I confirm that I have been forced to leave a situation due to domestic violence and am requesting emergency assistance.

","fieldId":"8EpShQymjV","type":"select","clarifications":{}},"O0nqEXvheL":{"id":"O0nqEXvheL","title":"When did your situation change?","description":"

It’s okay if you don’t remember the exact date

","fieldId":"Dh3ckv03Ho","type":"date"},"ZTHiO37Y3i":{"id":"ZTHiO37Y3i","title":"Payment method","description":"

I wish to recieve payment of claim:

","fieldId":"9ZHt9LY4kG","type":"select","clarifications":{"HRfqhR7slz":{"questionIds":["vaXnbLRu21"]},"22DlENrU31":{"questionIds":["CPocwl4nSX"]}}},"vaXnbLRu21":{"id":"vaXnbLRu21","title":"Please provide your bank details ","description":"

We care about your safety. Please make sure that you are the only person with access to this bank account. If you are unsure, or do not have access to a bank account, it may be safer for you to choose to pick up a gift card as it is not registered to your name.

","fieldId":"vUPuSvpKK1","type":"text"},"CPocwl4nSX":{"id":"CPocwl4nSX","title":"Please indicate which branch you want to pick up the gift card from","description":"

Arion gift cards are not associated with your name

","fieldId":"F1oVkuIacA","type":"select","clarifications":{"G4MnDkizR2":{"questionIds":["xOpDq2qsSO"]}}},"xOpDq2qsSO":{"id":"xOpDq2qsSO","title":"Which branch?","description":"","fieldId":"klU85WtUEq","type":"text"},"ocH8AFaSLG":{"id":"ocH8AFaSLG","title":"Please confirm","description":"

We are committed to processing all personal data in accordance with law. To protect your personal data, you must give us your consent to request confirmation from the professional you received support from.

I hereby authorize Vörður tryggingar hf. to obtain information from professionals who I received support from in connection with the reported event and my consent only applies to the collection of information in connection with that event.

I will review the detailed description of Vörður's processing of personal data and consent to share information contained in the final document before signing the document.

","fieldId":"9CRcPSiJRz","type":"select","clarifications":{}},"WgsdmyUn3t":{"id":"WgsdmyUn3t","title":"Anything you would like to add or that would be good for us to keep in mind?","description":"","fieldId":"wVdYAU7zYm","type":"text"},"wYHGbUGRW9":{"id":"wYHGbUGRW9","title":"I confirm I have Home Protection home insurance in my home","description":"","fieldId":"kK00tZriE8","type":"select","clarifications":{}},"suRMTip2dU":{"id":"suRMTip2dU","title":"I have changed my legal domicile in recent days due to circumstances","description":"","fieldId":"fL4zjBxkaI","type":"select","clarifications":{"IdE2xo7Wmh":{"questionIds":["2BtFecBe0x"]},"vDvW7LbU6F":{"questionIds":["oxWq0bO52o"]}}},"2BtFecBe0x":{"id":"2BtFecBe0x","title":"Please specify your former legal address if you had Home Protection registered there:","description":"

The reason we ask for your address is to verify Home Protection and make your experience as seamless as possible. No mail related to the emergency assistance will be sent to the address.

","fieldId":"JS3hkkG24c","type":"text"},"Mw7QjKy4lW":{"id":"Mw7QjKy4lW","title":"Have you accessed support from The Women’s Shelter (Kvennaathvarfið)?","description":"

We will get the confirmation from the Women’s Shelter if you mark 'Yes'.

Mark 'No' if your situation does not meet the eligibility criteria for The Women's Shelter, and we will be in touch.

","fieldId":"JM1Vi5GcJc","type":"select","clarifications":{"GWqkLelm0D":{"questionIds":["Y30HhWgT7c"]}}},"ZPllMcjYky":{"id":"ZPllMcjYky","title":"How can we reach out to you?","description":"

We may need to contact you, for example if we need more information or regarding the delivery of a gift card. How would you like us to contact you?

","fieldId":"WmCQh9hhAG","type":"select_multiple","clarifications":{"WxmzvTzZ3k":{"questionIds":["h8ZbFgp08H"]}}},"iZeze684Or":{"id":"iZeze684Or","title":"My social security number:","description":"","fieldId":"po75AioSvO","type":"text"},"h8ZbFgp08H":{"id":"h8ZbFgp08H","title":"What is your phone number?","description":"","fieldId":"MRcUx0Ps9b","type":"text"},"Y30HhWgT7c":{"id":"Y30HhWgT7c","title":"From what professional have you received support from?","description":"","fieldId":"TLc3JL3jhh","type":"text"},"oxWq0bO52o":{"id":"oxWq0bO52o","title":"My legal domicile is:","description":"","fieldId":"3fY4IYE28a","type":"text"}},"version":"2025-02-26T11:03:07Z","createdBy":"hrafnhildur+vordur@taktikal.is","hasChanges":false,"sm":{"documentId":"2025-02-26T11:03:07Z"},"prefilledData":null,"logics":null},"branding":{"colorPrimary":"#FFBA02","useBrandingInPortal":true,"colorOffWhite":"#f8f8f8","logo":"https://app.taktikal.is/api/company/f48128d0ca48/logo.png?w=210&h=72","logoDisplayMode":"medium"},"flowLanguage":"en-us","flowName":"Emergency Assistance due to domestic violence","flowSignatureType":"ClickToSign","companyName":"Vörður tryggingar hf.","flowAuthScreenTitle":"Sign in"}}