{"id":454,"date":"2026-02-11T10:10:25","date_gmt":"2026-02-11T10:10:25","guid":{"rendered":"https:\/\/partnershipone.com\/DDC\/?page_id=454"},"modified":"2026-06-19T15:19:02","modified_gmt":"2026-06-19T14:19:02","slug":"hb-change-overpayment-plan","status":"publish","type":"page","link":"https:\/\/partnershipone.com\/DDC\/hb-change-overpayment-plan\/","title":{"rendered":"Make or change an arrangement to pay your housing benefit overpayment"},"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 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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_74' class='gform_anchor' tabindex='-1'><\/div><form method='post' enctype='multipart\/form-data'  id='gform_74'  action='\/DDC\/wp-json\/wp\/v2\/pages\/454#gf_74' data-formid='74' novalidate><div id='gf_page_steps_74' class='gf_page_steps'><div id='gf_step_74_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_74_2' class='gf_step gf_step_next gf_step_pending'><span class='gf_step_number'>2<\/span><span class='gf_step_label'>Declaration<\/span><\/div><div id='gf_step_74_3' class='gf_step gf_step_pending'><span class='gf_step_number'>3<\/span><span class='gf_step_label'>About you<\/span><\/div><div id='gf_step_74_4' class='gf_step gf_step_pending'><span class='gf_step_number'>4<\/span><span class='gf_step_label'>Your arrangement<\/span><\/div><div id='gf_step_74_5' class='gf_step gf_step_pending'><span class='gf_step_number'>5<\/span><span class='gf_step_label'>Your income<\/span><\/div><div id='gf_step_74_6' class='gf_step gf_step_pending'><span class='gf_step_number'>6<\/span><span class='gf_step_label'>Your work<\/span><\/div><div id='gf_step_74_7' class='gf_step gf_step_pending'><span class='gf_step_number'>7<\/span><span class='gf_step_label'>Your outgoings<\/span><\/div><div id='gf_step_74_8' class='gf_step gf_step_pending'><span class='gf_step_number'>8<\/span><span class='gf_step_label'>Loans and debts<\/span><\/div><div id='gf_step_74_9' class='gf_step gf_step_last gf_step_pending'><span class='gf_step_number'>9<\/span><span class='gf_step_label'>Other information<\/span><\/div><\/div>\n                        <div class='gform-body gform_body'><div id='gform_page_74_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_74' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_74_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>Complete this form if you would like to make or change an arrangement to pay your housing benefit overpayment by instalments.<\/p>\n\n<h2>This form will ask you to provide<\/h2>\n\n<ul>\n\t<li>your details<\/li>\n\t<li>your National Insurance number<\/li>\n\t<li>the Housing Benefit overpayment invoice number<\/li>\n\t<li>the amount you&#8217;re offering to pay<\/li>\n\t<li>how often you&#8217;re offering to pay this amount<\/li>\n\t<li>when you would like the payment to start.<\/li>\n<\/ul>\n<p><\/p>\n<p>Depending on your answers, this form may also ask you to provide:<\/p>\n\n<ul>\n\t<li>if you work, information about your employer and employment<\/li>\n\t<li>if you don&#8217;t work, information about any benefits you receive<\/li>\n\t<li>details of your full income and outgoings<\/li>\n\t<li>details of any loans or debts you have.<\/li>\n<\/ul><\/p>\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<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_74_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_74_2' class='gform_page' data-js='page-field-id-1' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_74_2' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_74_576\" 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_74_576'><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<\/ul><\/div><\/div><fieldset id=\"field_74_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_74_11'><div class='gchoice gchoice_74_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_74_11_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_11_1' id='label_74_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>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_74_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_74_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_74_3' class='gform_page' data-js='page-field-id-22' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_74_3' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_74_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<\/h3><\/div><div id=\"field_74_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_74_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_74_24' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_74_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_74_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_74_25' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_74_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_74_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_74_26' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_74_512\" 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_74_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='ginput_container ginput_container_text'><input name='input_512' id='input_74_512' type='text' value='' class='large'    placeholder='99999 999999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"99999 999999\"\/><\/div><\/div><fieldset id=\"field_74_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_74_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_74_37_container'>\n                                <span id='input_74_37_1_container' class='ginput_left gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_74_37' class='gform-field-label gform-field-label--type-sub '>Enter email address<\/label>\n                                    <input class='' type='email' name='input_37' id='input_74_37' value=''    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_74_37\" \/>\n                                <\/span>\n                                <span id='input_74_37_2_container' class='ginput_right gform-grid-col gform-grid-col--size-auto'>\n                                    <label for='input_74_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_74_37_2' value=''    aria-required=\"true\" aria-invalid=\"false\" aria-describedby=\"gfield_description_74_37\" \/>\n                                <\/span>\n                                <div class='gf_clear gf_clear_complex'><\/div>\n                            <\/div><\/fieldset><fieldset id=\"field_74_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_74_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_74_38'>\n\t\t\t<div class='gchoice gchoice_74_38_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='Yes'  id='choice_74_38_0' onchange='gformToggleRadioOther( this )' aria-describedby=\"gfield_description_74_38\"   \/>\n\t\t\t\t\t<label for='choice_74_38_0' id='label_74_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_74_38_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_38' type='radio' value='No'  id='choice_74_38_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_38_1' id='label_74_38_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_28\" 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_74_28'><span class='gform-field-label__text'>Housing Benefit or Council Tax Support reference 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_28' id='input_74_28' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_74_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_74_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_74_29' type='text' value='' class='large'    placeholder='aa999999a' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"aa999999a\"\/><\/div><\/div><div id=\"field_74_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_74_575\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full custom-address-field d-block 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_74_575' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_74_575_1_container' >\n                                        <label for='input_74_575_1' id='input_74_575_1_label' class='gform-field-label gform-field-label--type-sub '>Address line 1<\/label>\n                                        <input type='text' name='input_575.1' id='input_74_575_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_74_575_2_container' >\n                                        <label for='input_74_575_2' id='input_74_575_2_label' class='gform-field-label gform-field-label--type-sub '>Address line 2<\/label>\n                                        <input type='text' name='input_575.2' id='input_74_575_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_74_575_3_container' >\n                                    <label for='input_74_575_3' id='input_74_575_3_label' class='gform-field-label gform-field-label--type-sub '>Town or city<\/label>\n                                    <input type='text' name='input_575.3' id='input_74_575_3' value=''    aria-required='true'    \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_575.4' id='input_74_575_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_74_575_5_container' >\n                                    <label for='input_74_575_5' id='input_74_575_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                    <input type='text' name='input_575.5' id='input_74_575_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_575.6' id='input_74_575_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><\/div>\n                    <\/div>\n                    <div class='gform-page-footer gform_page_footer top_label'>\n                        <button type='button' id='gform_previous_button_74_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_74_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_74_4' class='gform_page' data-js='page-field-id-49' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_74_4' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_74_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\">Your arrangement<\/h3><\/div><fieldset id=\"field_74_536\" 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 requesting a new arrangement or a change to an existing arrangement?<\/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_74_536'>\n\t\t\t<div class='gchoice gchoice_74_536_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_536' type='radio' value='New arrangement'  id='choice_74_536_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_536_0' id='label_74_536_0' class='gform-field-label gform-field-label--type-inline'>New arrangement<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_74_536_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_536' type='radio' value='Change to an existing arrangement'  id='choice_74_536_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_536_1' id='label_74_536_1' class='gform-field-label gform-field-label--type-inline'>Change to an existing arrangement<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_537\" 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_74_537'><span class='gform-field-label__text'>Invoice reference 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_537' id='input_74_537' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_74_538\" 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_74_538'><span class='gform-field-label__text'>Total amount you owe (amount on the invoice)<\/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_538' id='input_74_538' type='text' step='any'   value='' class='large'    placeholder='\u00a30.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_541\" 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_74_541'><span class='gform-field-label__text'>How much are you offering to pay?<\/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_541' id='input_74_541' type='text' step='any'   value='' class='large'    placeholder='\u00a30.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_74_539\" 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'>Every<\/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_74_539'>\n\t\t\t<div class='gchoice gchoice_74_539_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_539' type='radio' value='26'  id='choice_74_539_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_539_0' id='label_74_539_0' class='gform-field-label gform-field-label--type-inline'>Week<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_74_539_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_539' type='radio' value='13'  id='choice_74_539_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_539_1' id='label_74_539_1' class='gform-field-label gform-field-label--type-inline'>Two weeks<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_74_539_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_539' type='radio' value='6.5'  id='choice_74_539_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_539_2' id='label_74_539_2' class='gform-field-label gform-field-label--type-inline'>Four weeks<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_74_539_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_539' type='radio' value='6'  id='choice_74_539_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_539_3' id='label_74_539_3' class='gform-field-label gform-field-label--type-inline'>Month<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_74_540\" 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'>When would you like this payment to start from?<\/span><span class=\"gfield_required\"><span class=\"gfield_required gfield_required_text\">(Required)<\/span><\/span><\/legend><div id='input_74_540' class='ginput_container ginput_complex gform-grid-row'><div class='gfield_date_dropdown_day ginput_container ginput_container_date gform-grid-col' id='input_74_540_2_container'><label for='input_74_540_2' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Day<\/label><select name='input_540[]' id='input_74_540_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_74_540_1_container'><label for='input_74_540_1' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Month<\/label><select name='input_540[]' id='input_74_540_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_74_540_3_container'><label for='input_74_540_3' class='gform-field-label gform-field-label--type-sub hidden_sub_label screen-reader-text'>Year<\/label><select name='input_540[]' id='input_74_540_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_74_556\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required gfield_calculation field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_74_556'><span class='gform-field-label__text'>Paid in 6 months calculation<\/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_556' id='input_74_556' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"  placeholder='\u00a30.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_557\" class=\"gfield gfield--type-number gfield--input-type-number gfield--width-full gfield_contains_required gfield_calculation field_sublabel_above gfield--no-description field_description_above field_validation_below gfield_visibility_hidden\"  ><div class=\"admin-hidden-markup\"><i class=\"gform-icon gform-icon--hidden\" aria-hidden=\"true\" title=\"This field is hidden when viewing the form\"><\/i><span>This field is hidden when viewing the form<\/span><\/div><label class='gfield_label gform-field-label' for='input_74_557'><span class='gform-field-label__text'>Paid in 6 months calculation final<\/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_557' id='input_74_557' type='text' step='any'   value='' class='large gform-text-input-reset'  readonly=\"readonly\"  placeholder='\u00a30.00' 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_74_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_74_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_74_5' class='gform_page' data-js='page-field-id-68' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_74_5' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_74_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_74_78'>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 id=\"field_74_79\" 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_74_79'><span class='gform-field-label__text'>Income type<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_79' id='input_74_79' class='large gfield_select'     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_74_80\" 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_74_80'><span class='gform-field-label__text'>Amount<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_80' id='input_74_80' type='text' step='any'   value='' class='large'    placeholder='0.00'  aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_85\" 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_74_85'><span class='gform-field-label__text'>How often<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_85' id='input_74_85' 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 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_74_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_74_354'>\n\t\t\t<div class='gchoice gchoice_74_354_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_354' type='radio' value='Yes'  id='choice_74_354_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_354_0' id='label_74_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_74_354_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_354' type='radio' value='No'  id='choice_74_354_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_354_1' id='label_74_354_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_94'><span class='gform-field-label__text'>Amount<\/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_74_94' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_356'>\n\t\t\t<div class='gchoice gchoice_74_356_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_356' type='radio' value='Yes'  id='choice_74_356_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_356_0' id='label_74_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_74_356_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_356' type='radio' value='No'  id='choice_74_356_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_356_1' id='label_74_356_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_136'><span class='gform-field-label__text'>Amount<\/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_74_136' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_358'>\n\t\t\t<div class='gchoice gchoice_74_358_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_358' type='radio' value='Yes'  id='choice_74_358_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_358_0' id='label_74_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_74_358_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_358' type='radio' value='No'  id='choice_74_358_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_358_1' id='label_74_358_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_97'><span class='gform-field-label__text'>Amount<\/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_74_97' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_362'>\n\t\t\t<div class='gchoice gchoice_74_362_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_362' type='radio' value='Yes'  id='choice_74_362_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_362_0' id='label_74_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_74_362_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_362' type='radio' value='No'  id='choice_74_362_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_362_1' id='label_74_362_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_108'><span class='gform-field-label__text'>Amount<\/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_74_108' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_364'>\n\t\t\t<div class='gchoice gchoice_74_364_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_364' type='radio' value='Yes'  id='choice_74_364_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_364_0' id='label_74_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_74_364_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_364' type='radio' value='No'  id='choice_74_364_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_364_1' id='label_74_364_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_139'><span class='gform-field-label__text'>Amount<\/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_74_139' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_366'>\n\t\t\t<div class='gchoice gchoice_74_366_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_366' type='radio' value='Yes'  id='choice_74_366_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_366_0' id='label_74_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_74_366_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_366' type='radio' value='No'  id='choice_74_366_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_366_1' id='label_74_366_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_106'><span class='gform-field-label__text'>Amount<\/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_74_106' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_368'>\n\t\t\t<div class='gchoice gchoice_74_368_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_368' type='radio' value='Yes'  id='choice_74_368_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_368_0' id='label_74_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_74_368_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_368' type='radio' value='No'  id='choice_74_368_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_368_1' id='label_74_368_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_107'><span class='gform-field-label__text'>Amount<\/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_74_107' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_370'>\n\t\t\t<div class='gchoice gchoice_74_370_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_370' type='radio' value='Yes'  id='choice_74_370_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_370_0' id='label_74_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_74_370_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_370' type='radio' value='No'  id='choice_74_370_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_370_1' id='label_74_370_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_145'><span class='gform-field-label__text'>Amount<\/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_74_145' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_372'>\n\t\t\t<div class='gchoice gchoice_74_372_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_372' type='radio' value='Yes'  id='choice_74_372_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_372_0' id='label_74_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_74_372_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_372' type='radio' value='No'  id='choice_74_372_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_372_1' id='label_74_372_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_142'><span class='gform-field-label__text'>Amount<\/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_74_142' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_374'>\n\t\t\t<div class='gchoice gchoice_74_374_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_374' type='radio' value='Yes'  id='choice_74_374_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_374_0' id='label_74_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_74_374_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_374' type='radio' value='No'  id='choice_74_374_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_374_1' id='label_74_374_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_110'><span class='gform-field-label__text'>Amount<\/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_74_110' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_376'>\n\t\t\t<div class='gchoice gchoice_74_376_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_376' type='radio' value='Yes'  id='choice_74_376_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_376_0' id='label_74_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_74_376_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_376' type='radio' value='No'  id='choice_74_376_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_376_1' id='label_74_376_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_109'><span class='gform-field-label__text'>Amount<\/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_74_109' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_378'>\n\t\t\t<div class='gchoice gchoice_74_378_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_378' type='radio' value='Yes'  id='choice_74_378_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_378_0' id='label_74_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_74_378_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_378' type='radio' value='No'  id='choice_74_378_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_378_1' id='label_74_378_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_112'><span class='gform-field-label__text'>Amount<\/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_74_112' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_380'>\n\t\t\t<div class='gchoice gchoice_74_380_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_380' type='radio' value='Yes'  id='choice_74_380_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_380_0' id='label_74_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_74_380_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_380' type='radio' value='No'  id='choice_74_380_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_380_1' id='label_74_380_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_111'><span class='gform-field-label__text'>Amount<\/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_74_111' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_382'>\n\t\t\t<div class='gchoice gchoice_74_382_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_382' type='radio' value='Yes'  id='choice_74_382_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_382_0' id='label_74_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_74_382_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_382' type='radio' value='No'  id='choice_74_382_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_382_1' id='label_74_382_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_148'><span class='gform-field-label__text'>Amount<\/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_74_148' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_384'>\n\t\t\t<div class='gchoice gchoice_74_384_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_384' type='radio' value='Yes'  id='choice_74_384_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_384_0' id='label_74_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_74_384_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_384' type='radio' value='No'  id='choice_74_384_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_384_1' id='label_74_384_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_151'><span class='gform-field-label__text'>Amount<\/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_74_151' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_386'>\n\t\t\t<div class='gchoice gchoice_74_386_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_386' type='radio' value='Yes'  id='choice_74_386_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_386_0' id='label_74_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_74_386_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_386' type='radio' value='No'  id='choice_74_386_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_386_1' id='label_74_386_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_154'><span class='gform-field-label__text'>Amount<\/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_74_154' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_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_74_122' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_74_558\" 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 work?<\/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_74_558'>\n\t\t\t<div class='gchoice gchoice_74_558_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_558' type='radio' value='Yes'  id='choice_74_558_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_558_0' id='label_74_558_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_74_558_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_558' type='radio' value='No'  id='choice_74_558_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_558_1' id='label_74_558_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_560\" 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 work<\/h3><\/div><div id=\"field_74_561\" 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_74_561'><span class='gform-field-label__text'>Employer&#039;s 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_561' id='input_74_561' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_74_577\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full custom-address-field d-block 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'>Employer&#039;s 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_74_577' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_74_577_1_container' >\n                                        <label for='input_74_577_1' id='input_74_577_1_label' class='gform-field-label gform-field-label--type-sub '>Address line 1<\/label>\n                                        <input type='text' name='input_577.1' id='input_74_577_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_74_577_2_container' >\n                                        <label for='input_74_577_2' id='input_74_577_2_label' class='gform-field-label gform-field-label--type-sub '>Address line 2<\/label>\n                                        <input type='text' name='input_577.2' id='input_74_577_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_74_577_3_container' >\n                                    <label for='input_74_577_3' id='input_74_577_3_label' class='gform-field-label gform-field-label--type-sub '>Town or city<\/label>\n                                    <input type='text' name='input_577.3' id='input_74_577_3' value=''    aria-required='true'    \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_577.4' id='input_74_577_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_74_577_5_container' >\n                                    <label for='input_74_577_5' id='input_74_577_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                    <input type='text' name='input_577.5' id='input_74_577_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_577.6' id='input_74_577_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_74_563\" 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_74_563'><span class='gform-field-label__text'>Employer&#039;s phone 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_563' id='input_74_563' type='text' value='' class='large'    placeholder='99999 999999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"99999 999999\"\/><\/div><\/div><div id=\"field_74_564\" 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_74_564'><span class='gform-field-label__text'>Payroll number<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_564' id='input_74_564' type='text' value='' class='large'      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_74_565' 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_74_565' 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_74_6' class='gform_page' data-js='page-field-id-565' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_74_6' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_74_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 work<\/h3><\/div><fieldset id=\"field_74_543\" 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 work?<\/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_74_543'>\n\t\t\t<div class='gchoice gchoice_74_543_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_543' type='radio' value='Yes'  id='choice_74_543_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_543_0' id='label_74_543_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_74_543_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_543' type='radio' value='No'  id='choice_74_543_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_543_1' id='label_74_543_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_544\" 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 work<\/h3><\/div><div id=\"field_74_545\" 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_74_545'><span class='gform-field-label__text'>Name of employer<\/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_545' id='input_74_545' type='text' value='' class='large'     aria-required=\"true\" aria-invalid=\"false\"   \/><\/div><\/div><fieldset id=\"field_74_578\" class=\"gfield gfield--type-address gfield--input-type-address gfield--width-full custom-address-field d-block 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 of employer<\/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_74_578' >\n                         <span class='ginput_full address_line_1 ginput_address_line_1 gform-grid-col' id='input_74_578_1_container' >\n                                        <label for='input_74_578_1' id='input_74_578_1_label' class='gform-field-label gform-field-label--type-sub '>Address line 1<\/label>\n                                        <input type='text' name='input_578.1' id='input_74_578_1' value=''    aria-required='true'    \/>\n                                   <\/span><span class='ginput_full address_line_2 ginput_address_line_2 gform-grid-col' id='input_74_578_2_container' >\n                                        <label for='input_74_578_2' id='input_74_578_2_label' class='gform-field-label gform-field-label--type-sub '>Address line 2<\/label>\n                                        <input type='text' name='input_578.2' id='input_74_578_2' value=''     aria-required='false'   \/>\n                                    <\/span><span class='ginput_left address_city ginput_address_city gform-grid-col' id='input_74_578_3_container' >\n                                    <label for='input_74_578_3' id='input_74_578_3_label' class='gform-field-label gform-field-label--type-sub '>Town or city<\/label>\n                                    <input type='text' name='input_578.3' id='input_74_578_3' value=''    aria-required='true'    \/>\n                                 <\/span><input type='hidden' class='gform_hidden' name='input_578.4' id='input_74_578_4' value=''\/><span class='ginput_right address_zip ginput_address_zip gform-grid-col' id='input_74_578_5_container' >\n                                    <label for='input_74_578_5' id='input_74_578_5_label' class='gform-field-label gform-field-label--type-sub '>Postcode<\/label>\n                                    <input type='text' name='input_578.5' id='input_74_578_5' value=''    aria-required='true'    \/>\n                                <\/span><input type='hidden' class='gform_hidden' name='input_578.6' id='input_74_578_6' value='' \/>\n                    <div class='gf_clear gf_clear_complex'><\/div>\n                <\/div><\/fieldset><div id=\"field_74_547\" 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_74_547'><span class='gform-field-label__text'>Phone number of employer<\/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_547' id='input_74_547' type='text' value='' class='large'    placeholder='99999 999999' aria-required=\"true\" aria-invalid=\"false\"   data-mask=\"99999 999999\"\/><\/div><\/div><div id=\"field_74_548\" 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_74_548'><span class='gform-field-label__text'>Payroll number<\/span><\/label><div class='ginput_container ginput_container_text'><input name='input_548' id='input_74_548' type='text' value='' class='large'      aria-invalid=\"false\"   \/><\/div><\/div><div id=\"field_74_549\" 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_74_549'><span class='gform-field-label__text'>Wages\/salary (after tax and National Insurance contributions)<\/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_549' id='input_74_549' type='text' step='any'   value='' class='large'    placeholder='\u00a30.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_74_550\" 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'>How often are you paid?<\/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_74_550'>\n\t\t\t<div class='gchoice gchoice_74_550_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_550' type='radio' value='Weekly'  id='choice_74_550_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_550_0' id='label_74_550_0' class='gform-field-label gform-field-label--type-inline'>Weekly<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_74_550_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_550' type='radio' value='Two-weekly'  id='choice_74_550_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_550_1' id='label_74_550_1' class='gform-field-label gform-field-label--type-inline'>Two-weekly<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_74_550_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_550' type='radio' value='Four-weekly'  id='choice_74_550_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_550_2' id='label_74_550_2' class='gform-field-label gform-field-label--type-inline'>Four-weekly<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_74_550_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_550' type='radio' value='Monthly'  id='choice_74_550_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_550_3' id='label_74_550_3' class='gform-field-label gform-field-label--type-inline'>Monthly<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_551\" 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 income<\/h3><\/div><fieldset id=\"field_74_552\" 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'>What benefit(s) do you claim?<\/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_74_552'><div class='gchoice gchoice_74_552_1'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_552.1' type='checkbox'  value='Disability Living Allowance (DLA)'  id='choice_74_552_1'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_552_1' id='label_74_552_1' class='gform-field-label gform-field-label--type-inline'>Disability Living Allowance (DLA)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_74_552_2'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_552.2' type='checkbox'  value='Employment and Support Allowance'  id='choice_74_552_2'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_552_2' id='label_74_552_2' class='gform-field-label gform-field-label--type-inline'>Employment and Support Allowance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_74_552_3'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_552.3' type='checkbox'  value='Housing Benefit'  id='choice_74_552_3'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_552_3' id='label_74_552_3' class='gform-field-label gform-field-label--type-inline'>Housing Benefit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_74_552_4'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_552.4' type='checkbox'  value='Income Support'  id='choice_74_552_4'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_552_4' id='label_74_552_4' class='gform-field-label gform-field-label--type-inline'>Income Support<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_74_552_5'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_552.5' type='checkbox'  value='Jobseeker&#039;s Allowance'  id='choice_74_552_5'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_552_5' id='label_74_552_5' class='gform-field-label gform-field-label--type-inline'>Jobseeker&#8217;s Allowance<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_74_552_6'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_552.6' type='checkbox'  value='Pension Credit guarantee credit'  id='choice_74_552_6'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_552_6' id='label_74_552_6' class='gform-field-label gform-field-label--type-inline'>Pension Credit guarantee credit<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_74_552_7'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_552.7' type='checkbox'  value='Personal Independence Payment (PIP)'  id='choice_74_552_7'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_552_7' id='label_74_552_7' class='gform-field-label gform-field-label--type-inline'>Personal Independence Payment (PIP)<\/label>\n\t\t\t\t\t\t\t<\/div><div class='gchoice gchoice_74_552_8'>\n\t\t\t\t\t\t\t\t<input class='gfield-choice-input' name='input_552.8' type='checkbox'  value='None of the above'  id='choice_74_552_8'   \/>\n\t\t\t\t\t\t\t\t<label for='choice_74_552_8' id='label_74_552_8' class='gform-field-label gform-field-label--type-inline'>None of the above<\/label>\n\t\t\t\t\t\t\t<\/div><\/div><\/div><\/fieldset><fieldset id=\"field_74_553\" 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'>If you and your partner claim benefit jointly, which of you receives payment?<\/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_74_553'>\n\t\t\t<div class='gchoice gchoice_74_553_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_553' type='radio' value='You'  id='choice_74_553_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_553_0' id='label_74_553_0' class='gform-field-label gform-field-label--type-inline'>You<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_74_553_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_553' type='radio' value='Your partner'  id='choice_74_553_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_553_1' id='label_74_553_1' class='gform-field-label gform-field-label--type-inline'>Your partner<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_554\" 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_74_554'><span class='gform-field-label__text'>Total amount of any other income you get<\/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_554' id='input_74_554' type='text' step='any'   value='' class='large'    placeholder='\u00a30.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_74_555\" 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'>How often do you get paid this 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_74_555'>\n\t\t\t<div class='gchoice gchoice_74_555_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_555' type='radio' value='Weekly'  id='choice_74_555_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_555_0' id='label_74_555_0' class='gform-field-label gform-field-label--type-inline'>Weekly<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_74_555_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_555' type='radio' value='Two-weekly'  id='choice_74_555_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_555_1' id='label_74_555_1' class='gform-field-label gform-field-label--type-inline'>Two-weekly<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_74_555_2'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_555' type='radio' value='Four-weekly'  id='choice_74_555_2' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_555_2' id='label_74_555_2' class='gform-field-label gform-field-label--type-inline'>Four-weekly<\/label>\n\t\t\t<\/div>\n\t\t\t<div class='gchoice gchoice_74_555_3'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_555' type='radio' value='Monthly'  id='choice_74_555_3' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_555_3' id='label_74_555_3' class='gform-field-label gform-field-label--type-inline'>Monthly<\/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_74_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_74_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_74_7' class='gform_page' data-js='page-field-id-123' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_74_7' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_74_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_74_124'>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 id=\"field_74_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_74_129\" 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_74_129'><span class='gform-field-label__text'>Type of outgoing<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_129' id='input_74_129' class='large gfield_select'     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_74_130\" 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_74_130'><span class='gform-field-label__text'>Amount<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_130' id='input_74_130' type='text' step='any'   value='' class='large'    placeholder='0.00'  aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_128\" 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_74_128'><span class='gform-field-label__text'>How often?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_128' id='input_74_128' 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_74_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_74_272'>\n\t\t\t<div class='gchoice gchoice_74_272_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_272' type='radio' value='Yes outgoing 2'  id='choice_74_272_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_272_0' id='label_74_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_74_272_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_272' type='radio' value='No'  id='choice_74_272_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_272_1' id='label_74_272_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_166'><span class='gform-field-label__text'>Amount<\/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_74_166' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_273'>\n\t\t\t<div class='gchoice gchoice_74_273_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_273' type='radio' value='Yes outgoing 3'  id='choice_74_273_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_273_0' id='label_74_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_74_273_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_273' type='radio' value='No'  id='choice_74_273_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_273_1' id='label_74_273_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_167'><span class='gform-field-label__text'>Amount<\/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_74_167' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_275'>\n\t\t\t<div class='gchoice gchoice_74_275_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_275' type='radio' value='Yes outgoing 3'  id='choice_74_275_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_275_0' id='label_74_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_74_275_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_275' type='radio' value='No'  id='choice_74_275_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_275_1' id='label_74_275_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_171'><span class='gform-field-label__text'>Amount<\/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_74_171' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_393'>\n\t\t\t<div class='gchoice gchoice_74_393_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_393' type='radio' value='Yes outgoing 3'  id='choice_74_393_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_393_0' id='label_74_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_74_393_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_393' type='radio' value='No'  id='choice_74_393_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_393_1' id='label_74_393_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_169'><span class='gform-field-label__text'>Amount<\/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_74_169' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_395'>\n\t\t\t<div class='gchoice gchoice_74_395_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_395' type='radio' value='Yes outgoing 3'  id='choice_74_395_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_395_0' id='label_74_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_74_395_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_395' type='radio' value='No'  id='choice_74_395_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_395_1' id='label_74_395_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_168'><span class='gform-field-label__text'>Amount<\/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_74_168' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_397'>\n\t\t\t<div class='gchoice gchoice_74_397_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_397' type='radio' value='Yes outgoing 3'  id='choice_74_397_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_397_0' id='label_74_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_74_397_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_397' type='radio' value='No'  id='choice_74_397_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_397_1' id='label_74_397_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_170'><span class='gform-field-label__text'>Amount<\/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_74_170' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_399'>\n\t\t\t<div class='gchoice gchoice_74_399_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_399' type='radio' value='Yes outgoing 3'  id='choice_74_399_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_399_0' id='label_74_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_74_399_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_399' type='radio' value='No'  id='choice_74_399_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_399_1' id='label_74_399_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_172'><span class='gform-field-label__text'>Amount<\/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_74_172' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_200\" 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_74_200'><span class='gform-field-label__text'>Type of outgoing<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_200' id='input_74_200' class='large gfield_select'     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_74_201\" 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_74_201'><span class='gform-field-label__text'>Amount<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_201' id='input_74_201' type='text' step='any'   value='' class='large'    placeholder='0.00'  aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_202\" 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_74_202'><span class='gform-field-label__text'>How often?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_202' id='input_74_202' 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_74_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_74_401'>\n\t\t\t<div class='gchoice gchoice_74_401_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_401' type='radio' value='Yes outgoing 3'  id='choice_74_401_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_401_0' id='label_74_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_74_401_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_401' type='radio' value='No'  id='choice_74_401_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_401_1' id='label_74_401_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_216'><span class='gform-field-label__text'>Amount<\/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_74_216' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_404'>\n\t\t\t<div class='gchoice gchoice_74_404_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_404' type='radio' value='Yes outgoing 3'  id='choice_74_404_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_404_0' id='label_74_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_74_404_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_404' type='radio' value='No'  id='choice_74_404_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_404_1' id='label_74_404_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_217'><span class='gform-field-label__text'>Amount<\/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_74_217' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_406'>\n\t\t\t<div class='gchoice gchoice_74_406_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_406' type='radio' value='Yes outgoing 3'  id='choice_74_406_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_406_0' id='label_74_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_74_406_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_406' type='radio' value='No'  id='choice_74_406_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_406_1' id='label_74_406_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_218'><span class='gform-field-label__text'>Amount<\/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_74_218' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_408'>\n\t\t\t<div class='gchoice gchoice_74_408_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_408' type='radio' value='Yes outgoing 3'  id='choice_74_408_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_408_0' id='label_74_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_74_408_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_408' type='radio' value='No'  id='choice_74_408_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_408_1' id='label_74_408_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_219'><span class='gform-field-label__text'>Amount<\/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_74_219' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_410'>\n\t\t\t<div class='gchoice gchoice_74_410_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_410' type='radio' value='Yes outgoing 3'  id='choice_74_410_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_410_0' id='label_74_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_74_410_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_410' type='radio' value='No'  id='choice_74_410_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_410_1' id='label_74_410_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_220'><span class='gform-field-label__text'>Amount<\/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_74_220' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_412'>\n\t\t\t<div class='gchoice gchoice_74_412_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_412' type='radio' value='Yes outgoing 3'  id='choice_74_412_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_412_0' id='label_74_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_74_412_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_412' type='radio' value='No'  id='choice_74_412_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_412_1' id='label_74_412_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_221'><span class='gform-field-label__text'>Amount<\/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_74_221' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_414'>\n\t\t\t<div class='gchoice gchoice_74_414_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_414' type='radio' value='Yes outgoing 3'  id='choice_74_414_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_414_0' id='label_74_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_74_414_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_414' type='radio' value='No'  id='choice_74_414_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_414_1' id='label_74_414_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_222'><span class='gform-field-label__text'>Amount<\/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_74_222' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_416'>\n\t\t\t<div class='gchoice gchoice_74_416_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_416' type='radio' value='Yes outgoing 3'  id='choice_74_416_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_416_0' id='label_74_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_74_416_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_416' type='radio' value='No'  id='choice_74_416_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_416_1' id='label_74_416_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_227'><span class='gform-field-label__text'>Amount<\/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_74_227' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_418'>\n\t\t\t<div class='gchoice gchoice_74_418_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_418' type='radio' value='Yes outgoing 3'  id='choice_74_418_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_418_0' id='label_74_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_74_418_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_418' type='radio' value='No'  id='choice_74_418_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_418_1' id='label_74_418_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_223'><span class='gform-field-label__text'>Amount<\/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_74_223' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_420'>\n\t\t\t<div class='gchoice gchoice_74_420_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_420' type='radio' value='Yes outgoing 3'  id='choice_74_420_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_420_0' id='label_74_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_74_420_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_420' type='radio' value='No'  id='choice_74_420_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_420_1' id='label_74_420_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_224'><span class='gform-field-label__text'>Amount<\/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_74_224' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_422'>\n\t\t\t<div class='gchoice gchoice_74_422_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_422' type='radio' value='Yes outgoing 3'  id='choice_74_422_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_422_0' id='label_74_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_74_422_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_422' type='radio' value='No'  id='choice_74_422_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_422_1' id='label_74_422_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_225'><span class='gform-field-label__text'>Amount<\/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_74_225' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_424'>\n\t\t\t<div class='gchoice gchoice_74_424_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_424' type='radio' value='Y'  id='choice_74_424_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_424_0' id='label_74_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_74_424_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_424' type='radio' value='No'  id='choice_74_424_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_424_1' id='label_74_424_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_226'><span class='gform-field-label__text'>Amount<\/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_74_226' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_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_74_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_74_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_74_133'><span class='gform-field-label__text'>Amount<\/span><\/label><div class='ginput_container ginput_container_number'><input name='input_133' id='input_74_133' type='text' step='any'   value='' class='large'    placeholder='0.00'  aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_134'><span class='gform-field-label__text'>How often?<\/span><\/label><div class='ginput_container ginput_container_select'><select name='input_134' id='input_74_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_74_429\" 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_74_429'>\n\t\t\t<div class='gchoice gchoice_74_429_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_429' type='radio' value='Yes outgoing 3'  id='choice_74_429_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_429_0' id='label_74_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_74_429_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_429' type='radio' value='No'  id='choice_74_429_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_429_1' id='label_74_429_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_185'><span class='gform-field-label__text'>Amount<\/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_74_185' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_431'>\n\t\t\t<div class='gchoice gchoice_74_431_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_431' type='radio' value='Yes outgoing 3'  id='choice_74_431_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_431_0' id='label_74_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_74_431_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_431' type='radio' value='No'  id='choice_74_431_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_431_1' id='label_74_431_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_189'><span class='gform-field-label__text'>Amount<\/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_74_189' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_433'>\n\t\t\t<div class='gchoice gchoice_74_433_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_433' type='radio' value='Yes outgoing 3'  id='choice_74_433_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_433_0' id='label_74_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_74_433_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_433' type='radio' value='No'  id='choice_74_433_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_433_1' id='label_74_433_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_188'><span class='gform-field-label__text'>Amount<\/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_74_188' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_435'>\n\t\t\t<div class='gchoice gchoice_74_435_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_435' type='radio' value='Yes outgoing 3'  id='choice_74_435_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_435_0' id='label_74_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_74_435_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_435' type='radio' value='No'  id='choice_74_435_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_435_1' id='label_74_435_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_186'><span class='gform-field-label__text'>Amount<\/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_74_186' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_438'>\n\t\t\t<div class='gchoice gchoice_74_438_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_438' type='radio' value='Yes outgoing 3'  id='choice_74_438_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_438_0' id='label_74_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_74_438_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_438' type='radio' value='No'  id='choice_74_438_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_438_1' id='label_74_438_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_187'><span class='gform-field-label__text'>Amount<\/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_74_187' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_440'>\n\t\t\t<div class='gchoice gchoice_74_440_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_440' type='radio' value='Yes outgoing 3'  id='choice_74_440_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_440_0' id='label_74_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_74_440_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_440' type='radio' value='No'  id='choice_74_440_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_440_1' id='label_74_440_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_190'><span class='gform-field-label__text'>Amount<\/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_74_190' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_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_74_198' class='textarea medium'      aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><fieldset id=\"field_74_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_74_203'>\n\t\t\t<div class='gchoice gchoice_74_203_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_203' type='radio' value='Yes'  id='choice_74_203_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_203_0' id='label_74_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_74_203_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_203' type='radio' value='No'  id='choice_74_203_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_203_1' id='label_74_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_74_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_74_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_74_8' class='gform_page' data-js='page-field-id-240' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_74_8' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_74_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_74_241'>Please list all of your loans and debts including the amount payable per week and the total amount you owe.<\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_255' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_262' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_74_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_74_281'>\n\t\t\t<div class='gchoice gchoice_74_281_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_281' type='radio' value='Yes'  id='choice_74_281_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_281_0' id='label_74_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_74_281_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_281' type='radio' value='No'  id='choice_74_281_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_281_1' id='label_74_281_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_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_74_260' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_268' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_74_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_74_283'>\n\t\t\t<div class='gchoice gchoice_74_283_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_283' type='radio' value='Yes'  id='choice_74_283_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_283_0' id='label_74_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_74_283_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_283' type='radio' value='No'  id='choice_74_283_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_283_1' id='label_74_283_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_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_74_267' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_257' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_74_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_74_289'>\n\t\t\t<div class='gchoice gchoice_74_289_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_289' type='radio' value='Yes'  id='choice_74_289_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_289_0' id='label_74_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_74_289_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_289' type='radio' value='No'  id='choice_74_289_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_289_1' id='label_74_289_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_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_74_293' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_295' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_74_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_74_296'>\n\t\t\t<div class='gchoice gchoice_74_296_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_296' type='radio' value='Yes'  id='choice_74_296_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_296_0' id='label_74_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_74_296_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_296' type='radio' value='No'  id='choice_74_296_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_296_1' id='label_74_296_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_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_74_518' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_301' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_74_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_74_302'>\n\t\t\t<div class='gchoice gchoice_74_302_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_302' type='radio' value='Yes'  id='choice_74_302_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_302_0' id='label_74_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_74_302_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_302' type='radio' value='No'  id='choice_74_302_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_302_1' id='label_74_302_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_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_74_305' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_307' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_74_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_74_308'>\n\t\t\t<div class='gchoice gchoice_74_308_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_308' type='radio' value='Yes'  id='choice_74_308_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_308_0' id='label_74_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_74_308_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_308' type='radio' value='No'  id='choice_74_308_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_308_1' id='label_74_308_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_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_74_311' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_313' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_74_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_74_314'>\n\t\t\t<div class='gchoice gchoice_74_314_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_314' type='radio' value='Yes'  id='choice_74_314_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_314_0' id='label_74_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_74_314_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_314' type='radio' value='No'  id='choice_74_314_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_314_1' id='label_74_314_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_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_74_317' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_319' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_74_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_74_320'>\n\t\t\t<div class='gchoice gchoice_74_320_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_320' type='radio' value='Yes'  id='choice_74_320_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_320_0' id='label_74_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_74_320_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_320' type='radio' value='No'  id='choice_74_320_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_320_1' id='label_74_320_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_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_74_323' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_325' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_74_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_74_326'>\n\t\t\t<div class='gchoice gchoice_74_326_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_326' type='radio' value='Yes'  id='choice_74_326_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_326_0' id='label_74_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_74_326_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_326' type='radio' value='No'  id='choice_74_326_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_326_1' id='label_74_326_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_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_74_329' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_331' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_74_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_74_332'>\n\t\t\t<div class='gchoice gchoice_74_332_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_332' type='radio' value='Yes'  id='choice_74_332_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_332_0' id='label_74_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_74_332_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_332' type='radio' value='No'  id='choice_74_332_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_332_1' id='label_74_332_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_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_74_335' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_337' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_74_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_74_338'>\n\t\t\t<div class='gchoice gchoice_74_338_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_338' type='radio' value='Yes'  id='choice_74_338_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_338_0' id='label_74_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_74_338_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_338' type='radio' value='No'  id='choice_74_338_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_338_1' id='label_74_338_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_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_74_341' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_343' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><fieldset id=\"field_74_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_74_344'>\n\t\t\t<div class='gchoice gchoice_74_344_0'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_344' type='radio' value='Yes'  id='choice_74_344_0' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_344_0' id='label_74_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_74_344_1'>\n\t\t\t\t\t<input class='gfield-choice-input' name='input_344' type='radio' value='No'  id='choice_74_344_1' onchange='gformToggleRadioOther( this )'    \/>\n\t\t\t\t\t<label for='choice_74_344_1' id='label_74_344_1' class='gform-field-label gform-field-label--type-inline'>No<\/label>\n\t\t\t<\/div><\/div><\/div><\/fieldset><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_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_74_347' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_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_74_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_74_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_74_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_74_349' type='text' step='any'   value='' class='large'    placeholder='0.00' aria-required=\"true\" aria-invalid=\"false\"  \/><\/div><\/div><div id=\"field_74_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_74_350\" 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_74_350'><span class='gform-field-label__text'>What steps have you taken to reduce the amounts owed?<\/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_350' id='input_74_350' class='textarea medium'     aria-required=\"true\" aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><div id=\"field_74_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_74_351'><span class='gform-field-label__text'>Please upload proof of these debts<\/span><\/label><div class='gfield_description' id='gfield_description_74_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_74_351' data-settings='{&quot;runtimes&quot;:&quot;html5,flash,html4&quot;,&quot;browse_button&quot;:&quot;gform_browse_button_74_351&quot;,&quot;container&quot;:&quot;gform_multifile_upload_74_351&quot;,&quot;drop_element&quot;:&quot;gform_drag_drop_area_74_351&quot;,&quot;filelist&quot;:&quot;gform_preview_74_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;:74,&quot;field_id&quot;:351,&quot;_gform_file_upload_nonce_74_351&quot;:&quot;daccdb050b&quot;},&quot;gf_vars&quot;:{&quot;max_files&quot;:&quot;5&quot;,&quot;message_id&quot;:&quot;gform_multifile_messages_74_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_74_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_74_351' class='button gform_button_select_files gform-theme-button gform-theme-button--control' aria-describedby=\"gfield_upload_rules_74_351 gfield_description_74_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_74_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_74_351'><\/ul> <div id='gform_preview_74_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_74_573' 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_74_573' 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_74_9' class='gform_page' data-js='page-field-id-573' style='display:none;'>\n                    <div class='gform_page_fields'>\n                        <div id='gform_fields_74_9' class='gform_fields top_label form_sublabel_above description_above validation_below'><div id=\"field_74_571\" 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\">Other information<\/h3><\/div><div id=\"field_74_572\" class=\"gfield gfield--type-textarea gfield--input-type-textarea gfield--width-full field_sublabel_above gfield--has-description field_description_above field_validation_below gfield_visibility_visible\"  ><label class='gfield_label gform-field-label' for='input_74_572'><span class='gform-field-label__text'>Please use this box to tell us any other information<\/span><\/label><div class='gfield_description' id='gfield_description_74_572'>If you have no further information to give us, leave the box blank<\/div><div class='ginput_container ginput_container_textarea'><textarea name='input_572' id='input_74_572' class='textarea medium'  aria-describedby=\"gfield_description_74_572\"    aria-invalid=\"false\"   rows='10' cols='50'><\/textarea><\/div><\/div><\/div><\/div>\n        <div class='gform-page-footer gform_page_footer top_label'><button type='submit' id='gform_previous_button_74' 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_74' 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_74' value='postback' \/>\n            <input type='hidden' class='gform_hidden' name='gform_theme' data-js='gform_theme_74' id='gform_theme_74' value='orbital' \/>\n            <input type='hidden' class='gform_hidden' name='gform_style_settings' data-js='gform_style_settings_74' id='gform_style_settings_74' value='{&quot;inputPrimaryColor&quot;:&quot;#025B99&quot;,&quot;buttonPrimaryBackgroundColor&quot;:&quot;#025B99&quot;}' \/>\n            <input type='hidden' class='gform_hidden' name='is_submit_74' value='1' \/>\n            <input type='hidden' class='gform_hidden' name='gform_submit' value='74' \/>\n            \n            <input type='hidden' class='gform_hidden' name='gform_currency' data-currency='GBP' value='fiLjP9lEvSfAb0mRYoAk1ta1Po\/zOwqRH7b0lJZz3QK0zkg6m0J+LlYN0wEMuO8K7GVx1W1W0yO03+00ss8Dyxolm44KFeIbOyXq0qBNl60nBwo=' \/>\n            <input type='hidden' class='gform_hidden' name='gform_unique_id' value='' \/>\n            <input type='hidden' class='gform_hidden' name='state_74' 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