\r\n  background:var(--bg);\r\n  padding:28px 16px 48px;\r\n  -webkit-font-smoothing:antialiased;\r\n  line-height:1.55;\r\n}\r\n#gel *,#gel *::before,#gel *::after{box-sizing:border-box;margin:0;padding:0;}\r\n#gel button{font-family:inherit;}\r\n\r\n\/* ---- Shell --------------------------------------------------------- *\/\r\n#gel .gel-shell{max-width:760px;margin:0 auto;}\r\n\r\n\/* ---- Progress ------------------------------------------------------ *\/\r\n#gel .gel-progress{margin:0 4px 22px;opacity:0;transform:translateY(-6px);\r\n  transition:opacity .4s ease,transform .4s ease;}\r\n#gel .gel-progress.on{opacity:1;transform:none;}\r\n#gel .gel-progress-top{display:flex;justify-content:space-between;align-items:baseline;\r\n  margin-bottom:10px;}\r\n#gel .gel-step-label{font-size:13px;font-weight:600;color:var(--muted);letter-spacing:.01em;}\r\n#gel .gel-step-name{font-size:13px;font-weight:600;color:var(--primary);}\r\n#gel .gel-track{height:7px;background:#E9EEF4;border-radius:99px;overflow:hidden;}\r\n#gel .gel-fill{height:100%;width:0;border-radius:99px;background:var(--grad);\r\n  transition:width .5s cubic-bezier(.4,0,.2,1);}\r\n\r\n\/* ---- Card \/ steps -------------------------------------------------- *\/\r\n#gel .gel-card{background:var(--card);border:1px solid var(--line-2);\r\n  border-radius:var(--radius);box-shadow:var(--shadow-m);\r\n  padding:36px 34px;position:relative;overflow:hidden;}\r\n#gel .gel-card::before{content:\"\";position:absolute;top:0;left:0;right:0;height:3px;\r\n  background:var(--grad);z-index:5;}\r\n#gel .gel-step{display:none;}\r\n#gel .gel-step.active{display:block;animation:gelIn .42s cubic-bezier(.22,.61,.36,1);}\r\n#gel .gel-step.leaving{animation:gelOut .28s ease forwards;}\r\n@keyframes gelIn{from{opacity:0;transform:translateY(14px)}to{opacity:1;transform:none}}\r\n@keyframes gelOut{to{opacity:0;transform:translateY(-10px)}}\r\n\r\n#gel .gel-eyebrow{display:inline-flex;align-items:center;gap:7px;font-size:12px;\r\n  font-weight:600;letter-spacing:.06em;text-transform:uppercase;color:var(--accent);\r\n  background:rgba(63,166,221,.09);padding:6px 12px;border-radius:99px;margin-bottom:16px;}\r\n#gel h2.gel-h{font-family:'Poppins',sans-serif;font-weight:600;font-size:25px;\r\n  line-height:1.25;letter-spacing:-.01em;color:var(--ink);margin-bottom:8px;}\r\n#gel .gel-sub{color:var(--muted);font-size:15px;margin-bottom:26px;max-width:56ch;}\r\n#gel .gel-sec{font-family:'Poppins',sans-serif;font-size:12.5px;font-weight:600;\r\n  color:var(--primary);letter-spacing:.03em;text-transform:uppercase;\r\n  margin:26px 0 14px;padding-top:18px;border-top:1px dashed var(--line);}\r\n#gel .gel-sec:first-of-type{margin-top:0;padding-top:0;border-top:0;}\r\n\r\n\/* ---- Fields -------------------------------------------------------- *\/\r\n#gel .gel-field{margin-bottom:20px;}\r\n#gel .gel-grid-2{display:grid;grid-template-columns:1fr 1fr;gap:16px;}\r\n#gel .gel-grid-3{display:grid;grid-template-columns:1fr 1fr 1fr;gap:16px;}\r\n#gel label.gel-lab{display:block;font-size:13.5px;font-weight:600;color:var(--ink);\r\n  margin-bottom:8px;}\r\n#gel .gel-req{color:var(--accent);}\r\n#gel .gel-hint{font-size:12.5px;color:var(--muted);margin-top:6px;}\r\n#gel .gel-input,#gel .gel-select,#gel .gel-area{\r\n  width:100%;font-family:inherit;font-size:15px;color:var(--ink);\r\n  background:#fff;border:1.5px solid var(--line);border-radius:var(--radius-in);\r\n  padding:13px 15px;transition:border-color .2s,box-shadow .2s,background .2s;}\r\n#gel .gel-area{resize:vertical;min-height:88px;}\r\n#gel .gel-input::placeholder,#gel .gel-area::placeholder{color:#9AA7B7;}\r\n#gel .gel-input:focus,#gel .gel-select:focus,#gel .gel-area:focus{\r\n  outline:none;border-color:var(--accent);box-shadow:0 0 0 4px rgba(63,166,221,.14);}\r\n#gel .gel-input.err,#gel .gel-select.err,#gel .gel-area.err{border-color:var(--err);\r\n  box-shadow:0 0 0 4px rgba(229,72,77,.12);}\r\n#gel .gel-err{display:none;color:var(--err);font-size:12.5px;font-weight:500;margin-top:7px;}\r\n#gel .gel-err.show{display:block;animation:gelShakeIn .3s ease;}\r\n@keyframes gelShakeIn{0%{opacity:0;transform:translateX(-4px)}100%{opacity:1;transform:none}}\r\n\r\n\/* currency prefix *\/\r\n#gel .gel-money{position:relative;}\r\n#gel .gel-money .gel-cur{position:absolute;left:15px;top:50%;transform:translateY(-50%);\r\n  font-size:14px;font-weight:600;color:var(--muted);pointer-events:none;}\r\n#gel .gel-money .gel-input{padding-left:52px;}\r\n\r\n\/* ---- Radio \/ choice rows ------------------------------------------ *\/\r\n#gel .gel-choices{display:grid;gap:10px;}\r\n#gel .gel-choices.row{grid-template-columns:1fr 1fr;}\r\n#gel .gel-choice{display:flex;align-items:center;gap:12px;cursor:pointer;\r\n  border:1.5px solid var(--line);border-radius:var(--radius-in);padding:13px 15px;\r\n  transition:border-color .18s,background .18s,box-shadow .18s;user-select:none;}\r\n#gel .gel-choice:hover{border-color:#C7D6E6;background:#FBFDFF;}\r\n#gel .gel-choice input{position:absolute;opacity:0;width:0;height:0;}\r\n#gel .gel-dot{width:20px;height:20px;border-radius:50%;border:2px solid #C4D0DE;\r\n  flex:none;position:relative;transition:border-color .18s;}\r\n#gel .gel-dot::after{content:\"\";position:absolute;inset:3px;border-radius:50%;\r\n  background:var(--grad);transform:scale(0);transition:transform .18s;}\r\n#gel .gel-box{width:20px;height:20px;border-radius:6px;border:2px solid #C4D0DE;\r\n  flex:none;position:relative;transition:border-color .18s,background .18s;}\r\n#gel .gel-box::after{content:\"\";position:absolute;left:5px;top:1.5px;width:6px;height:11px;\r\n  border:solid #fff;border-width:0 2.5px 2.5px 0;transform:rotate(45deg) scale(0);\r\n  transition:transform .18s;}\r\n#gel .gel-choice .gel-ctxt{font-size:14.5px;font-weight:500;}\r\n#gel .gel-choice.sel{border-color:var(--accent);background:rgba(63,166,221,.06);\r\n  box-shadow:0 0 0 3px rgba(63,166,221,.10);}\r\n#gel .gel-choice.sel .gel-dot{border-color:var(--accent);}\r\n#gel .gel-choice.sel .gel-dot::after{transform:scale(1);}\r\n#gel .gel-choice.sel .gel-box{border-color:var(--accent);background:var(--grad);}\r\n#gel .gel-choice.sel .gel-box::after{transform:rotate(45deg) scale(1);}\r\n\r\n\/* ---- Limit-of-liability option cards (single-select) ---------------- *\/\r\n#gel .gel-covercards{display:grid;grid-template-columns:repeat(4,1fr);gap:12px;}\r\n#gel .gel-covercard{position:relative;cursor:pointer;border:1.5px solid var(--line);\r\n  border-radius:var(--radius);background:#fff;padding:16px 12px;text-align:center;\r\n  transition:transform .18s,border-color .18s,box-shadow .18s,background .18s;user-select:none;}\r\n#gel .gel-covercard:hover{transform:translateY(-3px);border-color:#B9D3EA;\r\n  box-shadow:0 10px 22px rgba(57,54,128,.12);}\r\n#gel .gel-cc-name{font-family:'Poppins',sans-serif;font-size:16px;font-weight:700;color:var(--ink);margin-bottom:10px;}\r\n#gel .gel-cc-tier{font-size:11.5px;color:var(--muted);line-height:1.7;text-align:left;}\r\n#gel .gel-cc-tier b{color:var(--ink);font-weight:600;}\r\n#gel .gel-covercard.sel{border-color:var(--primary);background:var(--grad);\r\n  box-shadow:0 12px 26px rgba(57,54,128,.30);}\r\n#gel .gel-covercard.sel .gel-cc-name,#gel .gel-covercard.sel .gel-cc-tier,#gel .gel-covercard.sel .gel-cc-tier b{color:#fff;}\r\n\r\n\/* ---- Sum-insured total strip ---------------------------------------- *\/\r\n#gel .gel-total{display:flex;justify-content:space-between;align-items:center;\r\n  background:rgba(63,166,221,.08);border:1.5px solid rgba(63,166,221,.25);\r\n  border-radius:var(--radius-in);padding:14px 18px;margin-top:6px;}\r\n#gel .gel-total .lab{font-size:13.5px;font-weight:600;color:var(--ink);}\r\n#gel .gel-total .val{font-family:'Poppins',sans-serif;font-size:18px;font-weight:700;color:var(--accent);}\r\n\r\n\/* ---- Review -------------------------------------------------------- *\/\r\n#gel .gel-summary{display:grid;gap:14px;}\r\n#gel .gel-sblock{border:1px solid var(--line-2);border-radius:var(--radius-in);\r\n  padding:16px 18px;background:#FCFDFE;}\r\n#gel .gel-sblock h4{font-family:'Poppins',sans-serif;font-size:13px;font-weight:600;\r\n  color:var(--primary);letter-spacing:.02em;margin-bottom:12px;display:flex;\r\n  align-items:center;gap:8px;text-transform:uppercase;}\r\n#gel .gel-srow{display:flex;justify-content:space-between;gap:16px;font-size:14px;\r\n  padding:6px 0;border-top:1px dashed var(--line);}\r\n#gel .gel-srow:first-of-type{border-top:0;}\r\n#gel .gel-srow .k{color:var(--muted);}\r\n#gel .gel-srow .v{color:var(--ink);font-weight:600;text-align:right;}\r\n#gel .gel-tags{display:flex;flex-wrap:wrap;gap:8px;}\r\n#gel .gel-tag{font-size:12.5px;font-weight:600;color:var(--primary);\r\n  background:rgba(57,54,128,.09);border:1px solid rgba(57,54,128,.15);\r\n  padding:6px 11px;border-radius:99px;}\r\n\r\n\/* ---- Notice \/ reassurance ----------------------------------------- *\/\r\n#gel .gel-note{display:flex;gap:11px;align-items:flex-start;font-size:13px;\r\n  color:var(--muted);background:#F3F4FB;border:1px solid #E2E4F3;\r\n  border-radius:var(--radius-in);padding:13px 15px;margin-top:4px;}\r\n#gel .gel-note svg{flex:none;width:17px;height:17px;stroke:var(--primary);margin-top:1px;}\r\n\r\n\/* ---- Signature pad -------------------------------------------------- *\/\r\n#gel .gel-sigwrap{position:relative;border:1.5px solid var(--line);border-radius:var(--radius-in);\r\n  background:#fff;overflow:hidden;transition:border-color .2s,box-shadow .2s;}\r\n#gel .gel-sigwrap.focus{border-color:var(--accent);box-shadow:0 0 0 4px rgba(63,166,221,.14);}\r\n#gel .gel-sigcanvas{display:block;width:100%;height:170px;touch-action:none;cursor:crosshair;}\r\n#gel .gel-sig-placeholder{position:absolute;left:16px;bottom:12px;color:#B7C1D1;\r\n  font-size:13px;pointer-events:none;transition:opacity .15s;}\r\n#gel .gel-sig-placeholder.hide{opacity:0;}\r\n#gel .gel-sig-actions{display:flex;justify-content:flex-end;margin-top:8px;}\r\n#gel .gel-sig-actions .gel-btn{padding:8px 16px;font-size:13px;}\r\n\r\n\/* ---- Footer \/ buttons --------------------------------------------- *\/\r\n#gel .gel-foot{display:flex;justify-content:space-between;align-items:center;gap:14px;\r\n  margin-top:30px;}\r\n#gel .gel-btn{position:relative;font-size:15px;font-weight:600;border-radius:var(--radius-in);\r\n  padding:14px 26px;border:none;cursor:pointer;display:inline-flex;align-items:center;\r\n  justify-content:center;gap:9px;transition:transform .16s,box-shadow .2s,background .2s;\r\n  overflow:hidden;}\r\n#gel .gel-btn:active{transform:translateY(1px);}\r\n#gel .gel-btn:focus-visible{outline:3px solid rgba(63,166,221,.4);outline-offset:2px;}\r\n#gel .gel-primary{background:var(--grad);color:#fff;box-shadow:var(--shadow-btn);}\r\n#gel .gel-primary:hover{transform:translateY(-2px);box-shadow:0 12px 26px rgba(57,54,128,.36);}\r\n#gel .gel-ghost{background:#fff;color:var(--muted);border:1.5px solid var(--line);}\r\n#gel .gel-ghost:hover{border-color:#C7D6E6;color:var(--ink);background:#FBFDFF;}\r\n#gel .gel-btn.wide{width:100%;}\r\n#gel .gel-btn .gel-spin{width:18px;height:18px;border:2.5px solid rgba(255,255,255,.45);\r\n  border-top-color:#fff;border-radius:50%;display:none;animation:gelSpin .7s linear infinite;}\r\n#gel .gel-ghost .gel-spin{border-color:rgba(101,117,139,.4);border-top-color:var(--muted);}\r\n#gel .gel-btn.loading .gel-spin{display:block;}\r\n#gel .gel-btn.loading .gel-btxt{opacity:.7;}\r\n#gel .gel-btn[disabled]{opacity:.6;cursor:not-allowed;}\r\n@keyframes gelSpin{to{transform:rotate(360deg)}}\r\n\r\n\/* ---- Exit control + leave confirmation ----------------------------- *\/\r\n#gel .gel-exit{position:absolute;top:14px;right:14px;width:34px;height:34px;border-radius:50%;\r\n  border:1.5px solid var(--line);background:#fff;color:var(--muted);display:flex;align-items:center;\r\n  justify-content:center;cursor:pointer;transition:border-color .18s,color .18s,background .18s,transform .3s;z-index:6;}\r\n#gel .gel-exit:hover{border-color:#C7D6E6;color:var(--ink);background:#FBFDFF;transform:rotate(90deg);}\r\n#gel .gel-exit:focus-visible{outline:3px solid rgba(63,166,221,.4);outline-offset:2px;}\r\n#gel .gel-exit svg{width:15px;height:15px;stroke:currentColor;stroke-width:2.2;fill:none;stroke-linecap:round;stroke-linejoin:round;}\r\n#gel .gel-confirm{position:absolute;inset:0;background:rgba(248,249,251,.88);backdrop-filter:blur(3px);\r\n  -webkit-backdrop-filter:blur(3px);display:flex;align-items:center;justify-content:center;\r\n  z-index:12;padding:24px;animation:gelFade .2s ease;}\r\n#gel .gel-confirm[hidden]{display:none;}\r\n@keyframes gelFade{from{opacity:0}to{opacity:1}}\r\n#gel .gel-confirm-box{background:#fff;border:1px solid var(--line-2);border-radius:16px;\r\n  box-shadow:var(--shadow-m);padding:28px 26px;max-width:360px;width:100%;text-align:center;\r\n  animation:gelIn .28s cubic-bezier(.22,.61,.36,1);}\r\n#gel .gel-confirm-ic{width:52px;height:52px;border-radius:50%;background:rgba(63,166,221,.10);\r\n  display:flex;align-items:center;justify-content:center;margin:0 auto 14px;}\r\n#gel .gel-confirm-ic svg{width:24px;height:24px;stroke:var(--primary);fill:none;stroke-width:2;stroke-linecap:round;stroke-linejoin:round;}\r\n#gel .gel-confirm-box h3{font-family:'Poppins',sans-serif;font-size:18px;font-weight:600;color:var(--ink);margin-bottom:6px;}\r\n#gel .gel-confirm-box p{color:var(--muted);font-size:14px;margin-bottom:20px;}\r\n#gel .gel-confirm-actions{display:flex;gap:10px;}\r\n#gel .gel-confirm-actions .gel-btn{flex:1;padding:12px 16px;}\r\n\r\n\/* ---- Welcome (photo + content split hero) --------------------------- *\/\r\n#gel .gel-card.gel-card--hero::before{display:none;}\r\n#gel .gel-hero{display:flex;align-items:stretch;gap:32px;min-height:360px;}\r\n#gel .gel-hero-media{flex:1 1 44%;border-radius:28px;overflow:hidden;background:#DCE3EC;\r\n  box-shadow:0 20px 45px rgba(57,54,128,.16);position:relative;}\r\n#gel .gel-hero-media img{width:100%;height:100%;min-height:360px;object-fit:cover;display:block;}\r\n#gel .gel-hero-content{flex:1 1 56%;display:flex;flex-direction:column;justify-content:center;\r\n  padding:16px 12px 16px 4px;}\r\n#gel .gel-hero-content h1{font-family:'Poppins',sans-serif;font-weight:700;\r\n  font-size:clamp(24px,3.4vw,34px);line-height:1.2;letter-spacing:-.02em;\r\n  color:var(--ink);margin-bottom:16px;}\r\n#gel .gel-hero-content h1 .hl{color:var(--primary);}\r\n#gel .gel-hero-content p{color:var(--muted);font-size:15.5px;line-height:1.65;\r\n  max-width:42ch;margin-bottom:26px;}\r\n#gel .gel-hero-content .gel-btn{align-self:flex-start;padding:13px 24px;font-size:14.5px;}\r\n@media(max-width:680px){\r\n  #gel .gel-hero{flex-direction:column;min-height:0;}\r\n  #gel .gel-hero-media{flex:none;width:100%;aspect-ratio:16\/11;}\r\n  #gel .gel-hero-media img{min-height:0;}\r\n  #gel .gel-hero-content{padding:22px 4px 4px;}\r\n}\r\n\r\n\/* ---- Success ------------------------------------------------------- *\/\r\n#gel .gel-success{text-align:center;padding:18px 6px;}\r\n#gel .gel-scheck{width:104px;height:104px;margin:6px auto 26px;position:relative;}\r\n#gel .gel-scheck .disc{position:absolute;inset:0;border-radius:50%;background:var(--grad);\r\n  box-shadow:0 18px 40px rgba(57,54,128,.34);animation:gelPop .55s cubic-bezier(.2,.8,.3,1.4);}\r\n#gel .gel-scheck svg{position:absolute;inset:0;margin:auto;width:52px;height:52px;\r\n  stroke:#fff;fill:none;stroke-width:4;stroke-linecap:round;stroke-linejoin:round;}\r\n#gel .gel-scheck svg path{stroke-dasharray:48;stroke-dashoffset:48;\r\n  animation:gelDraw .5s .35s forwards cubic-bezier(.65,0,.35,1);}\r\n@keyframes gelPop{0%{transform:scale(0)}70%{transform:scale(1.06)}100%{transform:scale(1)}}\r\n@keyframes gelDraw{to{stroke-dashoffset:0}}\r\n#gel .gel-success h1{font-family:'Poppins',sans-serif;font-weight:700;font-size:29px;\r\n  margin-bottom:14px;color:var(--ink);}\r\n#gel .gel-success p{color:var(--muted);font-size:15.5px;max-width:44ch;margin:0 auto 12px;}\r\n#gel .gel-success .gel-btn{margin-top:22px;padding:15px 32px;}\r\n\r\n\/* ---- Responsive ---------------------------------------------------- *\/\r\n@media(max-width:560px){\r\n  #gel{padding:16px 10px 36px;}\r\n  #gel .gel-card{padding:26px 20px;border-radius:14px;}\r\n  #gel .gel-grid-2,#gel .gel-grid-3{grid-template-columns:1fr;}\r\n  #gel .gel-choices.row{grid-template-columns:1fr;}\r\n  #gel .gel-covercards{grid-template-columns:repeat(2,1fr);}\r\n  #gel h2.gel-h{font-size:22px;}\r\n  #gel .gel-foot .gel-btn{padding:13px 18px;font-size:14.5px;}\r\n}\r\n@media(prefers-reduced-motion:reduce){\r\n  #gel *{animation:none!important;transition:none!important;}\r\n}\r\n<\/style>\r\n\r\n<div class=\"gel-shell\">\r\n\r\n  <!-- Progress -->\r\n  <div class=\"gel-progress\" id=\"gelProgress\">\r\n    <div class=\"gel-progress-top\">\r\n      <span class=\"gel-step-label\">Step <b id=\"gelStepNo\">1<\/b> of 10<\/span>\r\n      <span class=\"gel-step-name\" id=\"gelStepName\">Welcome<\/span>\r\n    <\/div>\r\n    <div class=\"gel-track\"><div class=\"gel-fill\" id=\"gelFill\"><\/div><\/div>\r\n  <\/div>\r\n\r\n  <div class=\"gel-card\">\r\n\r\n    <!-- ===================== STEP 1 \u2014 WELCOME ===================== -->\r\n    <section class=\"gel-step active\" data-step=\"1\">\r\n      <div class=\"gel-hero\">\r\n        <div class=\"gel-hero-media\">\r\n          <!-- REPLACE: swap for your own photography, uploaded to the WP media library -->\r\n          <img decoding=\"async\" src=\"https:\/\/geminia.co.ke\/dev\/wp-content\/uploads\/2026\/08\/Employee-Liability.jpg\" alt=\"Workers on a factory floor\" loading=\"lazy\">\r\n        <\/div>\r\n        <div class=\"gel-hero-content\">\r\n          <h1>Protect Your Business <span class=\"hl\">in Minutes<\/span><\/h1>\r\n          <p>Answer a few questions about your business and employees, and we'll prepare your Employers Liability (Common Law) proposal for a Geminia advisor to quote.<\/p>\r\n          <button class=\"gel-btn gel-primary\" data-cta=\"start\">\r\n            <span class=\"gel-spin\"><\/span><span class=\"gel-btxt\">Get Started \u2192<\/span>\r\n          <\/button>\r\n        <\/div>\r\n      <\/div>\r\n    <\/section>\r\n\r\n    <!-- ===================== STEP 2 \u2014 PROPOSER ===================== -->\r\n    <section class=\"gel-step\" data-step=\"2\">\r\n      <span class=\"gel-eyebrow\">About you<\/span>\r\n      <h2 class=\"gel-h\">Proposer's details<\/h2>\r\n      <p class=\"gel-sub\">Part 1 of the official Geminia Employers Liability proposal form.<\/p>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\" for=\"fullName\">Name in full <span class=\"gel-req\">*<\/span><\/label>\r\n        <input class=\"gel-input\" id=\"fullName\" type=\"text\" placeholder=\"e.g. Company name\" autocomplete=\"organization\">\r\n        <div class=\"gel-err\" data-err=\"fullName\">Please enter the proposer's name.<\/div>\r\n      <\/div>\r\n\r\n      <div class=\"gel-grid-2\">\r\n        <div class=\"gel-field\">\r\n          <label class=\"gel-lab\" for=\"kraPin\">KRA PIN No <span style=\"font-weight:400;color:var(--muted);\">(optional)<\/span><\/label>\r\n          <input class=\"gel-input\" id=\"kraPin\" type=\"text\" placeholder=\"e.g. A001234567X\">\r\n        <\/div>\r\n        <div class=\"gel-field\">\r\n          <label class=\"gel-lab\" for=\"email\">Email address <span class=\"gel-req\">*<\/span><\/label>\r\n          <input class=\"gel-input\" id=\"email\" type=\"email\" placeholder=\"you@example.com\" autocomplete=\"email\" inputmode=\"email\">\r\n          <div class=\"gel-err\" data-err=\"email\">Enter a valid email address.<\/div>\r\n        <\/div>\r\n      <\/div>\r\n\r\n      <div class=\"gel-grid-3\">\r\n        <div class=\"gel-field\">\r\n          <label class=\"gel-lab\" for=\"postalAddress\">Postal address <span style=\"font-weight:400;color:var(--muted);\">(optional)<\/span><\/label>\r\n          <input class=\"gel-input\" id=\"postalAddress\" type=\"text\" placeholder=\"e.g. P.O. Box 1234-00100\">\r\n        <\/div>\r\n        <div class=\"gel-field\">\r\n          <label class=\"gel-lab\" for=\"postalCode\">Postal code <span style=\"font-weight:400;color:var(--muted);\">(optional)<\/span><\/label>\r\n          <input class=\"gel-input\" id=\"postalCode\" type=\"text\" placeholder=\"e.g. 00100\">\r\n        <\/div>\r\n        <div class=\"gel-field\">\r\n          <label class=\"gel-lab\" for=\"town\">Town <span style=\"font-weight:400;color:var(--muted);\">(optional)<\/span><\/label>\r\n          <input class=\"gel-input\" id=\"town\" type=\"text\" placeholder=\"e.g. Nairobi\">\r\n        <\/div>\r\n      <\/div>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\" for=\"location\">Location of the premises \/ physical address <span class=\"gel-req\">*<\/span><\/label>\r\n        <input class=\"gel-input\" id=\"location\" type=\"text\" placeholder=\"e.g. Industrial Area, Nairobi\">\r\n        <div class=\"gel-err\" data-err=\"location\">Please enter the location of the premises.<\/div>\r\n      <\/div>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\" for=\"natureOfBusiness\">Nature of business \/ occupation <span style=\"font-weight:400;color:var(--muted);\">(optional)<\/span><\/label>\r\n        <input class=\"gel-input\" id=\"natureOfBusiness\" type=\"text\" placeholder=\"e.g. Manufacturing\">\r\n      <\/div>\r\n\r\n      <div class=\"gel-grid-2\">\r\n        <div class=\"gel-field\">\r\n          <label class=\"gel-lab\" for=\"periodFrom\">Period of insurance \u2014 From <span style=\"font-weight:400;color:var(--muted);\">(optional)<\/span><\/label>\r\n          <input class=\"gel-input\" id=\"periodFrom\" type=\"date\">\r\n        <\/div>\r\n        <div class=\"gel-field\">\r\n          <label class=\"gel-lab\" for=\"periodTo\">Period of insurance \u2014 To <span style=\"font-weight:400;color:var(--muted);\">(optional)<\/span><\/label>\r\n          <input class=\"gel-input\" id=\"periodTo\" type=\"date\">\r\n        <\/div>\r\n      <\/div>\r\n\r\n      <div class=\"gel-note\">\r\n        <svg viewBox=\"0 0 24 24\" fill=\"none\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><rect x=\"3\" y=\"11\" width=\"18\" height=\"11\" rx=\"2\"\/><path d=\"M7 11V7a5 5 0 0 1 10 0v4\"\/><\/svg>\r\n        <span>Please have your Certificate of Incorporation and KRA PIN Certificate ready \u2014 your advisor will request copies.<\/span>\r\n      <\/div>\r\n    <\/section>\r\n\r\n    <!-- ===================== STEP 3 \u2014 PREMISES & MACHINERY ===================== -->\r\n    <section class=\"gel-step\" data-step=\"3\">\r\n      <span class=\"gel-eyebrow\">Premises &amp; machinery<\/span>\r\n      <h2 class=\"gel-h\">A few questions about your premises<\/h2>\r\n      <p class=\"gel-sub\">The truth of these statements is a condition precedent to liability \u2014 please answer in full.<\/p>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\">Does any law or regulation governing the conduct or maintenance of premises apply to your premises? <span class=\"gel-req\">*<\/span><\/label>\r\n        <div class=\"gel-choices row\" data-radio=\"lawsApply\">\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"lawsApply\" value=\"No\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">No<\/span><\/label>\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"lawsApply\" value=\"Yes\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">Yes<\/span><\/label>\r\n        <\/div>\r\n        <div class=\"gel-err\" data-err=\"lawsApply\">Please let us know.<\/div>\r\n      <\/div>\r\n      <div class=\"gel-field\" id=\"gelLawsDetailWrap\" style=\"display:none;\">\r\n        <label class=\"gel-lab\" for=\"lawsDetail\">If so, name such laws and regulations<\/label>\r\n        <input class=\"gel-input\" id=\"lawsDetail\" type=\"text\">\r\n      <\/div>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\">Have you carried out all obligations imposed on you by such laws and regulations? <span style=\"font-weight:400;color:var(--muted);\">(optional)<\/span><\/label>\r\n        <div class=\"gel-choices row\" data-radio=\"obligationsCarriedOut\">\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"obligationsCarriedOut\" value=\"Yes\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">Yes<\/span><\/label>\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"obligationsCarriedOut\" value=\"No\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">No<\/span><\/label>\r\n        <\/div>\r\n      <\/div>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\">Do you have any circular saws or other machinery driven by steam, gas, water, electricity or other mechanical power? <span class=\"gel-req\">*<\/span><\/label>\r\n        <div class=\"gel-choices row\" data-radio=\"circularSaws\">\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"circularSaws\" value=\"No\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">No<\/span><\/label>\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"circularSaws\" value=\"Yes\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">Yes<\/span><\/label>\r\n        <\/div>\r\n        <div class=\"gel-err\" data-err=\"circularSaws\">Please let us know.<\/div>\r\n      <\/div>\r\n      <div class=\"gel-field\" id=\"gelSawsDetailWrap\" style=\"display:none;\">\r\n        <label class=\"gel-lab\" for=\"sawsDetail\">If yes, give details<\/label>\r\n        <input class=\"gel-input\" id=\"sawsDetail\" type=\"text\">\r\n      <\/div>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\" for=\"boilers\">Do you have any boilers? <span style=\"font-weight:400;color:var(--muted);\">(optional)<\/span><\/label>\r\n        <input class=\"gel-input\" id=\"boilers\" type=\"text\" placeholder=\"e.g. No, or give details\">\r\n      <\/div>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\">Do you use acids, gases, chemicals or explosives? <span class=\"gel-req\">*<\/span><\/label>\r\n        <div class=\"gel-choices row\" data-radio=\"acidsChemicals\">\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"acidsChemicals\" value=\"No\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">No<\/span><\/label>\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"acidsChemicals\" value=\"Yes\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">Yes<\/span><\/label>\r\n        <\/div>\r\n        <div class=\"gel-err\" data-err=\"acidsChemicals\">Please let us know.<\/div>\r\n      <\/div>\r\n      <div class=\"gel-field\" id=\"gelAcidsDetailWrap\" style=\"display:none;\">\r\n        <label class=\"gel-lab\" for=\"acidsDetail\">If yes, give details<\/label>\r\n        <input class=\"gel-input\" id=\"acidsDetail\" type=\"text\">\r\n      <\/div>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\">Do you handle or use radioisotopes, radioactive substances, or other sources of ionising radiation? <span class=\"gel-req\">*<\/span><\/label>\r\n        <div class=\"gel-choices row\" data-radio=\"radioactive\">\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"radioactive\" value=\"No\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">No<\/span><\/label>\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"radioactive\" value=\"Yes\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">Yes<\/span><\/label>\r\n        <\/div>\r\n        <div class=\"gel-err\" data-err=\"radioactive\">Please let us know.<\/div>\r\n      <\/div>\r\n    <\/section>\r\n\r\n    <!-- ===================== STEP 4 \u2014 PRIOR INSURANCE & HEALTH ===================== -->\r\n    <section class=\"gel-step\" data-step=\"4\">\r\n      <span class=\"gel-eyebrow\">Quick check<\/span>\r\n      <h2 class=\"gel-h\">Prior insurance &amp; employee health<\/h2>\r\n      <p class=\"gel-sub\">A few background questions.<\/p>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\">Are you at present insured, or have you ever proposed for, a workmen's compensation policy or work injury benefit policy? <span class=\"gel-req\">*<\/span><\/label>\r\n        <div class=\"gel-choices row\" data-radio=\"workmenCompProposed\">\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"workmenCompProposed\" value=\"No\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">No<\/span><\/label>\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"workmenCompProposed\" value=\"Yes\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">Yes<\/span><\/label>\r\n        <\/div>\r\n        <div class=\"gel-err\" data-err=\"workmenCompProposed\">Please let us know.<\/div>\r\n      <\/div>\r\n      <div class=\"gel-field\" id=\"gelInsurerNameWrap\" style=\"display:none;\">\r\n        <label class=\"gel-lab\" for=\"insurerName\">Name of insurer(s)<\/label>\r\n        <input class=\"gel-input\" id=\"insurerName\" type=\"text\">\r\n      <\/div>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\">Have such proposals or renewals ever been declined or withdrawn? <span style=\"font-weight:400;color:var(--muted);\">(optional)<\/span><\/label>\r\n        <div class=\"gel-choices row\" data-radio=\"proposalsDeclined\">\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"proposalsDeclined\" value=\"No\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">No<\/span><\/label>\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"proposalsDeclined\" value=\"Yes\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">Yes<\/span><\/label>\r\n        <\/div>\r\n      <\/div>\r\n      <div class=\"gel-field\" id=\"gelDeclinedReasonsWrap\" style=\"display:none;\">\r\n        <label class=\"gel-lab\" for=\"declinedReasons\">If so, please give reasons and name of insurer(s)<\/label>\r\n        <input class=\"gel-input\" id=\"declinedReasons\" type=\"text\">\r\n      <\/div>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\">Have increased rates been required for such proposals or renewals? <span style=\"font-weight:400;color:var(--muted);\">(optional)<\/span><\/label>\r\n        <div class=\"gel-choices row\" data-radio=\"increasedRatesRequired\">\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"increasedRatesRequired\" value=\"No\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">No<\/span><\/label>\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"increasedRatesRequired\" value=\"Yes\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">Yes<\/span><\/label>\r\n        <\/div>\r\n      <\/div>\r\n      <div class=\"gel-field\" id=\"gelIncreasedRatesDetailWrap\" style=\"display:none;\">\r\n        <label class=\"gel-lab\" for=\"increasedRatesDetail\">If yes, give details<\/label>\r\n        <input class=\"gel-input\" id=\"increasedRatesDetail\" type=\"text\">\r\n      <\/div>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\">Do you have any employee with pre-existing medical conditions? <span class=\"gel-req\">*<\/span><\/label>\r\n        <div class=\"gel-choices row\" data-radio=\"preExistingConditions\">\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"preExistingConditions\" value=\"No\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">No<\/span><\/label>\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"preExistingConditions\" value=\"Yes\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">Yes<\/span><\/label>\r\n        <\/div>\r\n        <div class=\"gel-err\" data-err=\"preExistingConditions\">Please let us know.<\/div>\r\n      <\/div>\r\n      <div class=\"gel-field\" id=\"gelPreExistingDetailWrap\" style=\"display:none;\">\r\n        <label class=\"gel-lab\" for=\"preExistingDetail\">If yes, please give details<\/label>\r\n        <input class=\"gel-input\" id=\"preExistingDetail\" type=\"text\">\r\n      <\/div>\r\n    <\/section>\r\n\r\n    <!-- ===================== STEP 5 \u2014 EMPLOYEE SCHEDULE ===================== -->\r\n    <section class=\"gel-step\" data-step=\"5\">\r\n      <span class=\"gel-eyebrow\">Your employees<\/span>\r\n      <h2 class=\"gel-h\">Employee schedule<\/h2>\r\n      <p class=\"gel-sub\">Employees being workers as defined by Section 5 of the Work Injury Benefits Act, 2007.<\/p>\r\n\r\n      <div class=\"gel-sec\">Employee group 1<\/div>\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\" for=\"emp1Names\">Names \/ number of employees <span class=\"gel-req\">*<\/span><\/label>\r\n        <input class=\"gel-input\" id=\"emp1Names\" type=\"text\" placeholder=\"e.g. 12 factory workers\">\r\n        <div class=\"gel-err\" data-err=\"emp1Names\">Please describe this employee group.<\/div>\r\n      <\/div>\r\n      <div class=\"gel-grid-2\">\r\n        <div class=\"gel-field\">\r\n          <label class=\"gel-lab\" for=\"emp1Occupation\">Description of occupation<\/label>\r\n          <input class=\"gel-input\" id=\"emp1Occupation\" type=\"text\" placeholder=\"e.g. Machine operators\">\r\n        <\/div>\r\n        <div class=\"gel-field\">\r\n          <label class=\"gel-lab\" for=\"emp1Salary\">Estimated annual salary\/wages<\/label>\r\n          <div class=\"gel-money\"><span class=\"gel-cur\">KES<\/span><input class=\"gel-input\" id=\"emp1Salary\" type=\"text\" inputmode=\"numeric\" placeholder=\"0\"><\/div>\r\n        <\/div>\r\n      <\/div>\r\n\r\n      <div class=\"gel-sec\">Employee group 2 <span style=\"font-weight:400;color:var(--muted);text-transform:none;letter-spacing:0;\">(optional)<\/span><\/div>\r\n      <div class=\"gel-field\"><label class=\"gel-lab\" for=\"emp2Names\">Names \/ number of employees<\/label><input class=\"gel-input\" id=\"emp2Names\" type=\"text\"><\/div>\r\n      <div class=\"gel-grid-2\">\r\n        <div class=\"gel-field\"><label class=\"gel-lab\" for=\"emp2Occupation\">Description of occupation<\/label><input class=\"gel-input\" id=\"emp2Occupation\" type=\"text\"><\/div>\r\n        <div class=\"gel-field\"><label class=\"gel-lab\" for=\"emp2Salary\">Estimated annual salary\/wages<\/label>\r\n          <div class=\"gel-money\"><span class=\"gel-cur\">KES<\/span><input class=\"gel-input\" id=\"emp2Salary\" type=\"text\" inputmode=\"numeric\" placeholder=\"0\"><\/div><\/div>\r\n      <\/div>\r\n\r\n      <div class=\"gel-sec\">Employee group 3 <span style=\"font-weight:400;color:var(--muted);text-transform:none;letter-spacing:0;\">(optional)<\/span><\/div>\r\n      <div class=\"gel-field\"><label class=\"gel-lab\" for=\"emp3Names\">Names \/ number of employees<\/label><input class=\"gel-input\" id=\"emp3Names\" type=\"text\"><\/div>\r\n      <div class=\"gel-grid-2\">\r\n        <div class=\"gel-field\"><label class=\"gel-lab\" for=\"emp3Occupation\">Description of occupation<\/label><input class=\"gel-input\" id=\"emp3Occupation\" type=\"text\"><\/div>\r\n        <div class=\"gel-field\"><label class=\"gel-lab\" for=\"emp3Salary\">Estimated annual salary\/wages<\/label>\r\n          <div class=\"gel-money\"><span class=\"gel-cur\">KES<\/span><input class=\"gel-input\" id=\"emp3Salary\" type=\"text\" inputmode=\"numeric\" placeholder=\"0\"><\/div><\/div>\r\n      <\/div>\r\n\r\n      <div class=\"gel-hint\">More occupation groups? List the rest with your advisor on a supplementary sheet.<\/div>\r\n      <div class=\"gel-note\">\r\n        <svg viewBox=\"0 0 24 24\" fill=\"none\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><rect x=\"3\" y=\"11\" width=\"18\" height=\"11\" rx=\"2\"\/><path d=\"M7 11V7a5 5 0 0 1 10 0v4\"\/><\/svg>\r\n        <span>It's a condition of this policy that estimated annual wages, salaries and earnings are certified annually by your auditors within 3 months of the expiry date of the period of insurance.<\/span>\r\n      <\/div>\r\n    <\/section>\r\n\r\n    <!-- ===================== STEP 6 \u2014 SALARY & CLAIMS HISTORY ===================== -->\r\n    <section class=\"gel-step\" data-step=\"6\">\r\n      <span class=\"gel-eyebrow\">History<\/span>\r\n      <h2 class=\"gel-h\">Salary confirmation &amp; claims history<\/h2>\r\n      <p class=\"gel-sub\">A quick check, then your accident\/claims record for recent years.<\/p>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\">Do the above salaries include constant allowances (e.g. housing, commuters)? <span class=\"gel-req\">*<\/span><\/label>\r\n        <div class=\"gel-choices row\" data-radio=\"constantAllowanceIncluded\">\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"constantAllowanceIncluded\" value=\"Yes\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">Yes<\/span><\/label>\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"constantAllowanceIncluded\" value=\"No\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">No<\/span><\/label>\r\n        <\/div>\r\n        <div class=\"gel-err\" data-err=\"constantAllowanceIncluded\">Please let us know.<\/div>\r\n      <\/div>\r\n\r\n      <div class=\"gel-sec\">Year 1 <span style=\"font-weight:400;color:var(--muted);text-transform:none;letter-spacing:0;\">(most recent, optional)<\/span><\/div>\r\n      <div class=\"gel-grid-2\">\r\n        <div class=\"gel-field\"><label class=\"gel-lab\" for=\"claim1Year\">Year<\/label><input class=\"gel-input\" id=\"claim1Year\" type=\"text\" inputmode=\"numeric\" placeholder=\"e.g. 2025\"><\/div>\r\n        <div class=\"gel-field\"><label class=\"gel-lab\" for=\"claim1Wages\">Wages, salaries and other earnings<\/label>\r\n          <div class=\"gel-money\"><span class=\"gel-cur\">KES<\/span><input class=\"gel-input\" id=\"claim1Wages\" type=\"text\" inputmode=\"numeric\" placeholder=\"0\"><\/div><\/div>\r\n      <\/div>\r\n      <div class=\"gel-grid-2\">\r\n        <div class=\"gel-field\"><label class=\"gel-lab\" for=\"claim1Accidents\">Number of accidents (whether or not involving claims)<\/label><input class=\"gel-input\" id=\"claim1Accidents\" type=\"text\" inputmode=\"numeric\"><\/div>\r\n        <div class=\"gel-field\"><label class=\"gel-lab\" for=\"claim1SettledCount\">Claims settled \u2014 number<\/label><input class=\"gel-input\" id=\"claim1SettledCount\" type=\"text\" inputmode=\"numeric\"><\/div>\r\n      <\/div>\r\n      <div class=\"gel-grid-2\">\r\n        <div class=\"gel-field\"><label class=\"gel-lab\" for=\"claim1SettledCost\">Claims settled \u2014 cost<\/label>\r\n          <div class=\"gel-money\"><span class=\"gel-cur\">KES<\/span><input class=\"gel-input\" id=\"claim1SettledCost\" type=\"text\" inputmode=\"numeric\" placeholder=\"0\"><\/div><\/div>\r\n        <div class=\"gel-field\"><label class=\"gel-lab\" for=\"claim1OutstandingCount\">Claims outstanding \u2014 number<\/label><input class=\"gel-input\" id=\"claim1OutstandingCount\" type=\"text\" inputmode=\"numeric\"><\/div>\r\n      <\/div>\r\n      <div class=\"gel-field\"><label class=\"gel-lab\" for=\"claim1OutstandingCost\">Claims outstanding \u2014 cost<\/label>\r\n        <div class=\"gel-money\"><span class=\"gel-cur\">KES<\/span><input class=\"gel-input\" id=\"claim1OutstandingCost\" type=\"text\" inputmode=\"numeric\" placeholder=\"0\"><\/div><\/div>\r\n\r\n      <div class=\"gel-sec\">Year 2 <span style=\"font-weight:400;color:var(--muted);text-transform:none;letter-spacing:0;\">(optional)<\/span><\/div>\r\n      <div class=\"gel-grid-2\">\r\n        <div class=\"gel-field\"><label class=\"gel-lab\" for=\"claim2Year\">Year<\/label><input class=\"gel-input\" id=\"claim2Year\" type=\"text\" inputmode=\"numeric\"><\/div>\r\n        <div class=\"gel-field\"><label class=\"gel-lab\" for=\"claim2Wages\">Wages, salaries and other earnings<\/label>\r\n          <div class=\"gel-money\"><span class=\"gel-cur\">KES<\/span><input class=\"gel-input\" id=\"claim2Wages\" type=\"text\" inputmode=\"numeric\" placeholder=\"0\"><\/div><\/div>\r\n      <\/div>\r\n      <div class=\"gel-grid-2\">\r\n        <div class=\"gel-field\"><label class=\"gel-lab\" for=\"claim2Accidents\">Number of accidents<\/label><input class=\"gel-input\" id=\"claim2Accidents\" type=\"text\" inputmode=\"numeric\"><\/div>\r\n        <div class=\"gel-field\"><label class=\"gel-lab\" for=\"claim2SettledCount\">Claims settled \u2014 number<\/label><input class=\"gel-input\" id=\"claim2SettledCount\" type=\"text\" inputmode=\"numeric\"><\/div>\r\n      <\/div>\r\n      <div class=\"gel-grid-2\">\r\n        <div class=\"gel-field\"><label class=\"gel-lab\" for=\"claim2SettledCost\">Claims settled \u2014 cost<\/label>\r\n          <div class=\"gel-money\"><span class=\"gel-cur\">KES<\/span><input class=\"gel-input\" id=\"claim2SettledCost\" type=\"text\" inputmode=\"numeric\" placeholder=\"0\"><\/div><\/div>\r\n        <div class=\"gel-field\"><label class=\"gel-lab\" for=\"claim2OutstandingCount\">Claims outstanding \u2014 number<\/label><input class=\"gel-input\" id=\"claim2OutstandingCount\" type=\"text\" inputmode=\"numeric\"><\/div>\r\n      <\/div>\r\n      <div class=\"gel-field\"><label class=\"gel-lab\" for=\"claim2OutstandingCost\">Claims outstanding \u2014 cost<\/label>\r\n        <div class=\"gel-money\"><span class=\"gel-cur\">KES<\/span><input class=\"gel-input\" id=\"claim2OutstandingCost\" type=\"text\" inputmode=\"numeric\" placeholder=\"0\"><\/div><\/div>\r\n      <div class=\"gel-hint\">More years of history? Share the rest with your advisor.<\/div>\r\n    <\/section>\r\n\r\n    <!-- ===================== STEP 7 \u2014 LIMITS OF LIABILITY ===================== -->\r\n    <section class=\"gel-step\" data-step=\"7\">\r\n      <span class=\"gel-eyebrow\">Your cover<\/span>\r\n      <h2 class=\"gel-h\">Limits of liability<\/h2>\r\n      <p class=\"gel-sub\">Choose the option that fits your business.<\/p>\r\n      <div class=\"gel-covercards\" id=\"gelLimitCards\"><!-- injected --><\/div>\r\n      <div class=\"gel-err\" data-err=\"limitOption\" style=\"margin-top:14px;\">Please choose an option.<\/div>\r\n    <\/section>\r\n\r\n    <!-- ===================== STEP 8 \u2014 INSURANCE HISTORY ===================== -->\r\n    <section class=\"gel-step\" data-step=\"8\">\r\n      <span class=\"gel-eyebrow\">Part 3<\/span>\r\n      <h2 class=\"gel-h\">General insurance history<\/h2>\r\n      <p class=\"gel-sub\">A few short questions so we can price you fairly.<\/p>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\">9) Do the sums proposed for insurance represent the full value of the property? <span class=\"gel-req\">*<\/span><\/label>\r\n        <div class=\"gel-choices row\" data-radio=\"fullValue\">\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"fullValue\" value=\"Yes\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">Yes<\/span><\/label>\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"fullValue\" value=\"No\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">No<\/span><\/label>\r\n        <\/div>\r\n        <div class=\"gel-err\" data-err=\"fullValue\">Please let us know.<\/div>\r\n      <\/div>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\">10) Has the property proposed for this insurance been covered under a Fire Policy with Geminia Insurance Co. Ltd? <span class=\"gel-req\">*<\/span><\/label>\r\n        <div class=\"gel-choices row\" data-radio=\"firePolicyGeminia\">\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"firePolicyGeminia\" value=\"Yes\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">Yes<\/span><\/label>\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"firePolicyGeminia\" value=\"No\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">No<\/span><\/label>\r\n        <\/div>\r\n        <div class=\"gel-err\" data-err=\"firePolicyGeminia\">Please let us know.<\/div>\r\n      <\/div>\r\n      <div class=\"gel-field\" id=\"gelFireCoWrap\" style=\"display:none;\">\r\n        <label class=\"gel-lab\" for=\"fireInsCompany\">If not, with whom is the property insured against fire?<\/label>\r\n        <input class=\"gel-input\" id=\"fireInsCompany\" type=\"text\">\r\n      <\/div>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\">11) Will you advise the Company of any future changes in the value of the property insured or any other material alteration to the risk? <span class=\"gel-req\">*<\/span><\/label>\r\n        <div class=\"gel-choices row\" data-radio=\"willAdviseChanges\">\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"willAdviseChanges\" value=\"Yes\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">Yes<\/span><\/label>\r\n          <label class=\"gel-choice\"><input type=\"radio\" name=\"willAdviseChanges\" value=\"No\"><span class=\"gel-dot\"><\/span><span class=\"gel-ctxt\">No<\/span><\/label>\r\n        <\/div>\r\n        <div class=\"gel-err\" data-err=\"willAdviseChanges\">Please let us know.<\/div>\r\n      <\/div>\r\n    <\/section>\r\n\r\n    <!-- ===================== STEP 9 \u2014 CONTACT & DECLARATION ===================== -->\r\n    <section class=\"gel-step\" data-step=\"9\">\r\n      <span class=\"gel-eyebrow\">Almost done<\/span>\r\n      <h2 class=\"gel-h\">Contact &amp; declaration<\/h2>\r\n      <p class=\"gel-sub\">Part 4 of the form \u2014 how you'd like us to reach you and confirm the declaration.<\/p>\r\n\r\n      <div class=\"gel-grid-2\">\r\n        <div class=\"gel-field\">\r\n          <label class=\"gel-lab\" for=\"completingName\">Name of person completing this form <span class=\"gel-req\">*<\/span><\/label>\r\n          <input class=\"gel-input\" id=\"completingName\" type=\"text\" placeholder=\"e.g. Jane Wanjiru\">\r\n          <div class=\"gel-err\" data-err=\"completingName\">Please enter a name.<\/div>\r\n        <\/div>\r\n        <div class=\"gel-field\">\r\n          <label class=\"gel-lab\" for=\"designation\">Designation <span style=\"font-weight:400;color:var(--muted);\">(optional)<\/span><\/label>\r\n          <input class=\"gel-input\" id=\"designation\" type=\"text\" placeholder=\"e.g. HR Manager\">\r\n        <\/div>\r\n      <\/div>\r\n\r\n      <div class=\"gel-grid-2\">\r\n        <div class=\"gel-field\">\r\n          <label class=\"gel-lab\" for=\"idPassport\">ID number \/ Passport <span style=\"font-weight:400;color:var(--muted);\">(optional)<\/span><\/label>\r\n          <input class=\"gel-input\" id=\"idPassport\" type=\"text\" placeholder=\"e.g. 12345678\">\r\n        <\/div>\r\n        <div class=\"gel-field\">\r\n          <label class=\"gel-lab\" for=\"declarationEmail\">E-mail address <span style=\"font-weight:400;color:var(--muted);\">(optional, if different)<\/span><\/label>\r\n          <input class=\"gel-input\" id=\"declarationEmail\" type=\"email\" placeholder=\"you@example.com\">\r\n        <\/div>\r\n      <\/div>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\">Preferred communication channel(s) <span style=\"font-weight:400;color:var(--muted);\">(optional)<\/span><\/label>\r\n        <div class=\"gel-choices row\" data-check=\"channels\">\r\n          <label class=\"gel-choice\"><input type=\"checkbox\" value=\"SMS\"><span class=\"gel-box\"><\/span><span class=\"gel-ctxt\">SMS<\/span><\/label>\r\n          <label class=\"gel-choice\"><input type=\"checkbox\" value=\"WhatsApp\"><span class=\"gel-box\"><\/span><span class=\"gel-ctxt\">WhatsApp<\/span><\/label>\r\n          <label class=\"gel-choice\"><input type=\"checkbox\" value=\"Email\"><span class=\"gel-box\"><\/span><span class=\"gel-ctxt\">Email<\/span><\/label>\r\n          <label class=\"gel-choice\"><input type=\"checkbox\" value=\"Telephone\"><span class=\"gel-box\"><\/span><span class=\"gel-ctxt\">Telephone<\/span><\/label>\r\n        <\/div>\r\n      <\/div>\r\n\r\n      <div class=\"gel-field\">\r\n        <label class=\"gel-lab\">Your signature <span class=\"gel-req\">*<\/span><\/label>\r\n        <div class=\"gel-sigwrap\">\r\n          <canvas id=\"gelSigCanvas\" class=\"gel-sigcanvas\" width=\"700\" height=\"220\" aria-label=\"Draw your signature here with mouse or finger\"><\/canvas>\r\n          <span class=\"gel-sig-placeholder\" id=\"gelSigPlaceholder\">Sign here<\/span>\r\n        <\/div>\r\n        <div class=\"gel-sig-actions\">\r\n          <button type=\"button\" class=\"gel-btn gel-ghost\" id=\"gelSigClear\"><span class=\"gel-btxt\">Clear<\/span><\/button>\r\n        <\/div>\r\n        <div class=\"gel-hint\">Draw with your mouse, or your finger on a touchscreen. This is embedded into your proposal PDF.<\/div>\r\n        <div class=\"gel-err\" data-err=\"signature\">Please sign before submitting.<\/div>\r\n      <\/div>\r\n\r\n      <div class=\"gel-note\">\r\n        <svg viewBox=\"0 0 24 24\" fill=\"none\" stroke-width=\"2\" stroke-linecap=\"round\" stroke-linejoin=\"round\"><rect x=\"3\" y=\"11\" width=\"18\" height=\"11\" rx=\"2\"\/><path d=\"M7 11V7a5 5 0 0 1 10 0v4\"\/><\/svg>\r\n        <span>By signing and submitting, you declare that the statements set forth herein are true and complete, that you have not suppressed or misrepresented any material fact, and that you have fairly estimated the wages, salaries and other earnings declared.<\/span>\r\n      <\/div>\r\n    <\/section>\r\n\r\n    <!-- ===================== STEP 10 \u2014 REVIEW ===================== -->\r\n    <section class=\"gel-step\" data-step=\"10\">\r\n      <span class=\"gel-eyebrow\">Review<\/span>\r\n      <h2 class=\"gel-h\">Does everything look right?<\/h2>\r\n      <p class=\"gel-sub\">Take a quick look before we prepare your quotation.<\/p>\r\n      <div class=\"gel-summary\" id=\"gelSummary\"><!-- injected --><\/div>\r\n    <\/section>\r\n\r\n    <!-- ===================== SUCCESS ===================== -->\r\n    <section class=\"gel-step\" data-step=\"done\">\r\n      <div class=\"gel-success\">\r\n        <div class=\"gel-scheck\">\r\n          <div class=\"disc\"><\/div>\r\n          <svg viewBox=\"0 0 24 24\"><path d=\"M20 6 9 17l-5-5\"\/><\/svg>\r\n        <\/div>\r\n        <h1>Thank You! \ud83c\udf89<\/h1>\r\n        <p>We've received your request. A Geminia Insurance advisor will prepare your quotation and contact you shortly.<\/p>\r\n        <p>If we need any additional information, we'll reach out to you.<\/p>\r\n        <button class=\"gel-btn gel-primary\" data-cta=\"return\">\r\n          <span class=\"gel-spin\"><\/span><span class=\"gel-btxt\">Return to Website<\/span>\r\n        <\/button>\r\n      <\/div>\r\n    <\/section>\r\n\r\n    <!-- Footer nav (hidden on welcome + success) -->\r\n    <div class=\"gel-foot\" id=\"gelFoot\" style=\"display:none;\">\r\n      <button class=\"gel-btn gel-ghost\" id=\"gelPrev\">\r\n        <span class=\"gel-spin\"><\/span><span class=\"gel-btxt\">\u2190 Previous<\/span>\r\n      <\/button>\r\n      <button class=\"gel-btn gel-primary\" id=\"gelNext\">\r\n        <span class=\"gel-spin\"><\/span><span class=\"gel-btxt\">Next \u2192<\/span>\r\n      <\/button>\r\n    <\/div>\r\n\r\n    <!-- Exit control (shown on form steps) + leave confirmation -->\r\n    <button class=\"gel-exit\" id=\"gelExit\" type=\"button\" aria-label=\"Return to website\" title=\"Return to website\" style=\"display:none;\">\r\n      <svg viewBox=\"0 0 24 24\"><path d=\"M18 6 6 18M6 6l12 12\"\/><\/svg>\r\n    <\/button>\r\n    <div class=\"gel-confirm\" id=\"gelConfirm\" hidden role=\"dialog\" aria-modal=\"true\" aria-labelledby=\"gelConfirmTitle\">\r\n      <div class=\"gel-confirm-box\">\r\n        <div class=\"gel-confirm-ic\">\r\n          <svg viewBox=\"0 0 24 24\"><path d=\"M9 21H5a2 2 0 0 1-2-2V5a2 2 0 0 1 2-2h4\"\/><path d=\"m16 17 5-5-5-5\"\/><path d=\"M21 12H9\"\/><\/svg>\r\n        <\/div>\r\n        <h3 id=\"gelConfirmTitle\">Leave and return to the site?<\/h3>\r\n        <p>Your answers so far won't be saved.<\/p>\r\n        <div class=\"gel-confirm-actions\">\r\n          <button class=\"gel-btn gel-ghost\" id=\"gelStay\"><span class=\"gel-btxt\">Keep going<\/span><\/button>\r\n          <button class=\"gel-btn gel-primary\" id=\"gelLeave\"><span class=\"gel-spin\"><\/span><span class=\"gel-btxt\">Return to site<\/span><\/button>\r\n        <\/div>\r\n      <\/div>\r\n    <\/div>\r\n\r\n  <\/div><!-- \/card -->\r\n<\/div><!-- \/shell -->\r\n\r\n<!-- pdf-lib: generates the summary proposal PDF in the browser before submit -->\r\n<script src=\"https:\/\/cdn.jsdelivr.net\/npm\/pdf-lib@1.17.1\/dist\/pdf-lib.min.js\"><\/script>\r\n<script>\r\n(function(){\r\n  const root = document.getElementById('gel');\r\n  const ENDPOINT = (root.getAttribute('data-endpoint')||'').trim();\r\n  const RETURN_URL = 'https:\/\/geminia.co.ke';   \/\/ <-- change if needed\r\n\r\n  const LIMIT_OPTIONS = [\r\n    {key:'A', anyOnePerson:2000000, anyOneOccurrence:10000000, anyOneYear:20000000},\r\n    {key:'B', anyOnePerson:4000000, anyOneOccurrence:15000000, anyOneYear:30000000},\r\n    {key:'C', anyOnePerson:6000000, anyOneOccurrence:20000000, anyOneYear:40000000},\r\n    {key:'D', anyOnePerson:8000000, anyOneOccurrence:25000000, anyOneYear:50000000}\r\n  ];\r\n\r\n  \/* ---- State ------------------------------------------------------ *\/\r\n  const S = {step:1, channels:new Set(), limitOption:''};\r\n  let hasSignature=false;\r\n  const TOTAL = 10;\r\n  const STEP_NAMES = {1:'Welcome',2:'Proposer',3:'Premises',4:'Prior insurance',5:'Employees',\r\n    6:'Claims history',7:'Limits',8:'History',9:'Contact',10:'Review'};\r\n\r\n  const $  = (s,c=root)=>c.querySelector(s);\r\n  const $$ = (s,c=root)=>Array.from(c.querySelectorAll(s));\r\n  const stepEl = n => $('.gel-step[data-step=\"'+n+'\"]');\r\n  const fmtKES = v => 'KES '+Number(v).toLocaleString('en-US');\r\n\r\n  \/* ---- Build Limit of Liability cards (single-select) --------------- *\/\r\n  const limitWrap = $('#gelLimitCards');\r\n  LIMIT_OPTIONS.forEach(opt=>{\r\n    const el=document.createElement('div');\r\n    el.className='gel-covercard';el.dataset.key=opt.key;el.setAttribute('role','button');\r\n    el.setAttribute('tabindex','0');el.setAttribute('aria-pressed','false');\r\n    el.innerHTML='<div class=\"gel-cc-name\">'+opt.key+'<\/div>'\r\n      +'<div class=\"gel-cc-tier\">Any one person<br><b>'+fmtKES(opt.anyOnePerson)+'<\/b><br><br>'\r\n      +'Any one occurrence<br><b>'+fmtKES(opt.anyOneOccurrence)+'<\/b><br><br>'\r\n      +'Any one year<br><b>'+fmtKES(opt.anyOneYear)+'<\/b><\/div>';\r\n    const select=()=>{\r\n      $$('.gel-covercard',limitWrap).forEach(x=>{x.classList.remove('sel');x.setAttribute('aria-pressed','false');});\r\n      el.classList.add('sel'); el.setAttribute('aria-pressed','true');\r\n      S.limitOption=opt.key;\r\n      clearErr('limitOption');\r\n    };\r\n    el.addEventListener('click',select);\r\n    el.addEventListener('keydown',e=>{if(e.key===' '||e.key==='Enter'){e.preventDefault();select();}});\r\n    limitWrap.appendChild(el);\r\n  });\r\n  function limitLabel(){\r\n    const opt=LIMIT_OPTIONS.find(o=>o.key===S.limitOption);\r\n    if(!opt) return '\u2014';\r\n    return 'Option '+opt.key+' \u2014 '+fmtKES(opt.anyOnePerson)+' any one person';\r\n  }\r\n\r\n  \/* ---- Choice rows (radio\/checkbox visual state) ------------------- *\/\r\n  function wireChoice(ch){\r\n    const input=ch.querySelector('input');\r\n    if(input.dataset.wired) return; input.dataset.wired='1';\r\n    input.addEventListener('change',()=>{\r\n      if(input.type==='radio'){\r\n        $$('input[name=\"'+input.name+'\"]').forEach(r=>r.closest('.gel-choice').classList.remove('sel'));\r\n        ch.classList.add('sel');\r\n        const wrap=ch.closest('[data-radio]');\r\n        if(wrap) clearErr(wrap.dataset.radio);\r\n        onRadioChange(input.name,input.value);\r\n      }else{\r\n        const group=ch.closest('[data-check]');\r\n        ch.classList.toggle('sel',input.checked);\r\n        onCheckChange(group);\r\n      }\r\n    });\r\n  }\r\n  $$('.gel-choice').forEach(wireChoice);\r\n\r\n  \/* ---- Signature pad ------------------------------------------------ *\/\r\n  (function initSignaturePad(){\r\n    const canvas=$('#gelSigCanvas'); if(!canvas) return;\r\n    const wrap=canvas.closest('.gel-sigwrap');\r\n    const placeholder=$('#gelSigPlaceholder');\r\n    const ctx=canvas.getContext('2d');\r\n    ctx.lineWidth=3; ctx.lineCap='round'; ctx.lineJoin='round'; ctx.strokeStyle='#16283D';\r\n    let drawing=false, lastX=0, lastY=0;\r\n\r\n    function pos(e){\r\n      const rect=canvas.getBoundingClientRect();\r\n      const scaleX=canvas.width\/rect.width, scaleY=canvas.height\/rect.height;\r\n      return {x:(e.clientX-rect.left)*scaleX, y:(e.clientY-rect.top)*scaleY};\r\n    }\r\n    function start(e){\r\n      drawing=true; hasSignature=true;\r\n      placeholder.classList.add('hide'); wrap.classList.add('focus');\r\n      clearErr('signature');\r\n      try{ canvas.setPointerCapture(e.pointerId); }catch(_){}\r\n      const p=pos(e); lastX=p.x; lastY=p.y;\r\n      e.preventDefault();\r\n    }\r\n    function move(e){\r\n      if(!drawing) return;\r\n      const p=pos(e);\r\n      ctx.beginPath(); ctx.moveTo(lastX,lastY); ctx.lineTo(p.x,p.y); ctx.stroke();\r\n      lastX=p.x; lastY=p.y;\r\n      e.preventDefault();\r\n    }\r\n    function end(){ drawing=false; wrap.classList.remove('focus'); }\r\n\r\n    canvas.addEventListener('pointerdown',start);\r\n    canvas.addEventListener('pointermove',move);\r\n    canvas.addEventListener('pointerup',end);\r\n    canvas.addEventListener('pointerleave',()=>{ if(!drawing) wrap.classList.remove('focus'); });\r\n\r\n    $('#gelSigClear').addEventListener('click',()=>{\r\n      ctx.clearRect(0,0,canvas.width,canvas.height);\r\n      hasSignature=false;\r\n      placeholder.classList.remove('hide');\r\n    });\r\n  })();\r\n\r\n  function onRadioChange(name,value){\r\n    if(name==='lawsApply') $('#gelLawsDetailWrap').style.display = value==='Yes' ? 'block':'none';\r\n    if(name==='circularSaws') $('#gelSawsDetailWrap').style.display = value==='Yes' ? 'block':'none';\r\n    if(name==='acidsChemicals') $('#gelAcidsDetailWrap').style.display = value==='Yes' ? 'block':'none';\r\n    if(name==='workmenCompProposed') $('#gelInsurerNameWrap').style.display = value==='Yes' ? 'block':'none';\r\n    if(name==='proposalsDeclined') $('#gelDeclinedReasonsWrap').style.display = value==='Yes' ? 'block':'none';\r\n    if(name==='increasedRatesRequired') $('#gelIncreasedRatesDetailWrap').style.display = value==='Yes' ? 'block':'none';\r\n    if(name==='preExistingConditions') $('#gelPreExistingDetailWrap').style.display = value==='Yes' ? 'block':'none';\r\n    if(name==='firePolicyGeminia') $('#gelFireCoWrap').style.display = value==='No' ? 'block':'none';\r\n  }\r\n  function onCheckChange(group){\r\n    if(group.dataset.check==='channels'){\r\n      S.channels.clear();\r\n      group.querySelectorAll('input:checked').forEach(i=>S.channels.add(i.value));\r\n    }\r\n  }\r\n\r\n  \/* ---- Money formatting --------------------------------------------- *\/\r\n  $$('.gel-money .gel-input').forEach(inp=>{\r\n    inp.addEventListener('input',()=>{\r\n      let raw=inp.value.replace(\/[^\\d]\/g,'');\r\n      inp.value = raw ? 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if(!n.value.trim()){showErr('emp1Names',fail(n));} else clearErr('emp1Names');\r\n    }\r\n    if(step===6){\r\n      if(!$('input[name=\"constantAllowanceIncluded\"]:checked')){showErr('constantAllowanceIncluded');ok=false;} else clearErr('constantAllowanceIncluded');\r\n    }\r\n    if(step===7){\r\n      if(!S.limitOption){showErr('limitOption');ok=false;} else clearErr('limitOption');\r\n    }\r\n    if(step===8){\r\n      if(!$('input[name=\"fullValue\"]:checked')){showErr('fullValue');ok=false;} else clearErr('fullValue');\r\n      if(!$('input[name=\"firePolicyGeminia\"]:checked')){showErr('firePolicyGeminia');ok=false;} else clearErr('firePolicyGeminia');\r\n      if(!$('input[name=\"willAdviseChanges\"]:checked')){showErr('willAdviseChanges');ok=false;} else clearErr('willAdviseChanges');\r\n    }\r\n    if(step===9){\r\n      const n=$('#completingName'); if(!n.value.trim()){showErr('completingName',fail(n));} else clearErr('completingName');\r\n      if(!hasSignature){ showErr('signature'); ok=false; } else clearErr('signature');\r\n    }\r\n    if(!ok){\r\n      const firstErr=$('.gel-err.show');\r\n      if(firstErr) firstErr.closest('.gel-field, .gel-step').scrollIntoView({behavior:'smooth',block:'center'});\r\n    }\r\n    return ok;\r\n  }\r\n\r\n  \/* ---- Build review ---------------------------------------------- *\/\r\n  function escapeHtml(s){return String(s).replace(\/[&<>\"]\/g,c=>({'&':'&amp;','<':'&lt;','>':'&gt;','\"':'&quot;'}[c]));}\r\n  function buildReview(){\r\n    const g=$('#gelSummary');\r\n    const fullVal=$('input[name=\"fullValue\"]:checked');\r\n    const curFire=$('input[name=\"firePolicyGeminia\"]:checked');\r\n    const chans=S.channels.size?[...S.channels].join(', '):'\u2014';\r\n\r\n    g.innerHTML=\r\n      block('\ud83d\udc64 Proposer',[\r\n        row('Name',$('#fullName').value||'\u2014'),\r\n        row('Email',$('#email').value||'\u2014'),\r\n        row('Location',$('#location').value||'\u2014')\r\n      ])\r\n      +block('\ud83d\udc77 Employees',[\r\n        row('Group 1',($('#emp1Names').value||'\u2014')+' \u2014 '+($('#emp1Occupation').value||'\u2014')),\r\n        row('Est. annual salary',$('#emp1Salary').value?('KES '+$('#emp1Salary').value):'\u2014')\r\n      ])\r\n      +'<div class=\"gel-sblock\"><h4>\ud83d\udee1\ufe0f Limit of liability<\/h4><div class=\"gel-srow\"><span class=\"k\">Option<\/span><span class=\"v\">'+escapeHtml(limitLabel())+'<\/span><\/div><\/div>'\r\n      +block('\u2705 Insurance history',[\r\n        row('Sums represent full value',fullVal?fullVal.value:'\u2014'),\r\n        row('Fire policy with Geminia',curFire?curFire.value:'\u2014')\r\n      ])\r\n      +block('\ud83d\udcde Contact',[\r\n        row('Form completed by',$('#completingName').value||'\u2014'),\r\n        row('Preferred channels',chans),\r\n        row('Signature',hasSignature?'\u2713 Captured':'Not captured')\r\n      ]);\r\n\r\n    function block(title,rows){return '<div class=\"gel-sblock\"><h4>'+title+'<\/h4>'+rows.filter(Boolean).join('')+'<\/div>';}\r\n    function row(k,v){return '<div class=\"gel-srow\"><span class=\"k\">'+k+'<\/span><span class=\"v\">'+escapeHtml(v)+'<\/span><\/div>';}\r\n  }\r\n\r\n  \/* ---- Render \/ navigation --------------------------------------- *\/\r\n  function render(){\r\n    const cur=$('.gel-step.active');\r\n    const next=stepEl(S.step);\r\n    if(cur && cur!==next){\r\n      cur.classList.add('leaving');\r\n      setTimeout(()=>{cur.classList.remove('active','leaving');next.classList.add('active');},260);\r\n    }else{\r\n      $$('.gel-step').forEach(s=>s.classList.remove('active'));\r\n      next.classList.add('active');\r\n    }\r\n\r\n    const isWelcome=S.step===1, isDone=S.step==='done';\r\n    const showChrome = !isWelcome && !isDone;\r\n    $('.gel-card').classList.toggle('gel-card--hero',isWelcome);\r\n    $('#gelProgress').classList.toggle('on',showChrome);\r\n    $('#gelFoot').style.display = showChrome ? 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(continued)':''),\r\n        {x:margin,y:H-31,size:9,font,color:white});\r\n      y=H-58;\r\n    }\r\n    function ensureSpace(need){ if(y-need<bottom) newPage(true); }\r\n    function head(t){\r\n      ensureSpace(26);\r\n      pg.drawText(t.toUpperCase(),{x:margin,y,size:10,font:bold,color:navy});\r\n      pg.drawLine({start:{x:margin,y:y-4},end:{x:W-margin,y:y-4},thickness:1,color:acc});\r\n      y-=18;\r\n    }\r\n    function kv(k,v){\r\n      ensureSpace(15);\r\n      pg.drawText(k,{x:margin+2,y,size:9,font,color:mut});\r\n      pg.drawText(String(v||'\u2014'),{x:230,y,size:9.5,font:bold,color:ink,maxWidth:W-230-margin});\r\n      y-=15;\r\n    }\r\n    function money(v){ return v? 'KES '+Number(v).toLocaleString('en-US') : '\u2014'; }\r\n    function para(t,size=9){\r\n      const words=String(t).split(' '); const maxW=W-2*margin; let line='';\r\n      words.forEach(w=>{\r\n        const test=line?line+' '+w:w;\r\n        if(font.widthOfTextAtSize(test,size)>maxW){\r\n          ensureSpace(13); pg.drawText(line,{x:margin,y,size,font,color:mut}); y-=13; line=w;\r\n        }else line=test;\r\n      });\r\n      if(line){ ensureSpace(13); pg.drawText(line,{x:margin,y,size,font,color:mut}); y-=13; }\r\n    }\r\n\r\n    newPage(false);\r\n\r\n    head('Proposer');\r\n    kv('Name in full',p.proposer.fullName); kv('KRA PIN',p.proposer.kraPin);\r\n    kv('Postal address',(p.proposer.postalAddress||'\u2014')+' '+(p.proposer.postalCode||'')+', '+(p.proposer.town||'\u2014'));\r\n    kv('Email',p.proposer.email); kv('Location of premises',p.proposer.location);\r\n    kv('Nature of business',p.proposer.natureOfBusiness);\r\n    kv('Period of insurance',(p.proposer.periodFrom||'\u2014')+' to '+(p.proposer.periodTo||'\u2014'));\r\n\r\n    y-=6; head('Premises & machinery');\r\n    kv('Laws\/regulations apply',p.premises.lawsApply+(p.premises.lawsDetail?(' \u2014 '+p.premises.lawsDetail):''));\r\n    kv('Obligations carried out',p.premises.obligationsCarriedOut);\r\n    kv('Circular saws\/machinery',p.premises.circularSaws+(p.premises.sawsDetail?(' \u2014 '+p.premises.sawsDetail):''));\r\n    kv('Boilers',p.premises.boilers);\r\n    kv('Acids\/gases\/chemicals\/explosives',p.premises.acidsChemicals+(p.premises.acidsDetail?(' \u2014 '+p.premises.acidsDetail):''));\r\n    kv('Radioisotopes\/radioactive substances',p.premises.radioactive);\r\n\r\n    y-=6; head('Prior insurance & health');\r\n    kv('Workmen\\'s comp\/WIBA policy proposed',p.priorInsurance.workmenCompProposed+(p.priorInsurance.insurerName?(' \u2014 '+p.priorInsurance.insurerName):''));\r\n    kv('Proposals declined\/withdrawn',p.priorInsurance.proposalsDeclined+(p.priorInsurance.declinedReasons?(' \u2014 '+p.priorInsurance.declinedReasons):''));\r\n    kv('Increased rates required',p.priorInsurance.increasedRatesRequired+(p.priorInsurance.increasedRatesDetail?(' \u2014 '+p.priorInsurance.increasedRatesDetail):''));\r\n    kv('Pre-existing medical conditions',p.priorInsurance.preExistingConditions+(p.priorInsurance.preExistingDetail?(' \u2014 '+p.priorInsurance.preExistingDetail):''));\r\n\r\n    y-=6; head('Employee schedule');\r\n    (p.employees||[]).forEach((e,i)=>{\r\n      kv('Group '+(i+1),e.names+(e.occupation?(' \u2014 '+e.occupation):'')+(e.salary?(' \u2014 '+money(e.salary)+'\/yr'):''));\r\n    });\r\n    kv('Salaries include constant allowance',p.constantAllowanceIncluded);\r\n\r\n    if((p.claimsHistory||[]).length){\r\n      y-=6; head('Claims history');\r\n      p.claimsHistory.forEach(c=>{\r\n        kv('Year '+c.year,'Wages '+money(c.wages)+' \u00b7 Accidents '+(c.accidents||'\u2014'));\r\n        kv('  Settled \/ Outstanding',(c.settledCount||'0')+' claims ('+money(c.settledCost)+') \/ '+(c.outstandingCount||'0')+' claims ('+money(c.outstandingCost)+')');\r\n      });\r\n    }\r\n\r\n    y-=6; head('Limit of liability');\r\n    kv('Option selected',p.cover.limitLabel);\r\n\r\n    y-=6; head('Insurance history');\r\n    kv('Sums represent full value',p.risk.fullValue);\r\n    kv('Fire policy with Geminia',p.risk.firePolicyGeminia+(p.risk.firePolicyGeminia==='No'&&p.risk.fireInsCompany?(' \u2014 currently with '+p.risk.fireInsCompany):''));\r\n    kv('Will advise of future changes',p.risk.willAdviseChanges);\r\n\r\n    y-=6; head('Contact');\r\n    kv('Form completed by',p.contact.completingName); kv('Designation',p.contact.designation);\r\n    kv('ID\/Passport',p.contact.idPassport);\r\n    kv('Preferred channels',(p.contact.channels||[]).join(', ')||'\u2014');\r\n\r\n    y-=6; head('Declaration');\r\n    para('I\/We hereby declare that all the above statements and particulars are true and I\/we have not suppressed, misrepresented or incorrectly stated any material fact, and that I\/we have fairly estimated the total amount of wages, salaries and other earnings, and I\/we agree that this declaration shall be the basis of the contract between me\/us and the Company.');\r\n    y-=8;\r\n    ensureSpace(64);\r\n    pg.drawText('Signature:',{x:margin,y,size:9,font,color:mut});\r\n    if(sigDataUrl){\r\n      try{\r\n        const sigBytes=await fetch(sigDataUrl).then(r=>r.arrayBuffer());\r\n        const sigImg=await pdf.embedPng(sigBytes);\r\n        const dims=sigImg.scaleToFit(170,54);\r\n        pg.drawImage(sigImg,{x:margin+68,y:y-dims.height+9,width:dims.width,height:dims.height});\r\n        y-=(dims.height+16);\r\n      }catch(err){\r\n        pg.drawText('(signature image could not be embedded)',{x:margin+68,y,size:8.5,font,color:mut}); y-=16;\r\n      }\r\n    }else{\r\n      pg.drawText('Not captured online',{x:margin+68,y,size:9.5,font,color:ink}); y-=16;\r\n    }\r\n    kv('Date',new Date().toLocaleDateString('en-GB'));\r\n\r\n    pg.drawText('Figures are applicant estimates, subject to underwriting review and policy terms & conditions.',\r\n      {x:margin,y:30,size:8,font,color:mut});\r\n\r\n    return await pdf.saveAsBase64();\r\n  }\r\n\r\n  async function submit(){\r\n    const btn=$('#gelNext');\r\n    btn.classList.add('loading');btn.disabled=true;$('#gelPrev').disabled=true;\r\n    const finish=()=>{ btn.classList.remove('loading');btn.disabled=false;$('#gelPrev').disabled=false; goTo('done'); };\r\n    const p=buildPayload();\r\n    const sigCanvas=$('#gelSigCanvas');\r\n    const sigDataUrl = hasSignature && sigCanvas ? sigCanvas.toDataURL('image\/png') : '';\r\n    let pdfBase64=null;\r\n    try{ pdfBase64=await buildSummaryPdf(p, sigDataUrl); }\r\n    catch(err){ console.warn('PDF build skipped:',err); } \/\/ never block the customer\r\n    const body={ lead:p, pdfBase64,\r\n      filename:'Employers_Liability_'+((p.proposer.fullName||'Proposal').replace(\/[^\\w]+\/g,'_').slice(0,40))+'.pdf' };\r\n    if(!ENDPOINT){ setTimeout(finish,1200); return; } \/\/ demo mode\r\n    fetch(ENDPOINT,{\r\n      method:'POST',\r\n      headers:{'Content-Type':'text\/plain;charset=utf-8'}, \/\/ avoids Apps Script CORS preflight\r\n      body:JSON.stringify(body)\r\n    }).then(finish).catch(finish); \/\/ advisor still gets the lead; never block the user\r\n  }\r\n\r\n  \/* ---- Wire up ---------------------------------------------------- *\/\r\n  $('[data-cta=\"start\"]').addEventListener('click',function(){ withLoading(this,()=>goTo(2),420); });\r\n\r\n  \/\/ ---- Exit to website (available mid-journey) --------------------\r\n  const confirmEl=$('#gelConfirm');\r\n  $('#gelExit').addEventListener('click',()=>{ confirmEl.hidden=false; $('#gelStay').focus(); });\r\n  $('#gelStay').addEventListener('click',()=>{ confirmEl.hidden=true; $('#gelExit').focus(); });\r\n  $('#gelLeave').addEventListener('click',function(){ withLoading(this,()=>{ window.top.location.href=RETURN_URL; },500); });\r\n  root.addEventListener('keydown',e=>{ if(e.key==='Escape' && !confirmEl.hidden){ confirmEl.hidden=true; $('#gelExit').focus(); } });\r\n  $('[data-cta=\"return\"]').addEventListener('click',function(){ withLoading(this,()=>{ window.top.location.href=RETURN_URL; },500); });\r\n  $('#gelNext').addEventListener('click',next);\r\n  $('#gelPrev').addEventListener('click',prev);\r\n\r\n  render();\r\n})();\r\n<\/script>\r\n<\/div>\r\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t","protected":false},"excerpt":{"rendered":"<p>Step 1 of 10 Welcome Protect Your Business in Minutes Answer a few questions about your business and employees, and we&#8217;ll prepare your Employers Liability (Common Law) proposal for a Geminia advisor to quote. Get Started \u2192 About you Proposer&#8217;s details Part 1 of the official Geminia Employers Liability proposal form. Name in full * [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-1539","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.0 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Employee Liability Form - Geminia Insurance<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Employee Liability Form - Geminia Insurance\" \/>\n<meta property=\"og:description\" content=\"Step 1 of 10 Welcome Protect Your Business in Minutes Answer a few questions about your business and employees, and we&#8217;ll prepare your Employers Liability (Common Law) proposal for a Geminia advisor to quote. 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