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162.241.217.99  Public Scan

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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

Form analysis 1 forms found in the DOM

POST 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

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browser.

Please note that the Swiss Confederation only supports Chrome, Firefox, Edge and
Safari in their respective latest 2 versions.

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