Personal Details
{
parent.activateValidation({"message":"Your name is required.","minLength":1,"maxLength":"","type":"none","required":true,"expression":"null"}, el)
}}
/>
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-text"
as=${html``}
/>
{
parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":true,"expression":"null"}, el)
}}
/>
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-text"
as=${html``}
/>
parent.handleCheckbox(el, 'onLoad')}
class="mf-checkbox multi-option-input-type"
id="mf-input-checkbox-540c86a">
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-checkbox"
as=${html``}
/>
parent.activateValidation({"message":"This field is required.","emailMessage":"Please enter a valid Email address","minLength":1,"maxLength":"","type":"none","required":true,"expression":"null"}, el)}
/>
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-email"
as=${html``}
/>
parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)}
/>
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-number"
as=${html``}
/>
{
parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)
}}
/>
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-text"
as=${html``}
/>
{
parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)
}}
/>
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-text"
as=${html``}
/>
Address
{
parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)
}}
/>
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-text"
as=${html``}
/>
{
parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)
}}
/>
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-text"
as=${html``}
/>
{
parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)
}}
/>
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-text"
as=${html``}
/>
Socio Economic Conditions
{
parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)
}}
/>
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-text"
as=${html``}
/>
{
parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)
}}
/>
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-text"
as=${html``}
/>
parent.handleCheckbox(el, 'onLoad')}
class="mf-checkbox multi-option-input-type"
id="mf-input-checkbox-7482b9e">
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-checkbox"
as=${html``}
/>
parent.handleCheckbox(el, 'onLoad')}
class="mf-checkbox multi-option-input-type"
id="mf-input-checkbox-5f77338">
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-checkbox"
as=${html``}
/>
parent.handleCheckbox(el, 'onLoad')}
class="mf-checkbox multi-option-input-type"
id="mf-input-checkbox-ab835c5">
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-checkbox"
as=${html``}
/>
{
parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)
}}
/>
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-text"
as=${html``}
/>
Representative
{
parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)
}}
/>
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-text"
as=${html``}
/>
{
parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)
}}
/>
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-text"
as=${html``}
/>
{
parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)
}}
/>
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-text"
as=${html``}
/>
{
parent.activateValidation({"message":"This field is required.","minLength":1,"maxLength":"","type":"none","required":false,"expression":"null"}, el)
}}
/>
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-text"
as=${html``}
/>
Reason for the Complain
parent.handleCheckbox(el, 'onLoad')}
class="mf-checkbox multi-option-input-type"
id="mf-input-checkbox-2f7b44e">
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-checkbox"
as=${html``}
/>
parent.handleCheckbox(el, 'onLoad')}
class="mf-checkbox multi-option-input-type"
id="mf-input-checkbox-6915a3c">
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-checkbox"
as=${html``}
/>
Additional Comments
<${validation.ErrorMessage}
errors=${validation.errors}
name="mf-textarea"
as=${html``}
/>