{"id":422,"date":"2026-02-04T15:26:14","date_gmt":"2026-02-04T15:26:14","guid":{"rendered":"https:\/\/partnershipone.com\/DDC\/?page_id=422"},"modified":"2026-06-19T15:00:01","modified_gmt":"2026-06-19T14:00:01","slug":"hb-housing-payment","status":"publish","type":"page","link":"https:\/\/partnershipone.com\/DDC\/hb-housing-payment\/","title":{"rendered":"Apply for a housing payment"},"content":{"rendered":"<script>\nvar gform;gform||(document.addEventListener(\"gform_main_scripts_loaded\",function(){gform.scriptsLoaded=!0}),document.addEventListener(\"gform\/theme\/scripts_loaded\",function(){gform.themeScriptsLoaded=!0}),window.addEventListener(\"DOMContentLoaded\",function(){gform.domLoaded=!0}),gform={domLoaded:!1,scriptsLoaded:!1,themeScriptsLoaded:!1,isFormEditor:()=>\"function\"==typeof InitializeEditor,callIfLoaded:function(o){return!(!gform.domLoaded||!gform.scriptsLoaded||!gform.themeScriptsLoaded&&!gform.isFormEditor()||(gform.isFormEditor()&&console.warn(\"The use of gform.initializeOnLoaded() is deprecated in the form editor context and will be removed in Gravity Forms 3.1.\"),o(),0))},initializeOnLoaded:function(o){gform.callIfLoaded(o)||(document.addEventListener(\"gform_main_scripts_loaded\",()=>{gform.scriptsLoaded=!0,gform.callIfLoaded(o)}),document.addEventListener(\"gform\/theme\/scripts_loaded\",()=>{gform.themeScriptsLoaded=!0,gform.callIfLoaded(o)}),window.addEventListener(\"DOMContentLoaded\",()=>{gform.domLoaded=!0,gform.callIfLoaded(o)}))},hooks:{action:{},filter:{}},addAction:function(o,r,e,t){gform.addHook(\"action\",o,r,e,t)},addFilter:function(o,r,e,t){gform.addHook(\"filter\",o,r,e,t)},doAction:function(o){gform.doHook(\"action\",o,arguments)},applyFilters:function(o){return gform.doHook(\"filter\",o,arguments)},removeAction:function(o,r){gform.removeHook(\"action\",o,r)},removeFilter:function(o,r,e){gform.removeHook(\"filter\",o,r,e)},addHook:function(o,r,e,t,n){null==gform.hooks[o][r]&&(gform.hooks[o][r]=[]);var d=gform.hooks[o][r];null==n&&(n=r+\"_\"+d.length),gform.hooks[o][r].push({tag:n,callable:e,priority:t=null==t?10:t})},doHook:function(r,o,e){var t;if(e=Array.prototype.slice.call(e,1),null!=gform.hooks[r][o]&&((o=gform.hooks[r][o]).sort(function(o,r){return o.priority-r.priority}),o.forEach(function(o){\"function\"!=typeof(t=o.callable)&&(t=window[t]),\"action\"==r?t.apply(null,e):e[0]=t.apply(null,e)})),\"filter\"==r)return e[0]},removeHook:function(o,r,t,n){var e;null!=gform.hooks[o][r]&&(e=(e=gform.hooks[o][r]).filter(function(o,r,e){return!!(null!=n&&n!=o.tag||null!=t&&t!=o.priority)}),gform.hooks[o][r]=e)}});\n<\/script>\n\n                <div class='gf_browser_gecko gform_wrapper gform-theme gform-theme--foundation gform-theme--framework gform-theme--orbital' data-form-theme='orbital' data-form-index='0' id='gform_wrapper_59' style='display:none'><style>#gform_wrapper_59[data-form-index=\"0\"].gform-theme{--gf-color-primary: #025B99;--gf-color-primary-rgb: 2, 91, 153;--gf-color-primary-contrast: #fff;--gf-color-primary-contrast-rgb: 255, 255, 255;--gf-color-primary-darker: #002967;--gf-color-primary-lighter: #348DCB;--gf-color-secondary: #fff;--gf-color-secondary-rgb: 255, 255, 255;--gf-color-secondary-contrast: #112337;--gf-color-secondary-contrast-rgb: 17, 35, 55;--gf-color-secondary-darker: #F5F5F5;--gf-color-secondary-lighter: #FFFFFF;--gf-color-out-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-out-ctrl-light-rgb: 17, 35, 55;--gf-color-out-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-out-ctrl-light-lighter: #F5F5F5;--gf-color-out-ctrl-dark: #585e6a;--gf-color-out-ctrl-dark-rgb: 88, 94, 106;--gf-color-out-ctrl-dark-darker: #112337;--gf-color-out-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-color-in-ctrl: #fff;--gf-color-in-ctrl-rgb: 255, 255, 255;--gf-color-in-ctrl-contrast: #112337;--gf-color-in-ctrl-contrast-rgb: 17, 35, 55;--gf-color-in-ctrl-darker: #F5F5F5;--gf-color-in-ctrl-lighter: #FFFFFF;--gf-color-in-ctrl-primary: #025B99;--gf-color-in-ctrl-primary-rgb: 2, 91, 153;--gf-color-in-ctrl-primary-contrast: #fff;--gf-color-in-ctrl-primary-contrast-rgb: 255, 255, 255;--gf-color-in-ctrl-primary-darker: #002967;--gf-color-in-ctrl-primary-lighter: #348DCB;--gf-color-in-ctrl-light: rgba(17, 35, 55, 0.1);--gf-color-in-ctrl-light-rgb: 17, 35, 55;--gf-color-in-ctrl-light-darker: rgba(104, 110, 119, 0.35);--gf-color-in-ctrl-light-lighter: #F5F5F5;--gf-color-in-ctrl-dark: #585e6a;--gf-color-in-ctrl-dark-rgb: 88, 94, 106;--gf-color-in-ctrl-dark-darker: #112337;--gf-color-in-ctrl-dark-lighter: rgba(17, 35, 55, 0.65);--gf-radius: 3px;--gf-font-size-secondary: 14px;--gf-font-size-tertiary: 13px;--gf-icon-ctrl-number: url(\"data:image\/svg+xml,%3Csvg width='8' height='14' viewBox='0 0 8 14' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M4 0C4.26522 5.96046e-08 4.51957 0.105357 4.70711 0.292893L7.70711 3.29289C8.09763 3.68342 8.09763 4.31658 7.70711 4.70711C7.31658 5.09763 6.68342 5.09763 6.29289 4.70711L4 2.41421L1.70711 4.70711C1.31658 5.09763 0.683417 5.09763 0.292893 4.70711C-0.0976311 4.31658 -0.097631 3.68342 0.292893 3.29289L3.29289 0.292893C3.48043 0.105357 3.73478 0 4 0ZM0.292893 9.29289C0.683417 8.90237 1.31658 8.90237 1.70711 9.29289L4 11.5858L6.29289 9.29289C6.68342 8.90237 7.31658 8.90237 7.70711 9.29289C8.09763 9.68342 8.09763 10.3166 7.70711 10.7071L4.70711 13.7071C4.31658 14.0976 3.68342 14.0976 3.29289 13.7071L0.292893 10.7071C-0.0976311 10.3166 -0.0976311 9.68342 0.292893 9.29289Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-select: url(\"data:image\/svg+xml,%3Csvg width='10' height='6' viewBox='0 0 10 6' fill='none' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath fill-rule='evenodd' clip-rule='evenodd' d='M0.292893 0.292893C0.683417 -0.097631 1.31658 -0.097631 1.70711 0.292893L5 3.58579L8.29289 0.292893C8.68342 -0.0976311 9.31658 -0.0976311 9.70711 0.292893C10.0976 0.683417 10.0976 1.31658 9.70711 1.70711L5.70711 5.70711C5.31658 6.09763 4.68342 6.09763 4.29289 5.70711L0.292893 1.70711C-0.0976311 1.31658 -0.0976311 0.683418 0.292893 0.292893Z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-icon-ctrl-search: url(\"data:image\/svg+xml,%3Csvg width='640' height='640' xmlns='http:\/\/www.w3.org\/2000\/svg'%3E%3Cpath d='M256 128c-70.692 0-128 57.308-128 128 0 70.691 57.308 128 128 128 70.691 0 128-57.309 128-128 0-70.692-57.309-128-128-128zM64 256c0-106.039 85.961-192 192-192s192 85.961 192 192c0 41.466-13.146 79.863-35.498 111.248l154.125 154.125c12.496 12.496 12.496 32.758 0 45.254s-32.758 12.496-45.254 0L367.248 412.502C335.862 434.854 297.467 448 256 448c-106.039 0-192-85.962-192-192z' fill='rgba(17, 35, 55, 0.65)'\/%3E%3C\/svg%3E\");--gf-label-space-y-secondary: var(--gf-label-space-y-md-secondary);--gf-ctrl-border-color: #686e77;--gf-ctrl-size: var(--gf-ctrl-size-md);--gf-ctrl-label-color-primary: #112337;--gf-ctrl-label-color-secondary: #112337;--gf-ctrl-choice-size: var(--gf-ctrl-choice-size-md);--gf-ctrl-checkbox-check-size: var(--gf-ctrl-checkbox-check-size-md);--gf-ctrl-radio-check-size: var(--gf-ctrl-radio-check-size-md);--gf-ctrl-btn-font-size: var(--gf-ctrl-btn-font-size-md);--gf-ctrl-btn-padding-x: var(--gf-ctrl-btn-padding-x-md);--gf-ctrl-btn-size: var(--gf-ctrl-btn-size-md);--gf-ctrl-btn-border-color-secondary: #686e77;--gf-ctrl-btn-bg-color-hover-tertiary: #EBEBEB;--gf-field-img-choice-size: var(--gf-field-img-choice-size-md);--gf-field-img-choice-card-space: var(--gf-field-img-choice-card-space-md);--gf-field-img-choice-check-ind-size: var(--gf-field-img-choice-check-ind-size-md);--gf-field-img-choice-check-ind-icon-size: var(--gf-field-img-choice-check-ind-icon-size-md);--gf-field-pg-steps-number-color: rgba(17, 35, 55, 0.8);}<\/style><div id='gf_59' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_59'  action='\/DDC\/wp-json\/wp\/v2\/pages\/422#gf_59' data-formid='59' novalidate><div id='gf_page_steps_59' class='gf_page_steps'><div id='gf_step_59_1' class='gf_step gf_step_active gf_step_first'><span class='gf_step_number'>1<\/span><span class='gf_step_label'>Using the form<\/span><\/div><div id='gf_step_59_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>Completing the form<\/span><\/div><div id='gf_step_59_3' class='gf_step gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'>Declaration<\/span><\/div><div id='gf_step_59_4' class='gf_step gf_step_pending'><span class='gf_step_number'>4<\/span><span class='gf_step_label'>Declaration<\/span><\/div><div id='gf_step_59_5' class='gf_step gf_step_pending'><span class='gf_step_number'>5<\/span><span class='gf_step_label'>The claimant<\/span><\/div><div id='gf_step_59_6' class='gf_step gf_step_pending'><span class='gf_step_number'>6<\/span><span class='gf_step_label'>The landlord<\/span><\/div><div id='gf_step_59_7' class='gf_step gf_step_pending'><span class='gf_step_number'>7<\/span><span class='gf_step_label'>Reasons for applying<\/span><\/div><div id='gf_step_59_8' class='gf_step gf_step_pending'><span class='gf_step_number'>8<\/span><span class='gf_step_label'>The property<\/span><\/div><div id='gf_step_59_9' class='gf_step gf_step_pending'><span class='gf_step_number'>9<\/span><span class='gf_step_label'>Reasons continued<\/span><\/div><div id='gf_step_59_10' class='gf_step gf_step_pending'><span class='gf_step_number'>10<\/span><span class='gf_step_label'>Income<\/span><\/div><div id='gf_step_59_11' class='gf_step gf_step_pending'><span class='gf_step_number'>11<\/span><span class='gf_step_label'>Outgoings<\/span><\/div><div id='gf_step_59_12' class='gf_step gf_step_pending'><span class='gf_step_number'>12<\/span><span class='gf_step_label'>Loans and debts<\/span><\/div><div id='gf_step_59_13' class='gf_step gf_step_pending'><span class='gf_step_number'>13<\/span><span class='gf_step_label'>Proof<\/span><\/div><div id='gf_step_59_14' class='gf_step gf_step_pending'><span class='gf_step_number'>14<\/span><span class='gf_step_label'>Universal credit<\/span><\/div><div id='gf_step_59_15' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>15<\/span><span class='gf_step_label'>Payment<\/span><\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_59_1' class='gform_page ' data-js='page-field-id-0' >\n\t\t\t\t\t<div class='gform_page_fields'><div id='gform_fields_59' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_59_5\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><p>Use this form to apply for housing payments if you are getting Housing Benefit or the housing costs element of Universal Credit and need more help with your housing costs. If you aren&#8217;t getting one of these benefits, your application may be refused If you need advice on your housing situation, you need to speak to our <a href=\"https:\/\/www.dover.gov.uk\/Housing\/Housing-Advice\/Housing-Advice.aspx\" target=\"_blank\">Housing Team<\/a>.<\/p>\n\n<p>Please read the <a href=\"https:\/\/www.dover.gov.uk\/benefits\/discretionary-housing-payments\" target=\"_blank\">information about housing payments<\/a> including who can apply before completing this form.<\/p>\n\n<h2>This form will ask you to provide<\/h2>\n\n<ul>\n\t<li>your details including National Insurance number<\/li>\n\t<li>why you need help, future changes and what you are doing to help your situation<\/li>\n\t<li>the amount of rent you pay and Housing Benefit you get per week<\/li>\n\t<li>a full list of every type and amount of money coming into your household (your household income) and how often you get this<\/li>\n\t<li>a full list of every type and amount of money going out of your household (your household outgoings) and how often you pay these<\/li>\n\t<li>a full list of every type of loan and debt you pay per week and the total amount of each outstanding<\/li>\n\t<li>proof of all your bank, building society and Post Office accounts, and of all your income and outgoings<\/li>\n\t<li>if you are getting or have applied for Universal Credit, we will need a full list of people who live with you, including full name, date of birth and relationship to you<\/li>\n\t<li>if you are facing eviction, you will need to provide evidence such as rent arrears statements, section notices or possession orders<\/li>\n\t<li>evidence from your support worker (if you have one).<\/li>\n<\/ul>\n<p><\/p>\n\n<p>Please have this information ready as pages time-out after one hour.<\/p>\n\n<p>Do not use your browser back button &#8211; if you need to go to a previous page click on the previous button at the bottom of each page.<\/p>\n\n<h3>Proof to support your application<\/h3>\n\n<p>You can upload your proof to this form now or you can send it later, but your application won&#8217;t be decided until we have received proof. If you don&#8217;t provide proof within two weeks of completing this form your application will be cancelled and you will need to apply again, if you wish to do so. <p\/>\n\n<h2>Privacy Statement<\/h2>\nDover District Council is a Data Controller under GDPR.  In submitting this form we will collect and process your personal data.  For information about your rights and how the Council uses your data,  please view our Corporate and relevant service privacy notice which can be found on our <a href=\"https:\/\/www.dover.gov.uk\/Website\/Privacy-and-Cookies.aspx\"target=\"_blank\">Privacy page<\/a>.<\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                         <button type='button' id='gform_next_button_59_1' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_59_2' class='gform_page' data-js='page-field-id-1' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_59_2' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_59_6\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">The person completing this form<\/h3><\/div><fieldset id=\"field_59_7\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Are you filling in this form for yourself or on behalf of someone else?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_7'>\n\t\t\t<div class='gchoice gchoice_59_7_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='I am filling in this form for myself'  id='choice_59_7_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_7_0' id='label_59_7_0' class='gform-field-label gform-field-label--type-inline'>I am filling in this form for myself<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_7_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_7' type='radio' value='I am filling in this form on behalf of someone else'  id='choice_59_7_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_7_1' id='label_59_7_1' class='gform-field-label gform-field-label--type-inline'>I am filling in this form on behalf of someone else<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_59_8' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_59_8' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_59_3' class='gform_page' data-js='page-field-id-8' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_59_3' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_59_9\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Declaration &#8211; filled in this form on behalf of someone else<\/h3><div class='gsection_description' id='gfield_description_59_9'><p>Please check the box below to confirm that you have read, understand and agree to the following statements before completing this form:<\/p>\n\n<ul>\n\t<li>As far as possible, I will confirm with the person claiming that the answers I will give on this form are correct and that the documents I will upload as proof are original copies and have not been edited in any way.<\/li>\n\t<li>I understand that if I give information that is false this could lead to a penalty or legal proceedings being taken against me.<\/li>\n\t<li>I understand my data may be shared with other departments as permitted by law.<\/li>\n<\/ul><\/div><\/div><fieldset id=\"field_59_11\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Declaration<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_59_11'><div class='gchoice gchoice_59_11_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_11.1' type='checkbox'  value='I understand and accept the above declaration'  id='choice_59_11_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_59_11_1' id='label_59_11_1' class='gform-field-label gform-field-label--type-inline'>I understand and accept the above declaration<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_12\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_12'><span class='gform-field-label__text'>I am filling in this form on behalf of<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_12' id='input_59_12' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_13\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_13'><span class='gform-field-label__text'>As they cannot fill in the form because<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_13' id='input_59_13' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_14\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_14'><span class='gform-field-label__text'>Full name of the person completing this form<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_14' id='input_59_14' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_15\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_15'><span class='gform-field-label__text'>Relationship to the person claiming<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_15' id='input_59_15' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_16\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_16'><span class='gform-field-label__text'>Contact email address or phone number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_59_16'>If we need to check any of the details given, we may need to contact you<\/div><div class='ginput_container ginput_container_text'><input name='input_16' id='input_59_16' type='text' value='' class='large'  aria-describedby=\"gfield_description_59_16\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_59_18' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_59_18' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_59_4' class='gform_page' data-js='page-field-id-18' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_59_4' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_59_19\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Declaration<\/h3><div class='gsection_description' id='gfield_description_59_19'><p>Please check the box below to confirm that you have read, understand and agree to the following statements before completing this form:<\/p>\n\n<ul>\n\t<li>I confirm the details I will give on this form will be correct and true.<\/li>\n\t<li>I confirm that I will notify you of any relevant changes straight away.<\/li>\n\t<li>I understand that if I give information that is false this could lead to a penalty or legal proceedings being taken against me.<\/li>\n\t<li>I understand my data may be shared with other departments as permitted by law.<\/li>\n\t<li>I understand that housing payments can only be made if I am currently getting either Housing Benefit or the housing costs element of Universal Credit, and that I must provide proof of this. I understand that if I&#8217;m not getting either of these benefits then my application may be refused.<\/li>\n<\/ul><\/div><\/div><fieldset id=\"field_59_21\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Declaration<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_59_21'><div class='gchoice gchoice_59_21_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_21.1' type='checkbox'  value='I understand and accept the above declaration'  id='choice_59_21_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_59_21_1' id='label_59_21_1' class='gform-field-label gform-field-label--type-inline'>I understand and accept the above declaration<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_59_22' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_59_22' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_59_5' class='gform_page' data-js='page-field-id-22' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_59_5' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_59_23\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">About you &#8211; claimant<\/h3><\/div><div id=\"field_59_24\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_24'><span class='gform-field-label__text'>Title (for example Mr, Mrs, Ms, Miss)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_24' id='input_59_24' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_25\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_25'><span class='gform-field-label__text'>First name<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_25' id='input_59_25' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_26\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_26'><span class='gform-field-label__text'>Last name(s)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_26' id='input_59_26' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_512\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_512'><span class='gform-field-label__text'>Contact phone number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_59_512'>We ask for your phone number so we can call you or send you important text messages (if we need to) about your claim<\/div><div class='ginput_container ginput_container_text'><input name='input_512' id='input_59_512' type='text' value='' class='large'  aria-describedby=\"gfield_description_59_512\"  placeholder='99999 999999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"99999 999999\"\/><\/div><\/div><fieldset id=\"field_59_37\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Email address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_59_37'>We will use your email address to send the receipt of your form, including the form reference number. This may include personal data. We will also use your email address to contact you about your benefit claim and Council Tax account.<\/div><div class='ginput_complex ginput_container ginput_container_email gform-grid-row' id='input_59_37_container'>\n                                <span id='input_59_37_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_59_37' class='gform-field-label gform-field-label--type-sub '>Enter email address<\/label>\n                                    <input class='' type='email' name='input_37' id='input_59_37' value=''    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_59_37\" \/>\n                                <\/span>\n                                <span id='input_59_37_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_59_37_2' class='gform-field-label gform-field-label--type-sub '>Confirm email address<\/label>\n                                    <input class='' type='email' name='input_37_2' id='input_59_37_2' value=''    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_59_37\" \/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><fieldset id=\"field_59_38\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to receive your Housing Benefit, Council Tax Support notifications and Council Tax bills by email?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_59_38'>You can receive your Housing Benefit, Council Tax Support notifications and Council Tax bills by email rather than post. We will send all future Housing Benefit and Council Tax Support notification letters and Council Tax bills to the email address you have given above. If you change your email address you must let us know straight away. You can opt out of this at any time at dover.gov.uk\/paperless<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_38'>\n\t\t\t<div class='gchoice gchoice_59_38_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Yes'  id='choice_59_38_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_59_38\"   \/>\n\t\t\t\t\t<label for='choice_59_38_0' id='label_59_38_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_38_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='No'  id='choice_59_38_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_38_1' id='label_59_38_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_28\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_28'><span class='gform-field-label__text'>Housing Benefit or Council Tax Support reference number (if known)<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_28' id='input_59_28' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_29\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_29'><span class='gform-field-label__text'>National Insurance number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_29' id='input_59_29' type='text' value='' class='large'    placeholder='aa999999a' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"aa999999a\"\/><\/div><\/div><fieldset id=\"field_59_30\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Date of birth<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_59_30' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_59_30_2_container'><label for='input_59_30_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Day<\/label><select name='input_30[]' id='input_59_30_2'   aria-required='true'  ><option value=''>Day<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_59_30_1_container'><label for='input_59_30_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Month<\/label><select name='input_30[]' id='input_59_30_1'   aria-required='true'  ><option value=''>Month<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_59_30_3_container'><label for='input_59_30_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Year<\/label><select name='input_30[]' id='input_59_30_3'   aria-required='true'  ><option value=''>Year<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><div id=\"field_59_513\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">About your address<\/h3><\/div><fieldset id=\"field_59_524\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend>    \n                    <div class='ginput_complex ginput_container has_street has_street2 has_city has_zip ginput_container_address gform-grid-row' id='input_59_524' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_59_524_1_container' >\n                                        <label for='input_59_524_1' id='input_59_524_1_label' class='gform-field-label gform-field-label--type-sub '>Address line 1<\/label>\n                                        <input type='text' name='input_524.1' id='input_59_524_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_59_524_2_container' >\n                                        <label for='input_59_524_2' id='input_59_524_2_label' class='gform-field-label gform-field-label--type-sub '>Address line 2<\/label>\n                                        <input type='text' name='input_524.2' id='input_59_524_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_59_524_3_container' >\n                                    <label for='input_59_524_3' id='input_59_524_3_label' class='gform-field-label gform-field-label--type-sub '>Town or city<\/label>\n                                    <input type='text' name='input_524.3' id='input_59_524_3' value=''    aria-required='true'    \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_524.4' id='input_59_524_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_59_524_5_container' >\n                                    <label for='input_59_524_5' id='input_59_524_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                    <input type='text' name='input_524.5' id='input_59_524_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_524.6' id='input_59_524_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_59_36\" class=\"gfield gfield--type-html gfield--input-type-html gfield--width-full gfield_html gfield_html_formatted gfield_no_follows_desc field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  >If you are applying for a housing payment to help with rent in advance or rent deposit, you will be asked for the address of the new property later.<\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_59_44' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_59_44' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_59_6' class='gform_page' data-js='page-field-id-44' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_59_6' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_59_45\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">About your landlord<\/h3><\/div><div id=\"field_59_46\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_46'><span class='gform-field-label__text'>Name of landlord<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_46' id='input_59_46' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_47\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_47'><span class='gform-field-label__text'>Landlord&#039;s address (including postcode)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_47' id='input_59_47' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_59_514\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_514'><span class='gform-field-label__text'>Landlord&#039;s phone number<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_514' id='input_59_514' type='text' value='' class='large'    placeholder='99999 999999'  aria-invalid=\"false\"   data-mask=\"99999 999999\"\/><\/div><\/div><div id=\"field_59_525\" class=\"gfield gfield--type-email gfield--input-type-email gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_525'><span class='gform-field-label__text'>Landlord&#039;s email address<\/span><\/label><div class='ginput_container ginput_container_email'>\n                            <input name='input_525' id='input_59_525' type='email' value='' class='large'     aria-invalid=\"false\"  \/>\n                        <\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_59_49' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_59_49' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_59_7' class='gform_page' data-js='page-field-id-49' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_59_7' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_59_50\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Reasons for applying<\/h3><\/div><fieldset id=\"field_59_51\" class=\"gfield gfield--type-checkbox gfield--type-choice gfield--input-type-checkbox gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Please select what are you applying for a housing payment for help with<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_checkbox'><div class='gfield_checkbox ' id='input_59_51'><div class='gchoice gchoice_59_51_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.1' type='checkbox'  value='Rent in advance'  id='choice_59_51_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_59_51_1' id='label_59_51_1' class='gform-field-label gform-field-label--type-inline'>Rent in advance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_59_51_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.2' type='checkbox'  value='Rent deposit'  id='choice_59_51_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_59_51_2' id='label_59_51_2' class='gform-field-label gform-field-label--type-inline'>Rent deposit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_59_51_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_51.3' type='checkbox'  value='Help with paying rent'  id='choice_59_51_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_59_51_3' id='label_59_51_3' class='gform-field-label gform-field-label--type-inline'>Help with paying rent<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_52\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">About the rent deposit<\/h3><\/div><div id=\"field_59_54\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_54'><span class='gform-field-label__text'>How much is the rent deposit?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_54' id='input_59_54' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_55\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_55'><span class='gform-field-label__text'>How is the deposit going to be protected?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_59_55'>By law your deposit must be secured in a deposit protection scheme. Please ask your new landlord or agent which scheme they are going to use.<\/div><div class='ginput_container ginput_container_text'><input name='input_55' id='input_59_55' type='text' value='' class='large'  aria-describedby=\"gfield_description_59_55\"   aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_56\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">About the rent in advance<\/h3><\/div><div id=\"field_59_57\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_57'><span class='gform-field-label__text'>How much is the rent in advance?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_59_57'>Please enter numbers only, no pound (\u00a3) sign<\/div><div class='ginput_container ginput_container_number'><input name='input_57' id='input_59_57' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_59_57\" \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_59_58' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_59_58' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_59_8' class='gform_page' data-js='page-field-id-58' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_59_8' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_59_59\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">About the property you want to move to<\/h3><\/div><div id=\"field_59_60\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_60'><span class='gform-field-label__text'>Address you want to move to including postcode<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_60' id='input_59_60' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_59_61\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Date you want to move in<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_59_61' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_59_61_2_container'><label for='input_59_61_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Day<\/label><select name='input_61[]' id='input_59_61_2'   aria-required='true'  ><option value=''>Day<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_59_61_1_container'><label for='input_59_61_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Month<\/label><select name='input_61[]' id='input_59_61_1'   aria-required='true'  ><option value=''>Month<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_59_61_3_container'><label for='input_59_61_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Year<\/label><select name='input_61[]' id='input_59_61_3'   aria-required='true'  ><option value=''>Year<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><fieldset id=\"field_59_62\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Date you viewed the property<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_59_62' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_59_62_2_container'><label for='input_59_62_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Day<\/label><select name='input_62[]' id='input_59_62_2'   aria-required='true'  ><option value=''>Day<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_59_62_1_container'><label for='input_59_62_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Month<\/label><select name='input_62[]' id='input_59_62_1'   aria-required='true'  ><option value=''>Month<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_59_62_3_container'><label for='input_59_62_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Year<\/label><select name='input_62[]' id='input_59_62_3'   aria-required='true'  ><option value=''>Year<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><div id=\"field_59_64\" class=\"gfield gfield--type-number gfield--input-type-number gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_64'><span class='gform-field-label__text'>How much will the rent be?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_59_64'>Please enter numbers only, no pound (\u00a3) sign<\/div><div class='ginput_container ginput_container_number'><input name='input_64' id='input_59_64' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_59_64\" \/><\/div><\/div><div id=\"field_59_65\" class=\"gfield gfield--type-select gfield--input-type-select gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_65'><span class='gform-field-label__text'>How often will this rent need to be paid?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_65' id='input_59_65' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Weekly' >Weekly<\/option><option value='Two-weekly' >Two-weekly<\/option><option value='Four-weekly' >Four-weekly<\/option><option value='Monthly' >Monthly<\/option><\/select><\/div><\/div><div id=\"field_59_66\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_66'><span class='gform-field-label__text'>Why do you need to move from your current property?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_66' id='input_59_66' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_59_67\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_67'><span class='gform-field-label__text'>If your application is being supported by the Housing Options department or another agency, for example Social Services, Porchlight or the Probation Service, please give details<\/span><\/label><div class='gfield_description' id='gfield_description_59_67'>For example the name of the agency and officer supporting your application.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_67' id='input_59_67' class='textarea medium'  aria-describedby=\"gfield_description_59_67\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_59_68' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_59_68' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_59_9' class='gform_page' data-js='page-field-id-68' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_59_9' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_59_69\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Reasons for applying &#8211; continued<\/h3><\/div><div id=\"field_59_70\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_70'><span class='gform-field-label__text'>Why do you need housing payments?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_70' id='input_59_70' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_59_71\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_71'><span class='gform-field-label__text'>What are you doing to improve your financial situation?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_71' id='input_59_71' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_59_72\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_72'><span class='gform-field-label__text'>A housing payment is a short-term award. Is anything likely to change in the near future that will allow you to meet the shortfall in your rent?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_72' id='input_59_72' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_59_73\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Were you aware of the amount of Housing Benefit that could be paid before you moved in?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_73'>\n\t\t\t<div class='gchoice gchoice_59_73_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='Yes'  id='choice_59_73_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_73_0' id='label_59_73_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_73_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_73' type='radio' value='No'  id='choice_59_73_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_73_1' id='label_59_73_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_74\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_74'><span class='gform-field-label__text'>What steps have you taken to find other suitable housing or reduce your rent?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_74' id='input_59_74' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_59_75\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_75'><span class='gform-field-label__text'>How is the property suitable for you and your family?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_59_75'>For example, has it been adapted if you have a disability, or has ground floor accommodation?<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_75' id='input_59_75' class='textarea medium'  aria-describedby=\"gfield_description_59_75\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_59_76\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_76'><span class='gform-field-label__text'>Have you or a family member any health problems, disabilities or special dietary needs?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_59_76'>If you have any additional expenses due to health reasons, please tell us here. Please upload any supporting evidence later in this form, for example medical certificates.<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_76' id='input_59_76' class='textarea medium'  aria-describedby=\"gfield_description_59_76\"   aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_59_120' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_59_120' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_59_10' class='gform_page' data-js='page-field-id-120' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_59_10' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_59_78\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">About your income<\/h3><div class='gsection_description' id='gfield_description_59_78'><div class='gfield_description' id='gfield_description'>Please list all the money coming into the household and select how often. This includes any income you and your partner receive and if any other adults living in the property contribute any money towards the household. If you get any income not listed, please give amounts using the &#8216;other income&#8217; option.<\/div><\/div><\/div><div id=\"field_59_79\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_79'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_79' id='input_59_79' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_80\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_80'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_80' id='input_59_80' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_85\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_85'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_85' id='input_59_85' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_354\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to add another type of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_354'>\n\t\t\t<div class='gchoice gchoice_59_354_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_354' type='radio' value='Yes'  id='choice_59_354_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_354_0' id='label_59_354_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_354_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_354' type='radio' value='No'  id='choice_59_354_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_354_1' id='label_59_354_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_355\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_93\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_93'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_93' id='input_59_93' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_94\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_94'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_94' id='input_59_94' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_95\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_95'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_95' id='input_59_95' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_356\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to add another type of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_356'>\n\t\t\t<div class='gchoice gchoice_59_356_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_356' type='radio' value='Yes'  id='choice_59_356_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_356_0' id='label_59_356_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_356_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_356' type='radio' value='No'  id='choice_59_356_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_356_1' id='label_59_356_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_357\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_135\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_135'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_135' id='input_59_135' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_136\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_136'><span class='gform-field-label__text'>Amount  paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_136' id='input_59_136' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_137\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_137'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_137' id='input_59_137' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_358\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to add another type of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_358'>\n\t\t\t<div class='gchoice gchoice_59_358_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_358' type='radio' value='Yes'  id='choice_59_358_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_358_0' id='label_59_358_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_358_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_358' type='radio' value='No'  id='choice_59_358_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_358_1' id='label_59_358_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_359\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_96\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_96'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_96' id='input_59_96' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_97\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_97'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_97' id='input_59_97' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_98\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_98'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_98' id='input_59_98' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_362\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to add another type of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_362'>\n\t\t\t<div class='gchoice gchoice_59_362_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_362' type='radio' value='Yes'  id='choice_59_362_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_362_0' id='label_59_362_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_362_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_362' type='radio' value='No'  id='choice_59_362_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_362_1' id='label_59_362_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_363\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_100\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_100'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_100' id='input_59_100' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_108\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_108'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_108' id='input_59_108' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_119\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_119'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_119' id='input_59_119' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_364\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to add another type of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_364'>\n\t\t\t<div class='gchoice gchoice_59_364_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_364' type='radio' value='Yes'  id='choice_59_364_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_364_0' id='label_59_364_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_364_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_364' type='radio' value='No'  id='choice_59_364_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_364_1' id='label_59_364_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_365\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_138\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_138'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_138' id='input_59_138' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_139\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_139'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_139' id='input_59_139' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_140\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_140'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_140' id='input_59_140' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_366\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to add another type of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_366'>\n\t\t\t<div class='gchoice gchoice_59_366_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_366' type='radio' value='Yes'  id='choice_59_366_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_366_0' id='label_59_366_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_366_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_366' type='radio' value='No'  id='choice_59_366_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_366_1' id='label_59_366_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_367\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_99\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_99'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_99' id='input_59_99' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_106\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_106'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_106' id='input_59_106' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_118\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_118'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_118' id='input_59_118' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_368\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to add another type of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_368'>\n\t\t\t<div class='gchoice gchoice_59_368_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_368' type='radio' value='Yes'  id='choice_59_368_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_368_0' id='label_59_368_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_368_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_368' type='radio' value='No'  id='choice_59_368_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_368_1' id='label_59_368_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_369\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_102\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_102'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_102' id='input_59_102' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_107\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_107'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_107' id='input_59_107' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_116\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_116'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_116' id='input_59_116' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_370\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to add another type of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_370'>\n\t\t\t<div class='gchoice gchoice_59_370_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_370' type='radio' value='Yes'  id='choice_59_370_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_370_0' id='label_59_370_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_370_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_370' type='radio' value='No'  id='choice_59_370_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_370_1' id='label_59_370_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_371\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_144\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_144'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_144' id='input_59_144' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_145\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_145'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_145' id='input_59_145' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_146\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_146'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_146' id='input_59_146' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_372\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to add another type of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_372'>\n\t\t\t<div class='gchoice gchoice_59_372_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_372' type='radio' value='Yes'  id='choice_59_372_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_372_0' id='label_59_372_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_372_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_372' type='radio' value='No'  id='choice_59_372_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_372_1' id='label_59_372_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_373\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_141\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_141'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_141' id='input_59_141' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_142\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_142'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_142' id='input_59_142' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_143\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_143'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_143' id='input_59_143' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_374\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to add another type of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_374'>\n\t\t\t<div class='gchoice gchoice_59_374_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_374' type='radio' value='Yes'  id='choice_59_374_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_374_0' id='label_59_374_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_374_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_374' type='radio' value='No'  id='choice_59_374_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_374_1' id='label_59_374_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_375\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_101\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_101'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_101' id='input_59_101' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_110\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_110'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_110' id='input_59_110' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_117\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_117'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_117' id='input_59_117' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_376\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to add another type of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_376'>\n\t\t\t<div class='gchoice gchoice_59_376_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_376' type='radio' value='Yes'  id='choice_59_376_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_376_0' id='label_59_376_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_376_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_376' type='radio' value='No'  id='choice_59_376_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_376_1' id='label_59_376_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_377\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_103\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_103'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_103' id='input_59_103' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_109\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_109'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_109' id='input_59_109' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_115\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_115'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_115' id='input_59_115' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_378\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to add another type of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_378'>\n\t\t\t<div class='gchoice gchoice_59_378_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_378' type='radio' value='Yes'  id='choice_59_378_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_378_0' id='label_59_378_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_378_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_378' type='radio' value='No'  id='choice_59_378_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_378_1' id='label_59_378_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_379\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_104\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_104'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_104' id='input_59_104' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_112\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_112'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_112' id='input_59_112' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_114\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_114'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_114' id='input_59_114' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_380\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to add another type of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_380'>\n\t\t\t<div class='gchoice gchoice_59_380_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_380' type='radio' value='Yes'  id='choice_59_380_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_380_0' id='label_59_380_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_380_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_380' type='radio' value='No'  id='choice_59_380_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_380_1' id='label_59_380_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_381\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_105\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_105'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_105' id='input_59_105' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_111\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_111'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_111' id='input_59_111' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_113\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_113'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_113' id='input_59_113' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_382\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to add another type of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_382'>\n\t\t\t<div class='gchoice gchoice_59_382_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_382' type='radio' value='Yes'  id='choice_59_382_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_382_0' id='label_59_382_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_382_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_382' type='radio' value='No'  id='choice_59_382_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_382_1' id='label_59_382_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_383\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_147\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_147'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_147' id='input_59_147' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_148\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_148'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_148' id='input_59_148' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_149\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_149'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_149' id='input_59_149' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_384\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to add another type of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_384'>\n\t\t\t<div class='gchoice gchoice_59_384_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_384' type='radio' value='Yes'  id='choice_59_384_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_384_0' id='label_59_384_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_384_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_384' type='radio' value='No'  id='choice_59_384_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_384_1' id='label_59_384_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_385\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_150\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_150'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_150' id='input_59_150' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_151\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_151'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_151' id='input_59_151' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_152\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_152'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_152' id='input_59_152' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_386\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Would you like to add another type of income?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_386'>\n\t\t\t<div class='gchoice gchoice_59_386_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_386' type='radio' value='Yes'  id='choice_59_386_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_386_0' id='label_59_386_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_386_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_386' type='radio' value='No'  id='choice_59_386_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_386_1' id='label_59_386_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_387\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_153\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_153'><span class='gform-field-label__text'>Income type<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_153' id='input_59_153' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Attendance Allowance' >Attendance Allowance<\/option><option value='Carer&#039;s Allowance' >Carer&#039;s Allowance<\/option><option value='Child Benefit' >Child Benefit<\/option><option value='Child Maintenance' >Child Maintenance<\/option><option value='Child Tax Credit' >Child Tax Credit<\/option><option value='Disability Living Allowance' >Disability Living Allowance<\/option><option value='Employment and Support Allowance' >Employment and Support Allowance<\/option><option value='Incapacity Benefit' >Incapacity Benefit<\/option><option value='Income Support' >Income Support<\/option><option value='Jobseeker&#039;s Allowance' >Jobseeker&#039;s Allowance<\/option><option value='Money paid to you by any other adults who live with you (not your partner)' >Money paid to you by any other adults who live with you (not your partner)<\/option><option value='Personal Independence Payment' >Personal Independence Payment<\/option><option value='Severe Disability Allowance' >Severe Disability Allowance<\/option><option value='Wages or salary' >Wages or salary<\/option><option value='Working Tax Credit' >Working Tax Credit<\/option><option value='Universal Credit' >Universal Credit<\/option><option value='Other income' >Other income<\/option><\/select><\/div><\/div><div id=\"field_59_154\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_154'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_154' id='input_59_154' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_155\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_155'><span class='gform-field-label__text'>How often<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_155' id='input_59_155' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every two weeks' >Every two weeks<\/option><option value='Every four weeks' >Every four weeks<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_353\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_122\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_122'><span class='gform-field-label__text'>If you have included &#039;other income&#039; as an option above, please give details about this other income<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_122' id='input_59_122' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_59_123' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_59_123' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_59_11' class='gform_page' data-js='page-field-id-123' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_59_11' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_59_124\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">About your outgoings<\/h3><div class='gsection_description' id='gfield_description_59_124'><div class='gfield_description' id='gfield_description'>Please list all of your household outgoings and select how often. If you have any outgoings not listed, please give amounts using the &#8216;other expense&#8217; option.<\/div><\/div><\/div><div id=\"field_59_428\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Priority outgoings<\/h3><\/div><div id=\"field_59_129\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_129'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_129' id='input_59_129' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Broadband \/ home phone' >Broadband \/ home phone<\/option><option value='Child maintenance' >Child maintenance<\/option><option value='Council Tax' >Council Tax<\/option><option value='Electricity' >Electricity<\/option><option value='Gas' >Gas<\/option><option value='Rent' >Rent<\/option><option value='TV licence' >TV licence<\/option><option value='Water rates' >Water rates<\/option><\/select><\/div><\/div><div id=\"field_59_130\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_130'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_130' id='input_59_130' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_128\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_128'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_128' id='input_59_128' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_272\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another priority outgoing?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_272'>\n\t\t\t<div class='gchoice gchoice_59_272_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_272' type='radio' value='Yes outgoing 2'  id='choice_59_272_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_272_0' id='label_59_272_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_272_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_272' type='radio' value='No'  id='choice_59_272_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_272_1' id='label_59_272_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_390\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_162\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_162'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_162' id='input_59_162' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Broadband \/ home phone' >Broadband \/ home phone<\/option><option value='Child maintenance' >Child maintenance<\/option><option value='Council Tax' >Council Tax<\/option><option value='Electricity' >Electricity<\/option><option value='Gas' >Gas<\/option><option value='Rent' >Rent<\/option><option value='TV licence' >TV licence<\/option><option value='Water rates' >Water rates<\/option><\/select><\/div><\/div><div id=\"field_59_166\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_166'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_166' id='input_59_166' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_179\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_179'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_179' id='input_59_179' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_273\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another priority outgoing?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_273'>\n\t\t\t<div class='gchoice gchoice_59_273_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_273' type='radio' value='Yes outgoing 3'  id='choice_59_273_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_273_0' id='label_59_273_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_273_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_273' type='radio' value='No'  id='choice_59_273_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_273_1' id='label_59_273_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_391\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_161\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_161'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_161' id='input_59_161' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Broadband \/ home phone' >Broadband \/ home phone<\/option><option value='Child maintenance' >Child maintenance<\/option><option value='Council Tax' >Council Tax<\/option><option value='Electricity' >Electricity<\/option><option value='Gas' >Gas<\/option><option value='Rent' >Rent<\/option><option value='TV licence' >TV licence<\/option><option value='Water rates' >Water rates<\/option><\/select><\/div><\/div><div id=\"field_59_167\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_167'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_167' id='input_59_167' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_178\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_178'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_178' id='input_59_178' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_275\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another priority outgoing?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_275'>\n\t\t\t<div class='gchoice gchoice_59_275_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_275' type='radio' value='Yes outgoing 3'  id='choice_59_275_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_275_0' id='label_59_275_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_275_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_275' type='radio' value='No'  id='choice_59_275_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_275_1' id='label_59_275_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_392\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_163\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_163'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_163' id='input_59_163' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Broadband \/ home phone' >Broadband \/ home phone<\/option><option value='Child maintenance' >Child maintenance<\/option><option value='Council Tax' >Council Tax<\/option><option value='Electricity' >Electricity<\/option><option value='Gas' >Gas<\/option><option value='Rent' >Rent<\/option><option value='TV licence' >TV licence<\/option><option value='Water rates' >Water rates<\/option><\/select><\/div><\/div><div id=\"field_59_171\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_171'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_171' id='input_59_171' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_177\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_177'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_177' id='input_59_177' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_393\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another priority outgoing?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_393'>\n\t\t\t<div class='gchoice gchoice_59_393_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_393' type='radio' value='Yes outgoing 3'  id='choice_59_393_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_393_0' id='label_59_393_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_393_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_393' type='radio' value='No'  id='choice_59_393_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_393_1' id='label_59_393_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_394\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_159\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_159'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_159' id='input_59_159' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Broadband \/ home phone' >Broadband \/ home phone<\/option><option value='Child maintenance' >Child maintenance<\/option><option value='Council Tax' >Council Tax<\/option><option value='Electricity' >Electricity<\/option><option value='Gas' >Gas<\/option><option value='Rent' >Rent<\/option><option value='TV licence' >TV licence<\/option><option value='Water rates' >Water rates<\/option><\/select><\/div><\/div><div id=\"field_59_169\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_169'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_169' id='input_59_169' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_176\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_176'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_176' id='input_59_176' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_395\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another priority outgoing?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_395'>\n\t\t\t<div class='gchoice gchoice_59_395_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_395' type='radio' value='Yes outgoing 3'  id='choice_59_395_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_395_0' id='label_59_395_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_395_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_395' type='radio' value='No'  id='choice_59_395_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_395_1' id='label_59_395_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_396\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_164\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_164'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_164' id='input_59_164' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Broadband \/ home phone' >Broadband \/ home phone<\/option><option value='Child maintenance' >Child maintenance<\/option><option value='Council Tax' >Council Tax<\/option><option value='Electricity' >Electricity<\/option><option value='Gas' >Gas<\/option><option value='Rent' >Rent<\/option><option value='TV licence' >TV licence<\/option><option value='Water rates' >Water rates<\/option><\/select><\/div><\/div><div id=\"field_59_168\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_168'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_168' id='input_59_168' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_175\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_175'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_175' id='input_59_175' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_397\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another priority outgoing?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_397'>\n\t\t\t<div class='gchoice gchoice_59_397_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_397' type='radio' value='Yes outgoing 3'  id='choice_59_397_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_397_0' id='label_59_397_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_397_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_397' type='radio' value='No'  id='choice_59_397_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_397_1' id='label_59_397_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_398\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_160\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_160'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_160' id='input_59_160' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Broadband \/ home phone' >Broadband \/ home phone<\/option><option value='Child maintenance' >Child maintenance<\/option><option value='Council Tax' >Council Tax<\/option><option value='Electricity' >Electricity<\/option><option value='Gas' >Gas<\/option><option value='Rent' >Rent<\/option><option value='TV licence' >TV licence<\/option><option value='Water rates' >Water rates<\/option><\/select><\/div><\/div><div id=\"field_59_170\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_170'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_170' id='input_59_170' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_174\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_174'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_174' id='input_59_174' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_399\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another priority outgoing?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_399'>\n\t\t\t<div class='gchoice gchoice_59_399_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_399' type='radio' value='Yes outgoing 3'  id='choice_59_399_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_399_0' id='label_59_399_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_399_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_399' type='radio' value='No'  id='choice_59_399_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_399_1' id='label_59_399_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_400\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_165\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_165'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_165' id='input_59_165' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Broadband \/ home phone' >Broadband \/ home phone<\/option><option value='Child maintenance' >Child maintenance<\/option><option value='Council Tax' >Council Tax<\/option><option value='Electricity' >Electricity<\/option><option value='Gas' >Gas<\/option><option value='Rent' >Rent<\/option><option value='TV licence' >TV licence<\/option><option value='Water rates' >Water rates<\/option><\/select><\/div><\/div><div id=\"field_59_172\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_172'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_172' id='input_59_172' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_173\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_173'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_173' id='input_59_173' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_427\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Normal household expenses<\/h3><\/div><div id=\"field_59_200\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_200'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_200' id='input_59_200' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Childcare costs' >Childcare costs<\/option><option value='Clothing' >Clothing<\/option><option value='Food (including household products and toiletries)' >Food (including household products and toiletries)<\/option><option value='Insurance - home' >Insurance &#8211; home<\/option><option value='Insurance - life' >Insurance &#8211; life<\/option><option value='Insurance - vehicle' >Insurance &#8211; vehicle<\/option><option value='Insurance - other' >Insurance &#8211; other<\/option><option value='Mobile phone' >Mobile phone<\/option><option value='Petrol or diesel' >Petrol or diesel<\/option><option value='Prescription costs' >Prescription costs<\/option><option value='Public transport' >Public transport<\/option><option value='School meals' >School meals<\/option><option value='Vehicle expenses' >Vehicle expenses<\/option><\/select><\/div><\/div><div id=\"field_59_201\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_201'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_201' id='input_59_201' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_202\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_202'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_202' id='input_59_202' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_401\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another normal household expense?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_401'>\n\t\t\t<div class='gchoice gchoice_59_401_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_401' type='radio' value='Yes outgoing 3'  id='choice_59_401_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_401_0' id='label_59_401_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_401_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_401' type='radio' value='No'  id='choice_59_401_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_401_1' id='label_59_401_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_403\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_215\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_215'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_215' id='input_59_215' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Childcare costs' >Childcare costs<\/option><option value='Clothing' >Clothing<\/option><option value='Food (including household products and toiletries)' >Food (including household products and toiletries)<\/option><option value='Insurance - home' >Insurance &#8211; home<\/option><option value='Insurance - life' >Insurance &#8211; life<\/option><option value='Insurance - vehicle' >Insurance &#8211; vehicle<\/option><option value='Insurance - other' >Insurance &#8211; other<\/option><option value='Mobile phone' >Mobile phone<\/option><option value='Petrol or diesel' >Petrol or diesel<\/option><option value='Prescription costs' >Prescription costs<\/option><option value='Public transport' >Public transport<\/option><option value='School meals' >School meals<\/option><option value='Vehicle expenses' >Vehicle expenses<\/option><\/select><\/div><\/div><div id=\"field_59_216\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_216'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_216' id='input_59_216' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_239\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_239'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_239' id='input_59_239' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_404\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another normal household expense?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_404'>\n\t\t\t<div class='gchoice gchoice_59_404_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_404' type='radio' value='Yes outgoing 3'  id='choice_59_404_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_404_0' id='label_59_404_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_404_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_404' type='radio' value='No'  id='choice_59_404_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_404_1' id='label_59_404_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_405\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_214\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_214'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_214' id='input_59_214' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Childcare costs' >Childcare costs<\/option><option value='Clothing' >Clothing<\/option><option value='Food (including household products and toiletries)' >Food (including household products and toiletries)<\/option><option value='Insurance - home' >Insurance &#8211; home<\/option><option value='Insurance - life' >Insurance &#8211; life<\/option><option value='Insurance - vehicle' >Insurance &#8211; vehicle<\/option><option value='Insurance - other' >Insurance &#8211; other<\/option><option value='Mobile phone' >Mobile phone<\/option><option value='Petrol or diesel' >Petrol or diesel<\/option><option value='Prescription costs' >Prescription costs<\/option><option value='Public transport' >Public transport<\/option><option value='School meals' >School meals<\/option><option value='Vehicle expenses' >Vehicle expenses<\/option><\/select><\/div><\/div><div id=\"field_59_217\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_217'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_217' id='input_59_217' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_228\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_228'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_228' id='input_59_228' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_406\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another normal household expense?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_406'>\n\t\t\t<div class='gchoice gchoice_59_406_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_406' type='radio' value='Yes outgoing 3'  id='choice_59_406_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_406_0' id='label_59_406_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_406_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_406' type='radio' value='No'  id='choice_59_406_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_406_1' id='label_59_406_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_407\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_213\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_213'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_213' id='input_59_213' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Childcare costs' >Childcare costs<\/option><option value='Clothing' >Clothing<\/option><option value='Food (including household products and toiletries)' >Food (including household products and toiletries)<\/option><option value='Insurance - home' >Insurance &#8211; home<\/option><option value='Insurance - life' >Insurance &#8211; life<\/option><option value='Insurance - vehicle' >Insurance &#8211; vehicle<\/option><option value='Insurance - other' >Insurance &#8211; other<\/option><option value='Mobile phone' >Mobile phone<\/option><option value='Petrol or diesel' >Petrol or diesel<\/option><option value='Prescription costs' >Prescription costs<\/option><option value='Public transport' >Public transport<\/option><option value='School meals' >School meals<\/option><option value='Vehicle expenses' >Vehicle expenses<\/option><\/select><\/div><\/div><div id=\"field_59_218\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_218'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_218' id='input_59_218' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_229\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_229'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_229' id='input_59_229' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_408\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another normal household expense?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_408'>\n\t\t\t<div class='gchoice gchoice_59_408_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_408' type='radio' value='Yes outgoing 3'  id='choice_59_408_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_408_0' id='label_59_408_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_408_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_408' type='radio' value='No'  id='choice_59_408_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_408_1' id='label_59_408_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_409\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_212\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_212'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_212' id='input_59_212' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Childcare costs' >Childcare costs<\/option><option value='Clothing' >Clothing<\/option><option value='Food (including household products and toiletries)' >Food (including household products and toiletries)<\/option><option value='Insurance - home' >Insurance &#8211; home<\/option><option value='Insurance - life' >Insurance &#8211; life<\/option><option value='Insurance - vehicle' >Insurance &#8211; vehicle<\/option><option value='Insurance - other' >Insurance &#8211; other<\/option><option value='Mobile phone' >Mobile phone<\/option><option value='Petrol or diesel' >Petrol or diesel<\/option><option value='Prescription costs' >Prescription costs<\/option><option value='Public transport' >Public transport<\/option><option value='School meals' >School meals<\/option><option value='Vehicle expenses' >Vehicle expenses<\/option><\/select><\/div><\/div><div id=\"field_59_219\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_219'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_219' id='input_59_219' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_230\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_230'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_230' id='input_59_230' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_410\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another normal household expense?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_410'>\n\t\t\t<div class='gchoice gchoice_59_410_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_410' type='radio' value='Yes outgoing 3'  id='choice_59_410_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_410_0' id='label_59_410_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_410_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_410' type='radio' value='No'  id='choice_59_410_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_410_1' id='label_59_410_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_411\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_211\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_211'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_211' id='input_59_211' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Childcare costs' >Childcare costs<\/option><option value='Clothing' >Clothing<\/option><option value='Food (including household products and toiletries)' >Food (including household products and toiletries)<\/option><option value='Insurance - home' >Insurance &#8211; home<\/option><option value='Insurance - life' >Insurance &#8211; life<\/option><option value='Insurance - vehicle' >Insurance &#8211; vehicle<\/option><option value='Insurance - other' >Insurance &#8211; other<\/option><option value='Mobile phone' >Mobile phone<\/option><option value='Petrol or diesel' >Petrol or diesel<\/option><option value='Prescription costs' >Prescription costs<\/option><option value='Public transport' >Public transport<\/option><option value='School meals' >School meals<\/option><option value='Vehicle expenses' >Vehicle expenses<\/option><\/select><\/div><\/div><div id=\"field_59_220\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_220'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_220' id='input_59_220' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_231\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_231'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_231' id='input_59_231' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_412\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another normal household expense?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_412'>\n\t\t\t<div class='gchoice gchoice_59_412_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_412' type='radio' value='Yes outgoing 3'  id='choice_59_412_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_412_0' id='label_59_412_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_412_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_412' type='radio' value='No'  id='choice_59_412_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_412_1' id='label_59_412_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_413\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_210\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_210'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_210' id='input_59_210' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Childcare costs' >Childcare costs<\/option><option value='Clothing' >Clothing<\/option><option value='Food (including household products and toiletries)' >Food (including household products and toiletries)<\/option><option value='Insurance - home' >Insurance &#8211; home<\/option><option value='Insurance - life' >Insurance &#8211; life<\/option><option value='Insurance - vehicle' >Insurance &#8211; vehicle<\/option><option value='Insurance - other' >Insurance &#8211; other<\/option><option value='Mobile phone' >Mobile phone<\/option><option value='Petrol or diesel' >Petrol or diesel<\/option><option value='Prescription costs' >Prescription costs<\/option><option value='Public transport' >Public transport<\/option><option value='School meals' >School meals<\/option><option value='Vehicle expenses' >Vehicle expenses<\/option><\/select><\/div><\/div><div id=\"field_59_221\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_221'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_221' id='input_59_221' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_232\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_232'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_232' id='input_59_232' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_414\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another normal household expense?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_414'>\n\t\t\t<div class='gchoice gchoice_59_414_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_414' type='radio' value='Yes outgoing 3'  id='choice_59_414_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_414_0' id='label_59_414_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_414_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_414' type='radio' value='No'  id='choice_59_414_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_414_1' id='label_59_414_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_415\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_209\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_209'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_209' id='input_59_209' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Childcare costs' >Childcare costs<\/option><option value='Clothing' >Clothing<\/option><option value='Food (including household products and toiletries)' >Food (including household products and toiletries)<\/option><option value='Insurance - home' >Insurance &#8211; home<\/option><option value='Insurance - life' >Insurance &#8211; life<\/option><option value='Insurance - vehicle' >Insurance &#8211; vehicle<\/option><option value='Insurance - other' >Insurance &#8211; other<\/option><option value='Mobile phone' >Mobile phone<\/option><option value='Petrol or diesel' >Petrol or diesel<\/option><option value='Prescription costs' >Prescription costs<\/option><option value='Public transport' >Public transport<\/option><option value='School meals' >School meals<\/option><option value='Vehicle expenses' >Vehicle expenses<\/option><\/select><\/div><\/div><div id=\"field_59_222\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_222'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_222' id='input_59_222' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_234\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_234'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_234' id='input_59_234' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_416\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another normal household expense?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_416'>\n\t\t\t<div class='gchoice gchoice_59_416_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_416' type='radio' value='Yes outgoing 3'  id='choice_59_416_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_416_0' id='label_59_416_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_416_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_416' type='radio' value='No'  id='choice_59_416_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_416_1' id='label_59_416_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_417\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_208\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_208'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_208' id='input_59_208' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Childcare costs' >Childcare costs<\/option><option value='Clothing' >Clothing<\/option><option value='Food (including household products and toiletries)' >Food (including household products and toiletries)<\/option><option value='Insurance - home' >Insurance &#8211; home<\/option><option value='Insurance - life' >Insurance &#8211; life<\/option><option value='Insurance - vehicle' >Insurance &#8211; vehicle<\/option><option value='Insurance - other' >Insurance &#8211; other<\/option><option value='Mobile phone' >Mobile phone<\/option><option value='Petrol or diesel' >Petrol or diesel<\/option><option value='Prescription costs' >Prescription costs<\/option><option value='Public transport' >Public transport<\/option><option value='School meals' >School meals<\/option><option value='Vehicle expenses' >Vehicle expenses<\/option><\/select><\/div><\/div><div id=\"field_59_227\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_227'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_227' id='input_59_227' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_233\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_233'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_233' id='input_59_233' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_418\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another normal household expense?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_418'>\n\t\t\t<div class='gchoice gchoice_59_418_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_418' type='radio' value='Yes outgoing 3'  id='choice_59_418_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_418_0' id='label_59_418_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_418_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_418' type='radio' value='No'  id='choice_59_418_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_418_1' id='label_59_418_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_419\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_207\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_207'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_207' id='input_59_207' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Childcare costs' >Childcare costs<\/option><option value='Clothing' >Clothing<\/option><option value='Food (including household products and toiletries)' >Food (including household products and toiletries)<\/option><option value='Insurance - home' >Insurance &#8211; home<\/option><option value='Insurance - life' >Insurance &#8211; life<\/option><option value='Insurance - vehicle' >Insurance &#8211; vehicle<\/option><option value='Insurance - other' >Insurance &#8211; other<\/option><option value='Mobile phone' >Mobile phone<\/option><option value='Petrol or diesel' >Petrol or diesel<\/option><option value='Prescription costs' >Prescription costs<\/option><option value='Public transport' >Public transport<\/option><option value='School meals' >School meals<\/option><option value='Vehicle expenses' >Vehicle expenses<\/option><\/select><\/div><\/div><div id=\"field_59_223\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_223'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_223' id='input_59_223' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_235\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_235'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_235' id='input_59_235' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_420\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another normal household expense?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_420'>\n\t\t\t<div class='gchoice gchoice_59_420_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_420' type='radio' value='Yes outgoing 3'  id='choice_59_420_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_420_0' id='label_59_420_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_420_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_420' type='radio' value='No'  id='choice_59_420_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_420_1' id='label_59_420_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_421\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_206\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_206'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_206' id='input_59_206' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Childcare costs' >Childcare costs<\/option><option value='Clothing' >Clothing<\/option><option value='Food (including household products and toiletries)' >Food (including household products and toiletries)<\/option><option value='Insurance - home' >Insurance &#8211; home<\/option><option value='Insurance - life' >Insurance &#8211; life<\/option><option value='Insurance - vehicle' >Insurance &#8211; vehicle<\/option><option value='Insurance - other' >Insurance &#8211; other<\/option><option value='Mobile phone' >Mobile phone<\/option><option value='Petrol or diesel' >Petrol or diesel<\/option><option value='Prescription costs' >Prescription costs<\/option><option value='Public transport' >Public transport<\/option><option value='School meals' >School meals<\/option><option value='Vehicle expenses' >Vehicle expenses<\/option><\/select><\/div><\/div><div id=\"field_59_224\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_224'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_224' id='input_59_224' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_237\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_237'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_237' id='input_59_237' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_422\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another normal household expense?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_422'>\n\t\t\t<div class='gchoice gchoice_59_422_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_422' type='radio' value='Yes outgoing 3'  id='choice_59_422_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_422_0' id='label_59_422_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_422_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_422' type='radio' value='No'  id='choice_59_422_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_422_1' id='label_59_422_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_423\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_205\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_205'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_205' id='input_59_205' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Childcare costs' >Childcare costs<\/option><option value='Clothing' >Clothing<\/option><option value='Food (including household products and toiletries)' >Food (including household products and toiletries)<\/option><option value='Insurance - home' >Insurance &#8211; home<\/option><option value='Insurance - life' >Insurance &#8211; life<\/option><option value='Insurance - vehicle' >Insurance &#8211; vehicle<\/option><option value='Insurance - other' >Insurance &#8211; other<\/option><option value='Mobile phone' >Mobile phone<\/option><option value='Petrol or diesel' >Petrol or diesel<\/option><option value='Prescription costs' >Prescription costs<\/option><option value='Public transport' >Public transport<\/option><option value='School meals' >School meals<\/option><option value='Vehicle expenses' >Vehicle expenses<\/option><\/select><\/div><\/div><div id=\"field_59_225\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_225'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_225' id='input_59_225' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_236\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_236'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_236' id='input_59_236' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_424\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another normal household expense?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_424'>\n\t\t\t<div class='gchoice gchoice_59_424_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_424' type='radio' value='Y'  id='choice_59_424_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_424_0' id='label_59_424_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_424_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_424' type='radio' value='No'  id='choice_59_424_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_424_1' id='label_59_424_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_425\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_204\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_204'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_204' id='input_59_204' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Childcare costs' >Childcare costs<\/option><option value='Clothing' >Clothing<\/option><option value='Food (including household products and toiletries)' >Food (including household products and toiletries)<\/option><option value='Insurance - home' >Insurance &#8211; home<\/option><option value='Insurance - life' >Insurance &#8211; life<\/option><option value='Insurance - vehicle' >Insurance &#8211; vehicle<\/option><option value='Insurance - other' >Insurance &#8211; other<\/option><option value='Mobile phone' >Mobile phone<\/option><option value='Petrol or diesel' >Petrol or diesel<\/option><option value='Prescription costs' >Prescription costs<\/option><option value='Public transport' >Public transport<\/option><option value='School meals' >School meals<\/option><option value='Vehicle expenses' >Vehicle expenses<\/option><\/select><\/div><\/div><div id=\"field_59_226\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_226'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_226' id='input_59_226' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_238\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_238'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_238' id='input_59_238' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_426\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Non-essential costs<\/h3><\/div><div id=\"field_59_132\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_132'><span class='gform-field-label__text'>Type of outgoing<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_132' id='input_59_132' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Cable or Sky TV' >Cable or Sky TV<\/option><option value='Cigarettes or vape \/ alcohol' >Cigarettes or vape \/ alcohol<\/option><option value='Eating out' >Eating out<\/option><option value='Gambling' >Gambling<\/option><option value='Leisure activities' >Leisure activities<\/option><option value='Lottery' >Lottery<\/option><option value='Other expense' >Other expense<\/option><\/select><\/div><\/div><div id=\"field_59_133\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_133'><span class='gform-field-label__text'>Amount paid<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_133' id='input_59_133' type='text' step='any'   value='' class='large'    placeholder='0.00'  aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_134\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_134'><span class='gform-field-label__text'>How often?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_134' id='input_59_134' class='large gfield_select'     aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_429\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another non-essential cost?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_429'>\n\t\t\t<div class='gchoice gchoice_59_429_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_429' type='radio' value='Yes outgoing 3'  id='choice_59_429_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_429_0' id='label_59_429_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_429_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_429' type='radio' value='No'  id='choice_59_429_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_429_1' id='label_59_429_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_430\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_197\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_197'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_197' id='input_59_197' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Cable or Sky TV' >Cable or Sky TV<\/option><option value='Cigarettes or vape \/ alcohol' >Cigarettes or vape \/ alcohol<\/option><option value='Eating out' >Eating out<\/option><option value='Gambling' >Gambling<\/option><option value='Leisure activities' >Leisure activities<\/option><option value='Lottery' >Lottery<\/option><option value='Other expense' >Other expense<\/option><\/select><\/div><\/div><div id=\"field_59_185\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_185'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_185' id='input_59_185' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_196\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_196'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_196' id='input_59_196' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_431\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another non-essential cost?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_431'>\n\t\t\t<div class='gchoice gchoice_59_431_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_431' type='radio' value='Yes outgoing 3'  id='choice_59_431_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_431_0' id='label_59_431_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_431_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_431' type='radio' value='No'  id='choice_59_431_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_431_1' id='label_59_431_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_432\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_182\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_182'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_182' id='input_59_182' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Cable or Sky TV' >Cable or Sky TV<\/option><option value='Cigarettes or vape \/ alcohol' >Cigarettes or vape \/ alcohol<\/option><option value='Eating out' >Eating out<\/option><option value='Gambling' >Gambling<\/option><option value='Leisure activities' >Leisure activities<\/option><option value='Lottery' >Lottery<\/option><option value='Other expense' >Other expense<\/option><\/select><\/div><\/div><div id=\"field_59_189\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_189'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_189' id='input_59_189' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_195\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_195'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_195' id='input_59_195' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_433\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another non-essential cost?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_433'>\n\t\t\t<div class='gchoice gchoice_59_433_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_433' type='radio' value='Yes outgoing 3'  id='choice_59_433_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_433_0' id='label_59_433_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_433_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_433' type='radio' value='No'  id='choice_59_433_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_433_1' id='label_59_433_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_434\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_184\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_184'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_184' id='input_59_184' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Cable or Sky TV' >Cable or Sky TV<\/option><option value='Cigarettes or vape \/ alcohol' >Cigarettes or vape \/ alcohol<\/option><option value='Eating out' >Eating out<\/option><option value='Gambling' >Gambling<\/option><option value='Leisure activities' >Leisure activities<\/option><option value='Lottery' >Lottery<\/option><option value='Other expense' >Other expense<\/option><\/select><\/div><\/div><div id=\"field_59_188\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_188'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_188' id='input_59_188' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_194\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_194'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_194' id='input_59_194' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_435\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another non-essential cost?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_435'>\n\t\t\t<div class='gchoice gchoice_59_435_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_435' type='radio' value='Yes outgoing 3'  id='choice_59_435_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_435_0' id='label_59_435_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_435_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_435' type='radio' value='No'  id='choice_59_435_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_435_1' id='label_59_435_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_436\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_180\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_180'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_180' id='input_59_180' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Cable or Sky TV' >Cable or Sky TV<\/option><option value='Cigarettes or vape \/ alcohol' >Cigarettes or vape \/ alcohol<\/option><option value='Eating out' >Eating out<\/option><option value='Gambling' >Gambling<\/option><option value='Leisure activities' >Leisure activities<\/option><option value='Lottery' >Lottery<\/option><option value='Other expense' >Other expense<\/option><\/select><\/div><\/div><div id=\"field_59_186\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_186'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_186' id='input_59_186' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_193\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_193'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_193' id='input_59_193' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_438\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another non-essential cost?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_438'>\n\t\t\t<div class='gchoice gchoice_59_438_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_438' type='radio' value='Yes outgoing 3'  id='choice_59_438_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_438_0' id='label_59_438_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_438_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_438' type='radio' value='No'  id='choice_59_438_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_438_1' id='label_59_438_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_439\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_181\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_181'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_181' id='input_59_181' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Cable or Sky TV' >Cable or Sky TV<\/option><option value='Cigarettes or vape \/ alcohol' >Cigarettes or vape \/ alcohol<\/option><option value='Eating out' >Eating out<\/option><option value='Gambling' >Gambling<\/option><option value='Leisure activities' >Leisure activities<\/option><option value='Lottery' >Lottery<\/option><option value='Other expense' >Other expense<\/option><\/select><\/div><\/div><div id=\"field_59_187\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_187'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_187' id='input_59_187' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_192\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_192'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_192' id='input_59_192' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><fieldset id=\"field_59_440\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add another non-essential cost?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_440'>\n\t\t\t<div class='gchoice gchoice_59_440_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_440' type='radio' value='Yes outgoing 3'  id='choice_59_440_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_440_0' id='label_59_440_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_440_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_440' type='radio' value='No'  id='choice_59_440_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_440_1' id='label_59_440_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_441\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_183\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_183'><span class='gform-field-label__text'>Type of outgoing<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_183' id='input_59_183' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Cable or Sky TV' >Cable or Sky TV<\/option><option value='Cigarettes or vape \/ alcohol' >Cigarettes or vape \/ alcohol<\/option><option value='Eating out' >Eating out<\/option><option value='Gambling' >Gambling<\/option><option value='Leisure activities' >Leisure activities<\/option><option value='Lottery' >Lottery<\/option><option value='Other expense' >Other expense<\/option><\/select><\/div><\/div><div id=\"field_59_190\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_190'><span class='gform-field-label__text'>Amount paid<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_190' id='input_59_190' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_191\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-third gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_191'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_191' id='input_59_191' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_437\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_198\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_198'><span class='gform-field-label__text'>If you have included &#039;insurance &#8211; other&#039; as an option above or have any other outgoings, please give details about these<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_198' id='input_59_198' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_59_203\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you have any outstanding loans or debts (including rent arrears)?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_203'>\n\t\t\t<div class='gchoice gchoice_59_203_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_203' type='radio' value='Yes'  id='choice_59_203_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_203_0' id='label_59_203_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_203_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_203' type='radio' value='No'  id='choice_59_203_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_203_1' id='label_59_203_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_59_240' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_59_240' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_59_12' class='gform_page' data-js='page-field-id-240' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_59_12' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_59_241\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">About your loans and debts<\/h3><div class='gsection_description' id='gfield_description_59_241'><div class='gfield_description' id='gfield_description'>Please list all of your loans and debts including the amount payable per week and the total amount you owe.<\/div><\/div><\/div><div id=\"field_59_280\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_280'><span class='gform-field-label__text'>Type of loan or debt<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_280' id='input_59_280' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Catalogue(s)' >Catalogue(s)<\/option><option value='Credit card 1' >Credit card 1<\/option><option value='Credit card 2' >Credit card 2<\/option><option value='Credit card 3' >Credit card 3<\/option><option value='Court fines' >Court fines<\/option><option value='Loan 1' >Loan 1<\/option><option value='Loan 2' >Loan 2<\/option><option value='Loan 3' >Loan 3<\/option><option value='Loans from friends \/ family' >Loans from friends \/ family<\/option><option value='Store card(s)' >Store card(s)<\/option><option value='Utility (for example gas, water, electricity) arrears' >Utility (for example gas, water, electricity) arrears<\/option><option value='Rent arrears' >Rent arrears<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_59_255\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_255'><span class='gform-field-label__text'>Amount payable<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_255' id='input_59_255' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_256\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_256'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_256' id='input_59_256' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_262\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_262'><span class='gform-field-label__text'>Total amount outstanding or owed<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_262' id='input_59_262' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_59_281\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you have another loan or debt?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_281'>\n\t\t\t<div class='gchoice gchoice_59_281_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_281' type='radio' value='Yes'  id='choice_59_281_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_281_0' id='label_59_281_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_281_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_281' type='radio' value='No'  id='choice_59_281_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_281_1' id='label_59_281_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_282\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_284\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_284'><span class='gform-field-label__text'>Type of loan or debt<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_284' id='input_59_284' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Catalogue(s)' >Catalogue(s)<\/option><option value='Credit card 1' >Credit card 1<\/option><option value='Credit card 2' >Credit card 2<\/option><option value='Credit card 3' >Credit card 3<\/option><option value='Court fines' >Court fines<\/option><option value='Loan 1' >Loan 1<\/option><option value='Loan 2' >Loan 2<\/option><option value='Loan 3' >Loan 3<\/option><option value='Loans from friends \/ family' >Loans from friends \/ family<\/option><option value='Store card(s)' >Store card(s)<\/option><option value='Utility (for example gas, water, electricity) arrears' >Utility (for example gas, water, electricity) arrears<\/option><option value='Rent arrears' >Rent arrears<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_59_260\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_260'><span class='gform-field-label__text'>Amount payable<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_260' id='input_59_260' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_261\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_261'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_261' id='input_59_261' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_268\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_268'><span class='gform-field-label__text'>Total amount outstanding or owed<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_268' id='input_59_268' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_59_283\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you have another loan or debt?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_283'>\n\t\t\t<div class='gchoice gchoice_59_283_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_283' type='radio' value='Yes'  id='choice_59_283_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_283_0' id='label_59_283_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_283_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_283' type='radio' value='No'  id='choice_59_283_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_283_1' id='label_59_283_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_290\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_286\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_286'><span class='gform-field-label__text'>Type of loan or debt<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_286' id='input_59_286' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Catalogue(s)' >Catalogue(s)<\/option><option value='Credit card 1' >Credit card 1<\/option><option value='Credit card 2' >Credit card 2<\/option><option value='Credit card 3' >Credit card 3<\/option><option value='Court fines' >Court fines<\/option><option value='Loan 1' >Loan 1<\/option><option value='Loan 2' >Loan 2<\/option><option value='Loan 3' >Loan 3<\/option><option value='Loans from friends \/ family' >Loans from friends \/ family<\/option><option value='Store card(s)' >Store card(s)<\/option><option value='Utility (for example gas, water, electricity) arrears' >Utility (for example gas, water, electricity) arrears<\/option><option value='Rent arrears' >Rent arrears<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_59_267\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_267'><span class='gform-field-label__text'>Amount payable<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_267' id='input_59_267' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_265\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_265'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_265' id='input_59_265' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_257\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_257'><span class='gform-field-label__text'>Total amount outstanding or owed<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_257' id='input_59_257' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_59_289\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you have another loan or debt?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_289'>\n\t\t\t<div class='gchoice gchoice_59_289_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_289' type='radio' value='Yes'  id='choice_59_289_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_289_0' id='label_59_289_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_289_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_289' type='radio' value='No'  id='choice_59_289_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_289_1' id='label_59_289_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_291\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_292\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_292'><span class='gform-field-label__text'>Type of loan or debt<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_292' id='input_59_292' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Catalogue(s)' >Catalogue(s)<\/option><option value='Credit card 1' >Credit card 1<\/option><option value='Credit card 2' >Credit card 2<\/option><option value='Credit card 3' >Credit card 3<\/option><option value='Court fines' >Court fines<\/option><option value='Loan 1' >Loan 1<\/option><option value='Loan 2' >Loan 2<\/option><option value='Loan 3' >Loan 3<\/option><option value='Loans from friends \/ family' >Loans from friends \/ family<\/option><option value='Store card(s)' >Store card(s)<\/option><option value='Utility (for example gas, water, electricity) arrears' >Utility (for example gas, water, electricity) arrears<\/option><option value='Rent arrears' >Rent arrears<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_59_293\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_293'><span class='gform-field-label__text'>Amount payable<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_293' id='input_59_293' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_294\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_294'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_294' id='input_59_294' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_295\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_295'><span class='gform-field-label__text'>Total amount outstanding or owed<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_295' id='input_59_295' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_59_296\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you have another loan or debt?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_296'>\n\t\t\t<div class='gchoice gchoice_59_296_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_296' type='radio' value='Yes'  id='choice_59_296_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_296_0' id='label_59_296_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_296_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_296' type='radio' value='No'  id='choice_59_296_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_296_1' id='label_59_296_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_297\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_298\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_298'><span class='gform-field-label__text'>Type of loan or debt<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_298' id='input_59_298' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Catalogue(s)' >Catalogue(s)<\/option><option value='Credit card 1' >Credit card 1<\/option><option value='Credit card 2' >Credit card 2<\/option><option value='Credit card 3' >Credit card 3<\/option><option value='Court fines' >Court fines<\/option><option value='Loan 1' >Loan 1<\/option><option value='Loan 2' >Loan 2<\/option><option value='Loan 3' >Loan 3<\/option><option value='Loans from friends \/ family' >Loans from friends \/ family<\/option><option value='Store card(s)' >Store card(s)<\/option><option value='Utility (for example gas, water, electricity) arrears' >Utility (for example gas, water, electricity) arrears<\/option><option value='Rent arrears' >Rent arrears<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_59_518\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_518'><span class='gform-field-label__text'>Amount payable<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_518' id='input_59_518' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_300\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_300'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_300' id='input_59_300' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_301\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_301'><span class='gform-field-label__text'>Total amount outstanding or owed<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_301' id='input_59_301' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_59_302\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you have another loan or debt?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_302'>\n\t\t\t<div class='gchoice gchoice_59_302_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_302' type='radio' value='Yes'  id='choice_59_302_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_302_0' id='label_59_302_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_302_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_302' type='radio' value='No'  id='choice_59_302_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_302_1' id='label_59_302_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_303\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_304\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_304'><span class='gform-field-label__text'>Type of loan or debt<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_304' id='input_59_304' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Catalogue(s)' >Catalogue(s)<\/option><option value='Credit card 1' >Credit card 1<\/option><option value='Credit card 2' >Credit card 2<\/option><option value='Credit card 3' >Credit card 3<\/option><option value='Court fines' >Court fines<\/option><option value='Loan 1' >Loan 1<\/option><option value='Loan 2' >Loan 2<\/option><option value='Loan 3' >Loan 3<\/option><option value='Loans from friends \/ family' >Loans from friends \/ family<\/option><option value='Store card(s)' >Store card(s)<\/option><option value='Utility (for example gas, water, electricity) arrears' >Utility (for example gas, water, electricity) arrears<\/option><option value='Rent arrears' >Rent arrears<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_59_305\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_305'><span class='gform-field-label__text'>Amount payable<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_305' id='input_59_305' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_306\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_306'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_306' id='input_59_306' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_307\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_307'><span class='gform-field-label__text'>Total amount outstanding or owed<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_307' id='input_59_307' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_59_308\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you have another loan or debt?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_308'>\n\t\t\t<div class='gchoice gchoice_59_308_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_308' type='radio' value='Yes'  id='choice_59_308_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_308_0' id='label_59_308_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_308_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_308' type='radio' value='No'  id='choice_59_308_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_308_1' id='label_59_308_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_309\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_310\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_310'><span class='gform-field-label__text'>Type of loan or debt<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_310' id='input_59_310' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Catalogue(s)' >Catalogue(s)<\/option><option value='Credit card 1' >Credit card 1<\/option><option value='Credit card 2' >Credit card 2<\/option><option value='Credit card 3' >Credit card 3<\/option><option value='Court fines' >Court fines<\/option><option value='Loan 1' >Loan 1<\/option><option value='Loan 2' >Loan 2<\/option><option value='Loan 3' >Loan 3<\/option><option value='Loans from friends \/ family' >Loans from friends \/ family<\/option><option value='Store card(s)' >Store card(s)<\/option><option value='Utility (for example gas, water, electricity) arrears' >Utility (for example gas, water, electricity) arrears<\/option><option value='Rent arrears' >Rent arrears<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_59_311\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_311'><span class='gform-field-label__text'>Amount payable<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_311' id='input_59_311' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_312\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_312'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_312' id='input_59_312' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_313\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_313'><span class='gform-field-label__text'>Total amount outstanding or owed<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_313' id='input_59_313' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_59_314\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you have another loan or debt?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_314'>\n\t\t\t<div class='gchoice gchoice_59_314_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_314' type='radio' value='Yes'  id='choice_59_314_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_314_0' id='label_59_314_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_314_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_314' type='radio' value='No'  id='choice_59_314_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_314_1' id='label_59_314_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_315\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_316\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_316'><span class='gform-field-label__text'>Type of loan or debt<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_316' id='input_59_316' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Catalogue(s)' >Catalogue(s)<\/option><option value='Credit card 1' >Credit card 1<\/option><option value='Credit card 2' >Credit card 2<\/option><option value='Credit card 3' >Credit card 3<\/option><option value='Court fines' >Court fines<\/option><option value='Loan 1' >Loan 1<\/option><option value='Loan 2' >Loan 2<\/option><option value='Loan 3' >Loan 3<\/option><option value='Loans from friends \/ family' >Loans from friends \/ family<\/option><option value='Store card(s)' >Store card(s)<\/option><option value='Utility (for example gas, water, electricity) arrears' >Utility (for example gas, water, electricity) arrears<\/option><option value='Rent arrears' >Rent arrears<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_59_317\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_317'><span class='gform-field-label__text'>Amount payable<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_317' id='input_59_317' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_318\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_318'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_318' id='input_59_318' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_319\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_319'><span class='gform-field-label__text'>Total amount outstanding or owed<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_319' id='input_59_319' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_59_320\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you have another loan or debt?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_320'>\n\t\t\t<div class='gchoice gchoice_59_320_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_320' type='radio' value='Yes'  id='choice_59_320_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_320_0' id='label_59_320_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_320_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_320' type='radio' value='No'  id='choice_59_320_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_320_1' id='label_59_320_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_321\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_322\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_322'><span class='gform-field-label__text'>Type of loan or debt<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_322' id='input_59_322' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Catalogue(s)' >Catalogue(s)<\/option><option value='Credit card 1' >Credit card 1<\/option><option value='Credit card 2' >Credit card 2<\/option><option value='Credit card 3' >Credit card 3<\/option><option value='Court fines' >Court fines<\/option><option value='Loan 1' >Loan 1<\/option><option value='Loan 2' >Loan 2<\/option><option value='Loan 3' >Loan 3<\/option><option value='Loans from friends \/ family' >Loans from friends \/ family<\/option><option value='Store card(s)' >Store card(s)<\/option><option value='Utility (for example gas, water, electricity) arrears' >Utility (for example gas, water, electricity) arrears<\/option><option value='Rent arrears' >Rent arrears<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_59_323\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_323'><span class='gform-field-label__text'>Amount payable<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_323' id='input_59_323' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_324\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_324'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_324' id='input_59_324' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_325\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_325'><span class='gform-field-label__text'>Total amount outstanding or owed<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_325' id='input_59_325' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_59_326\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you have another loan or debt?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_326'>\n\t\t\t<div class='gchoice gchoice_59_326_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_326' type='radio' value='Yes'  id='choice_59_326_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_326_0' id='label_59_326_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_326_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_326' type='radio' value='No'  id='choice_59_326_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_326_1' id='label_59_326_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_327\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_328\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_328'><span class='gform-field-label__text'>Type of loan or debt<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_328' id='input_59_328' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Catalogue(s)' >Catalogue(s)<\/option><option value='Credit card 1' >Credit card 1<\/option><option value='Credit card 2' >Credit card 2<\/option><option value='Credit card 3' >Credit card 3<\/option><option value='Court fines' >Court fines<\/option><option value='Loan 1' >Loan 1<\/option><option value='Loan 2' >Loan 2<\/option><option value='Loan 3' >Loan 3<\/option><option value='Loans from friends \/ family' >Loans from friends \/ family<\/option><option value='Store card(s)' >Store card(s)<\/option><option value='Utility (for example gas, water, electricity) arrears' >Utility (for example gas, water, electricity) arrears<\/option><option value='Rent arrears' >Rent arrears<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_59_329\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_329'><span class='gform-field-label__text'>Amount payable<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_329' id='input_59_329' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_330\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_330'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_330' id='input_59_330' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_331\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_331'><span class='gform-field-label__text'>Total amount outstanding or owed<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_331' id='input_59_331' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_59_332\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you have another loan or debt?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_332'>\n\t\t\t<div class='gchoice gchoice_59_332_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_332' type='radio' value='Yes'  id='choice_59_332_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_332_0' id='label_59_332_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_332_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_332' type='radio' value='No'  id='choice_59_332_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_332_1' id='label_59_332_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_333\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_334\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_334'><span class='gform-field-label__text'>Type of loan or debt<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_334' id='input_59_334' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Catalogue(s)' >Catalogue(s)<\/option><option value='Credit card 1' >Credit card 1<\/option><option value='Credit card 2' >Credit card 2<\/option><option value='Credit card 3' >Credit card 3<\/option><option value='Court fines' >Court fines<\/option><option value='Loan 1' >Loan 1<\/option><option value='Loan 2' >Loan 2<\/option><option value='Loan 3' >Loan 3<\/option><option value='Loans from friends \/ family' >Loans from friends \/ family<\/option><option value='Store card(s)' >Store card(s)<\/option><option value='Utility (for example gas, water, electricity) arrears' >Utility (for example gas, water, electricity) arrears<\/option><option value='Rent arrears' >Rent arrears<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_59_335\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_335'><span class='gform-field-label__text'>Amount payable<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_335' id='input_59_335' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_336\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_336'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_336' id='input_59_336' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_337\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_337'><span class='gform-field-label__text'>Total amount outstanding or owed<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_337' id='input_59_337' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_59_338\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you have another loan or debt?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_338'>\n\t\t\t<div class='gchoice gchoice_59_338_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_338' type='radio' value='Yes'  id='choice_59_338_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_338_0' id='label_59_338_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_338_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_338' type='radio' value='No'  id='choice_59_338_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_338_1' id='label_59_338_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_339\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_340\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_340'><span class='gform-field-label__text'>Type of loan or debt<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_340' id='input_59_340' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Catalogue(s)' >Catalogue(s)<\/option><option value='Credit card 1' >Credit card 1<\/option><option value='Credit card 2' >Credit card 2<\/option><option value='Credit card 3' >Credit card 3<\/option><option value='Court fines' >Court fines<\/option><option value='Loan 1' >Loan 1<\/option><option value='Loan 2' >Loan 2<\/option><option value='Loan 3' >Loan 3<\/option><option value='Loans from friends \/ family' >Loans from friends \/ family<\/option><option value='Store card(s)' >Store card(s)<\/option><option value='Utility (for example gas, water, electricity) arrears' >Utility (for example gas, water, electricity) arrears<\/option><option value='Rent arrears' >Rent arrears<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_59_341\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_341'><span class='gform-field-label__text'>Amount payable<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_341' id='input_59_341' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_342\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_342'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_342' id='input_59_342' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_343\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_343'><span class='gform-field-label__text'>Total amount outstanding or owed<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_343' id='input_59_343' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_59_344\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Do you have another loan or debt?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_344'>\n\t\t\t<div class='gchoice gchoice_59_344_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_344' type='radio' value='Yes'  id='choice_59_344_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_344_0' id='label_59_344_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_344_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_344' type='radio' value='No'  id='choice_59_344_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_344_1' id='label_59_344_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_345\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_346\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_346'><span class='gform-field-label__text'>Type of loan or debt<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_346' id='input_59_346' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Catalogue(s)' >Catalogue(s)<\/option><option value='Credit card 1' >Credit card 1<\/option><option value='Credit card 2' >Credit card 2<\/option><option value='Credit card 3' >Credit card 3<\/option><option value='Court fines' >Court fines<\/option><option value='Loan 1' >Loan 1<\/option><option value='Loan 2' >Loan 2<\/option><option value='Loan 3' >Loan 3<\/option><option value='Loans from friends \/ family' >Loans from friends \/ family<\/option><option value='Store card(s)' >Store card(s)<\/option><option value='Utility (for example gas, water, electricity) arrears' >Utility (for example gas, water, electricity) arrears<\/option><option value='Rent arrears' >Rent arrears<\/option><option value='Other' >Other<\/option><\/select><\/div><\/div><div id=\"field_59_347\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_347'><span class='gform-field-label__text'>Amount payable<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_347' id='input_59_347' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_348\" class=\"gfield gfield--type-select gfield--input-type-select gfield--width-half gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_348'><span class='gform-field-label__text'>How often?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_348' id='input_59_348' class='large gfield_select'    aria-required=\"true\" aria-invalid=\"false\" ><option value='' selected='selected' class='gf_placeholder'>Please select&#8230;<\/option><option value='Every week' >Every week<\/option><option value='Every month' >Every month<\/option><\/select><\/div><\/div><div id=\"field_59_349\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_349'><span class='gform-field-label__text'>Total amount outstanding or owed<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_349' id='input_59_349' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_59_352\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\"><\/h3><\/div><div id=\"field_59_350\" class=\"gfield gfield--type-textarea gfield--input-type-textarea field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_350'><span class='gform-field-label__text'>What steps have you taken to reduce the amounts owed?<\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_350' id='input_59_350' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_59_351\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_59_351'><span class='gform-field-label__text'>Please upload proof of these debts<\/span><\/label><div class='gfield_description' id='gfield_description_59_351'>You can upload up to five documents. Each document should be no bigger than 2MB. If you have more documents to upload, you can do so later in the form<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_59_351' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_59_351&quot;,&quot;container&quot;:&quot;gform_multifile_upload_59_351&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_59_351&quot;,&quot;filelist&quot;:&quot;gform_preview_59_351&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/partnershipone.com\\\/DDC\\\/?gf_page=cd67508b2a8ca4d&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/partnershipone.com\\\/DDC\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/partnershipone.com\\\/DDC\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;txt,pdf,doc,docx,rtf,jpg,jpeg,tif,tiff,bmp,png,xls,xlsx&quot;}],&quot;max_file_size&quot;:&quot;15728640b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:59,&quot;field_id&quot;:351,&quot;_gform_file_upload_nonce_59_351&quot;:&quot;a2ac86661a&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;5&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_59_351&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_59_351' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_59_351' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_59_351 gfield_description_59_351\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_59_351'>Accepted file types: txt, pdf, doc, docx, rtf, jpg, jpeg, tif, tiff, bmp, png, xls, xlsx, Max. file size: 15 MB, Max. files: 5.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_59_351'><\/ul> <div id='gform_preview_59_351' class='ginput_preview_list'><\/div><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_59_442' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_59_442' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_59_13' class='gform_page' data-js='page-field-id-442' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_59_13' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_59_445\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Proof for your application<\/h3><div class='gsection_description' id='gfield_description_59_445'>You need to provide proof of your bank, building society or Post Office accounts and of all your income and outgoings. You can upload these to this form now or you can send them later but we won&#8217;t process your application until we have received your proof.<\/div><\/div><fieldset id=\"field_59_447\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Will you upload your proof now or within the next two weeks?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='gfield_description' id='gfield_description_59_447'>You must send your proof within the next two weeks otherwise we will cancel your application and you will need to reapply, if you wish to do so.\u00a0<\/div><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_447'>\n\t\t\t<div class='gchoice gchoice_59_447_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_447' type='radio' value='I will upload my proof to this form now'  id='choice_59_447_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_59_447\"   \/>\n\t\t\t\t\t<label for='choice_59_447_0' id='label_59_447_0' class='gform-field-label gform-field-label--type-inline'>I will upload my proof to this form now<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_447_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_447' type='radio' value='I can&#039;t upload my proof to this form now, I&#039;ll send it within the next two weeks'  id='choice_59_447_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_447_1' id='label_59_447_1' class='gform-field-label gform-field-label--type-inline'>I can&#8217;t upload my proof to this form now, I&#8217;ll send it within the next two weeks<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_448\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Upload proof for your application<\/h3><\/div><div id=\"field_59_449\" class=\"gfield gfield--type-fileupload gfield--input-type-fileupload gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='gform_browse_button_59_449'><span class='gform-field-label__text'>Upload up to five documents<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_59_449'>You can upload up to five documents. Each document should be no bigger than 2MB. We&#8217;ll give you a link at the end of this form to upload more documents, if you need to.<\/div><div class='ginput_container ginput_container_fileupload'><div id='gform_multifile_upload_59_449' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_59_449&quot;,&quot;container&quot;:&quot;gform_multifile_upload_59_449&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_59_449&quot;,&quot;filelist&quot;:&quot;gform_preview_59_449&quot;,&quot;unique_names&quot;:true,&quot;file_data_name&quot;:&quot;file&quot;,&quot;url&quot;:&quot;https:\\\/\\\/partnershipone.com\\\/DDC\\\/?gf_page=cd67508b2a8ca4d&quot;,&quot;flash_swf_url&quot;:&quot;https:\\\/\\\/partnershipone.com\\\/DDC\\\/wp-includes\\\/js\\\/plupload\\\/plupload.flash.swf&quot;,&quot;silverlight_xap_url&quot;:&quot;https:\\\/\\\/partnershipone.com\\\/DDC\\\/wp-includes\\\/js\\\/plupload\\\/plupload.silverlight.xap&quot;,&quot;filters&quot;:{&quot;mime_types&quot;:[{&quot;title&quot;:&quot;Allowed Files&quot;,&quot;extensions&quot;:&quot;txt,pdf,doc,docx,rtf,jpg,jpeg,tif,tiff,bmp,png,xls,xlsx&quot;}],&quot;max_file_size&quot;:&quot;15728640b&quot;},&quot;multipart&quot;:true,&quot;urlstream_upload&quot;:false,&quot;multipart_params&quot;:{&quot;form_id&quot;:59,&quot;field_id&quot;:449,&quot;_gform_file_upload_nonce_59_449&quot;:&quot;733523e3d8&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;5&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_59_449&quot;,&quot;disallowed_extensions&quot;:[&quot;php&quot;,&quot;asp&quot;,&quot;aspx&quot;,&quot;cmd&quot;,&quot;csh&quot;,&quot;bat&quot;,&quot;html&quot;,&quot;htm&quot;,&quot;hta&quot;,&quot;jar&quot;,&quot;exe&quot;,&quot;com&quot;,&quot;js&quot;,&quot;lnk&quot;,&quot;htaccess&quot;,&quot;phar&quot;,&quot;phtml&quot;,&quot;ps1&quot;,&quot;ps2&quot;,&quot;php3&quot;,&quot;php4&quot;,&quot;php5&quot;,&quot;php6&quot;,&quot;py&quot;,&quot;rb&quot;,&quot;tmp&quot;]}}' class='gform_fileupload_multifile'>\n\t\t\t\t\t\t\t\t\t\t<div id='gform_drag_drop_area_59_449' class='gform_drop_area gform-theme-field-control'>\n\t\t\t\t\t\t\t\t\t\t\t<span class='gform_drop_instructions'>Drop files here or <\/span>\n\t\t\t\t\t\t\t\t\t\t\t<button type='button' id='gform_browse_button_59_449' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_59_449 gfield_description_59_449\"  >Select files<\/button>\n\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t\t<\/div><span class='gfield_description gform_fileupload_rules' id='gfield_upload_rules_59_449'>Accepted file types: txt, pdf, doc, docx, rtf, jpg, jpeg, tif, tiff, bmp, png, xls, xlsx, Max. file size: 15 MB, Max. files: 5.<\/span><ul class='validation_message--hidden-on-empty gform-ul-reset' id='gform_multifile_messages_59_449'><\/ul> <div id='gform_preview_59_449' class='ginput_preview_list'><\/div><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_59_450' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_59_450' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_59_14' class='gform_page' data-js='page-field-id-450' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_59_14' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_59_451\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Universal Credit<\/h3><\/div><fieldset id=\"field_59_452\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Are you getting or have you applied for Universal Credit?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_452'>\n\t\t\t<div class='gchoice gchoice_59_452_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_452' type='radio' value='Yes'  id='choice_59_452_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_452_0' id='label_59_452_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_452_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_452' type='radio' value='No'  id='choice_59_452_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_452_1' id='label_59_452_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_453\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Additional information for Universal Credit claimants<\/h3><\/div><fieldset id=\"field_59_520\" class=\"gfield gfield--type-list gfield--input-type-list gfield--width-full field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label gfield_label_before_complex' ><span class='gform-field-label__text'>Please tell us all the people who live with you<\/span><\/legend><div class='gfield_description' id='gfield_description_59_520'>Click on the + sign at the end of the row to add a new person<\/div><div class='ginput_container ginput_container_list ginput_list ginput_container_list--columns'><div class='gfield_list gfield_list_container'><div class=\"gfield_list_header gform-grid-row\"><div class=\"gform-field-label gfield_header_item gform-grid-col\">First name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Last name<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Date of birth (dd\/mm\/yy)<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Sex of child<\/div><div class=\"gform-field-label gfield_header_item gform-grid-col\">Relationship to you<\/div><div class=\"gfield_header_item gfield_header_item--icons gform-grid-col\">&nbsp;<\/div><\/div><div class=\"gfield_list_groups\"><div class='gfield_list_row_odd gfield_list_group gform-grid-row'><div class='gfield_list_group_item gfield_list_cell gfield_list_520_cell1 gform-grid-col' data-label='First name'><input aria-invalid='false'  aria-describedby=\"gfield_description_59_520\" aria-label='First name, Row 1' data-aria-label-template='First name, Row {0}' type='text' name='input_520[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_520_cell2 gform-grid-col' data-label='Last name'><input aria-invalid='false'  aria-describedby=\"gfield_description_59_520\" aria-label='Last name, Row 1' data-aria-label-template='Last name, Row {0}' type='text' name='input_520[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_520_cell3 gform-grid-col' data-label='Date of birth (dd\/mm\/yy)'><input aria-invalid='false'  aria-describedby=\"gfield_description_59_520\" aria-label='Date of birth (dd\/mm\/yy), Row 1' data-aria-label-template='Date of birth (dd\/mm\/yy), Row {0}' type='text' name='input_520[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_520_cell4 gform-grid-col' data-label='Sex of child'><input aria-invalid='false'  aria-describedby=\"gfield_description_59_520\" aria-label='Sex of child, Row 1' data-aria-label-template='Sex of child, Row {0}' type='text' name='input_520[]' value=''   \/><\/div><div class='gfield_list_group_item gfield_list_cell gfield_list_520_cell5 gform-grid-col' data-label='Relationship to you'><input aria-invalid='false'  aria-describedby=\"gfield_description_59_520\" aria-label='Relationship to you, Row 1' data-aria-label-template='Relationship to you, Row {0}' type='text' name='input_520[]' value=''   \/><\/div><div class='gfield_list_icons gform-grid-col'>   <button type='button'  class='add_list_item ' aria-label='Add another row' onclick='gformAddListItem(this, 0)'>Add<\/button>   <button type='button'  class='delete_list_item' aria-label='Remove row 1' data-aria-label-template='Remove row {0}' onclick='gformDeleteListItem(this, 0)' style=\"visibility:hidden;\">Remove<\/button><\/div><\/div><\/div><\/div><\/div><\/fieldset><div id=\"field_59_462\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Person 1<\/h3><div class='gsection_description' id='gfield_description_59_462'>Please tell us all the people who live with you<\/div><\/div><div id=\"field_59_455\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_455'><span class='gform-field-label__text'>First name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_455' id='input_59_455' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_456\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_456'><span class='gform-field-label__text'>Last name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_456' id='input_59_456' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_457\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_457'><span class='gform-field-label__text'>Date of birth<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_59_457'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_457'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_59_457' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_59_457' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_59_457' aria-label='Date of birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_59_458\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_458'><span class='gform-field-label__text'>Sex of child<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_458' id='input_59_458' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_459\" class=\"gfield gfield--type-text gfield--input-type-text field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_459'><span class='gform-field-label__text'>Relationship to you<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_459' id='input_59_459' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_59_460\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add a second person?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_460'>\n\t\t\t<div class='gchoice gchoice_59_460_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_460' type='radio' value='Yes'  id='choice_59_460_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_460_0' id='label_59_460_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_460_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_460' type='radio' value='No'  id='choice_59_460_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_460_1' id='label_59_460_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_461\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Person 2<\/h3><\/div><div id=\"field_59_463\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_463'><span class='gform-field-label__text'>First name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_463' id='input_59_463' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_464\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_464'><span class='gform-field-label__text'>Last name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_464' id='input_59_464' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_465\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_465'><span class='gform-field-label__text'>Date of birth<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_59_465'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_465'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_59_465' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_59_465' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_59_465' aria-label='Date of birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_59_466\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_466'><span class='gform-field-label__text'>Sex of child<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_466' id='input_59_466' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_467\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_467'><span class='gform-field-label__text'>Relationship to you<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_467' id='input_59_467' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_59_468\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add a third person?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_468'>\n\t\t\t<div class='gchoice gchoice_59_468_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_468' type='radio' value='Yes'  id='choice_59_468_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_468_0' id='label_59_468_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_468_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_468' type='radio' value='No'  id='choice_59_468_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_468_1' id='label_59_468_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_469\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Person 3<\/h3><\/div><div id=\"field_59_477\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_477'><span class='gform-field-label__text'>First name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_477' id='input_59_477' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_479\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_479'><span class='gform-field-label__text'>Last name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_479' id='input_59_479' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_480\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_480'><span class='gform-field-label__text'>Date of birth<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_59_480'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_480'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_59_480' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_59_480' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_59_480' aria-label='Date of birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_59_481\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_481'><span class='gform-field-label__text'>Sex of child<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_481' id='input_59_481' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_482\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_482'><span class='gform-field-label__text'>Relationship to you<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_482' id='input_59_482' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_59_483\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add a forth person?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_483'>\n\t\t\t<div class='gchoice gchoice_59_483_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_483' type='radio' value='Yes'  id='choice_59_483_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_483_0' id='label_59_483_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_483_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_483' type='radio' value='No'  id='choice_59_483_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_483_1' id='label_59_483_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_484\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Person 4<\/h3><\/div><div id=\"field_59_485\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_485'><span class='gform-field-label__text'>First name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_485' id='input_59_485' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_486\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_486'><span class='gform-field-label__text'>Last name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_486' id='input_59_486' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_487\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_487'><span class='gform-field-label__text'>Date of birth<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_59_487'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_487'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_59_487' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_59_487' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_59_487' aria-label='Date of birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_59_488\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_488'><span class='gform-field-label__text'>Sex of child<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_488' id='input_59_488' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_489\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_489'><span class='gform-field-label__text'>Relationship to you<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_489' id='input_59_489' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_59_490\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add a fifth person?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_490'>\n\t\t\t<div class='gchoice gchoice_59_490_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_490' type='radio' value='Yes'  id='choice_59_490_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_490_0' id='label_59_490_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_490_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_490' type='radio' value='No'  id='choice_59_490_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_490_1' id='label_59_490_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_491\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Person 5<\/h3><\/div><div id=\"field_59_492\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_492'><span class='gform-field-label__text'>First name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_492' id='input_59_492' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_493\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_493'><span class='gform-field-label__text'>Last name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_493' id='input_59_493' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_494\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_494'><span class='gform-field-label__text'>Date of birth<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_59_494'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_494'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_59_494' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_59_494' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_59_494' aria-label='Date of birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_59_495\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_495'><span class='gform-field-label__text'>Sex of child<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_495' id='input_59_495' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_496\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_496'><span class='gform-field-label__text'>Relationship to you<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_496' id='input_59_496' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_59_497\" class=\"gfield gfield--type-radio gfield--type-choice gfield--input-type-radio gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible gfield--choice-align-vertical\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Add a sixth person?<\/span><\/legend><div class='ginput_container ginput_container_radio'><div class='gfield_radio' id='input_59_497'>\n\t\t\t<div class='gchoice gchoice_59_497_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_497' type='radio' value='Yes'  id='choice_59_497_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_497_0' id='label_59_497_0' class='gform-field-label gform-field-label--type-inline'>Yes<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_59_497_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_497' type='radio' value='No'  id='choice_59_497_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_59_497_1' id='label_59_497_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_59_498\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Person 6<\/h3><\/div><div id=\"field_59_499\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_499'><span class='gform-field-label__text'>First name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_499' id='input_59_499' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_500\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_500'><span class='gform-field-label__text'>Last name<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_500' id='input_59_500' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_501\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datepicker gfield--datepicker-default-icon gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_501'><span class='gform-field-label__text'>Date of birth<\/span><\/label><div class='ginput_container ginput_container_date'>\n\t\t\t\t\t<input\n\t\t\t\t\tplaceholder='dd\/mm\/yyyy'\n\t\t\t\t\tid='input_59_501'\n\t\t\t\t\tclass='datepicker gform-datepicker dmy datepicker_with_icon gdatepicker_with_icon'\n\t\t\t\t\ttype='text'\n\t\t\t\t\tname='input_501'\n\t\t\t\t\tvalue=''\n\t\t\t\t\t \n\t\t\t\t\taria-invalid=\"false\" \n\t\t\t\t\t\n\t\t\t\t\t \n\t\t\t\t\t\n\t\t\t\t\t\/>\n\t\t\t\t<kbd id='keyboardHint_input_59_501' hidden class='down'><\/kbd>\n\t\t\t\t<button type='button' id='datepicker_toggle_input_59_501' class='gform-datepicker-toggle gform-datepicker-toggle--default accCalendar aria-date-picker gform-button gform-theme-button gform-theme-button--simple gform-theme-button--simple-in-ctrl' aria-expanded='false' aria-controls='input_59_501' aria-label='Date of birth: Choose date on calendar' >\n\t\t\t\t\t\t\t<span class=\"gform-calendar-icon gform-datepicker-toggle-icon gform-datepicker-toggle-icon--default dashicons dashicons-calendar-alt\" aria-hidden=\"true\"><\/span>\n\t\t\t\t\t\t<\/button>\n\t\t\t<\/div><\/div><div id=\"field_59_502\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_502'><span class='gform-field-label__text'>Sex of child<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_502' id='input_59_502' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_503\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_503'><span class='gform-field-label__text'>Relationship to you<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_503' id='input_59_503' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_470\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Additional information about your property<\/h3><div class='gsection_description' id='gfield_description_59_470'>Please tell us the following information about your property<\/div><\/div><div id=\"field_59_471\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_471'><span class='gform-field-label__text'>Number of bedrooms<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_471' id='input_59_471' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_472\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_472'><span class='gform-field-label__text'>Number of living rooms<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_472' id='input_59_472' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_474\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_474'><span class='gform-field-label__text'>Weekly or monthly rent due (please state if weekly or monthly)<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_474' id='input_59_474' type='text' value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_59_475\" class=\"gfield gfield--type-date gfield--input-type-date gfield--input-type-datedropdown gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><legend class='gfield_label gform-field-label' ><span class='gform-field-label__text'>Tenancy start date<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_59_475' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_59_475_2_container'><label for='input_59_475_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Day<\/label><select name='input_475[]' id='input_59_475_2'   aria-required='true'  ><option value=''>Day<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><option value='13' >13<\/option><option value='14' >14<\/option><option value='15' >15<\/option><option value='16' >16<\/option><option value='17' >17<\/option><option value='18' >18<\/option><option value='19' >19<\/option><option value='20' >20<\/option><option value='21' >21<\/option><option value='22' >22<\/option><option value='23' >23<\/option><option value='24' >24<\/option><option value='25' >25<\/option><option value='26' >26<\/option><option value='27' >27<\/option><option value='28' >28<\/option><option value='29' >29<\/option><option value='30' >30<\/option><option value='31' >31<\/option><\/select><\/div><div class='gfield_date_dropdown_month ginput_container ginput_container_date gform-grid-col' id='input_59_475_1_container'><label for='input_59_475_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Month<\/label><select name='input_475[]' id='input_59_475_1'   aria-required='true'  ><option value=''>Month<\/option><option value='1' >1<\/option><option value='2' >2<\/option><option value='3' >3<\/option><option value='4' >4<\/option><option value='5' >5<\/option><option value='6' >6<\/option><option value='7' >7<\/option><option value='8' >8<\/option><option value='9' >9<\/option><option value='10' >10<\/option><option value='11' >11<\/option><option value='12' >12<\/option><\/select><\/div><div class='gfield_date_dropdown_year ginput_container ginput_container_date gform-grid-col' id='input_59_475_3_container'><label for='input_59_475_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Year<\/label><select name='input_475[]' id='input_59_475_3'   aria-required='true'  ><option value=''>Year<\/option><option value='2027' >2027<\/option><option value='2026' >2026<\/option><option value='2025' >2025<\/option><option value='2024' >2024<\/option><option value='2023' >2023<\/option><option value='2022' >2022<\/option><option value='2021' >2021<\/option><option value='2020' >2020<\/option><option value='2019' >2019<\/option><option value='2018' >2018<\/option><option value='2017' >2017<\/option><option value='2016' >2016<\/option><option value='2015' >2015<\/option><option value='2014' >2014<\/option><option value='2013' >2013<\/option><option value='2012' >2012<\/option><option value='2011' >2011<\/option><option value='2010' >2010<\/option><option value='2009' >2009<\/option><option value='2008' >2008<\/option><option value='2007' >2007<\/option><option value='2006' >2006<\/option><option value='2005' >2005<\/option><option value='2004' >2004<\/option><option value='2003' >2003<\/option><option value='2002' >2002<\/option><option value='2001' >2001<\/option><option value='2000' >2000<\/option><option value='1999' >1999<\/option><option value='1998' >1998<\/option><option value='1997' >1997<\/option><option value='1996' >1996<\/option><option value='1995' >1995<\/option><option value='1994' >1994<\/option><option value='1993' >1993<\/option><option value='1992' >1992<\/option><option value='1991' >1991<\/option><option value='1990' >1990<\/option><option value='1989' >1989<\/option><option value='1988' >1988<\/option><option value='1987' >1987<\/option><option value='1986' >1986<\/option><option value='1985' >1985<\/option><option value='1984' >1984<\/option><option value='1983' >1983<\/option><option value='1982' >1982<\/option><option value='1981' >1981<\/option><option value='1980' >1980<\/option><option value='1979' >1979<\/option><option value='1978' >1978<\/option><option value='1977' >1977<\/option><option value='1976' >1976<\/option><option value='1975' >1975<\/option><option value='1974' >1974<\/option><option value='1973' >1973<\/option><option value='1972' >1972<\/option><option value='1971' >1971<\/option><option value='1970' >1970<\/option><option value='1969' >1969<\/option><option value='1968' >1968<\/option><option value='1967' >1967<\/option><option value='1966' >1966<\/option><option value='1965' >1965<\/option><option value='1964' >1964<\/option><option value='1963' >1963<\/option><option value='1962' >1962<\/option><option value='1961' >1961<\/option><option value='1960' >1960<\/option><option value='1959' >1959<\/option><option value='1958' >1958<\/option><option value='1957' >1957<\/option><option value='1956' >1956<\/option><option value='1955' >1955<\/option><option value='1954' >1954<\/option><option value='1953' >1953<\/option><option value='1952' >1952<\/option><option value='1951' >1951<\/option><option value='1950' >1950<\/option><option value='1949' >1949<\/option><option value='1948' >1948<\/option><option value='1947' >1947<\/option><option value='1946' >1946<\/option><option value='1945' >1945<\/option><option value='1944' >1944<\/option><option value='1943' >1943<\/option><option value='1942' >1942<\/option><option value='1941' >1941<\/option><option value='1940' >1940<\/option><option value='1939' >1939<\/option><option value='1938' >1938<\/option><option value='1937' >1937<\/option><option value='1936' >1936<\/option><option value='1935' >1935<\/option><option value='1934' >1934<\/option><option value='1933' >1933<\/option><option value='1932' >1932<\/option><option value='1931' >1931<\/option><option value='1930' >1930<\/option><option value='1929' >1929<\/option><option value='1928' >1928<\/option><option value='1927' >1927<\/option><option value='1926' >1926<\/option><option value='1925' >1925<\/option><option value='1924' >1924<\/option><option value='1923' >1923<\/option><option value='1922' >1922<\/option><option value='1921' >1921<\/option><option value='1920' >1920<\/option><\/select><\/div><\/div><\/fieldset><div id=\"field_59_476\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_476'><span class='gform-field-label__text'>Name of your landlord or agent<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_476' id='input_59_476' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_59_504' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='button' id='gform_next_button_59_504' class='gform_next_button gform-theme-button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='next' >Next<\/button> \n                    <\/div>\n                <\/div>\n                <div id='gform_page_59_15' class='gform_page' data-js='page-field-id-504' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_59_15' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_59_505\" class=\"gfield gfield--type-section gfield--input-type-section gsection field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><h3 class=\"gsection_title\">Paying your housing payment award<\/h3><\/div><div id=\"field_59_506\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_506'><span class='gform-field-label__text'>Name of bank or building society<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_506' id='input_59_506' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_507\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_507'><span class='gform-field-label__text'>Branch address<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_textarea'><textarea name='input_507' id='input_59_507' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_59_508\" class=\"gfield gfield--type-text gfield--input-type-text gfield--width-full gfield_contains_required field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_508'><span class='gform-field-label__text'>Name(s) as they appear on your bank or building society account<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_508' id='input_59_508' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_59_509\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_509'><span class='gform-field-label__text'>Account number<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_59_509'>This will be the 8 digit account number shown on your bank statement<\/div><div class='ginput_container ginput_container_text'><input name='input_509' id='input_59_509' type='text' value='' class='large'  aria-describedby=\"gfield_description_59_509\"  placeholder='99999999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"99999999\"\/><\/div><\/div><div id=\"field_59_511\" class=\"gfield gfield--type-text gfield--input-type-text gfield_contains_required field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_59_511'><span class='gform-field-label__text'>Sort code<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/label><div class='gfield_description' id='gfield_description_59_511'>Please enter numbers only, for example 112233<\/div><div class='ginput_container ginput_container_text'><input name='input_511' id='input_59_511' type='text' value='' class='large'  aria-describedby=\"gfield_description_59_511\"  placeholder='99-99-99' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"99-99-99\"\/><\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><button type='submit' id='gform_previous_button_59' class='gform_previous_button gform-theme-button gform-theme-button--secondary button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='previous' >Previous<\/button> <button type='submit' id='gform_submit_button_59' class='gform_button button' onclick='gform.submission.handleButtonClick(this);' data-submission-type='submit' >Submit<\/button> \n            <input type='hidden' class='gform_hidden' name='gform_submission_method' data-js='gform_submission_method_59' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_59' id='gform_theme_59' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_59' id='gform_style_settings_59' value='{&quot;inputPrimaryColor&quot;:&quot;#025B99&quot;,&quot;buttonPrimaryBackgroundColor&quot;:&quot;#025B99&quot;}' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_59' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='59' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='GBP' value='TiqL5WIcIv93DjeU0szyNgggOGinOYdISM6eIa5SVqMYblhqNOLCunsZM8PActTaT7uCvFxnMaTOOm1sm9XaiFRY0oxTkYEq5YknOHJ3\/MJQ7Xs=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_59' value='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' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_target_page_number_59' id='gform_target_page_number_59' value='2' \/>\n            <input type='hidden' autocomplete='off' class='gform_hidden' name='gform_source_page_number_59' id='gform_source_page_number_59' value='1' \/>\n            <input type='hidden' name='gform_field_values' value='' \/>\n            <input type='hidden' name='gform_uploaded_files' id='gform_uploaded_files_59' value='' \/>\n        <\/div>\n             <\/div><\/div>\n                        <\/form>\n                        <\/div>","protected":false},"excerpt":{"rendered":"","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"default","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-422","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/partnershipone.com\/DDC\/wp-json\/wp\/v2\/pages\/422","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/partnershipone.com\/DDC\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/partnershipone.com\/DDC\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/partnershipone.com\/DDC\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/partnershipone.com\/DDC\/wp-json\/wp\/v2\/comments?post=422"}],"version-history":[{"count":2,"href":"https:\/\/partnershipone.com\/DDC\/wp-json\/wp\/v2\/pages\/422\/revisions"}],"predecessor-version":[{"id":489,"href":"https:\/\/partnershipone.com\/DDC\/wp-json\/wp\/v2\/pages\/422\/revisions\/489"}],"wp:attachment":[{"href":"https:\/\/partnershipone.com\/DDC\/wp-json\/wp\/v2\/media?parent=422"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}