{"id":3625,"date":"2026-07-02T15:32:03","date_gmt":"2026-07-02T13:32:03","guid":{"rendered":"https:\/\/polisarium.ozx.pl\/kalkulator-zdrowie-i-zycie\/"},"modified":"2026-10-26T14:17:36","modified_gmt":"2026-10-26T13:17:36","slug":"%d0%ba%d0%b0%d0%bb%d1%8c%d0%ba%d1%83%d0%bb%d1%8f%d1%82%d0%be%d1%80-%d0%b7%d0%b4%d0%be%d1%80%d0%be%d0%b2%d1%8f-%d1%82%d0%b0-%d0%b6%d0%b8%d1%82%d1%82%d1%8f","status":"publish","type":"page","link":"https:\/\/polisarium.pl\/uk\/kalkulator\/zdrowie-i-zycie\/","title":{"rendered":"\u0421\u0442\u0440\u0430\u0445\u0443\u0432\u0430\u043d\u043d\u044f \u0436\u0438\u0442\u0442\u044f"},"content":{"rendered":"<style>.kb-row-layout-id905_3967f1-f7 > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id905_3967f1-f7 > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id905_3967f1-f7 > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:var( --global-content-width, 1290px );padding-left:var(--global-content-edge-padding);padding-right:var(--global-content-edge-padding);padding-top:var(--global-kb-spacing-sm, 1.5rem);padding-right:var(--global-kb-spacing-sm, 1.5rem);padding-bottom:var(--global-kb-spacing-xs, 1rem);padding-left:var(--global-kb-spacing-sm, 1.5rem);grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id905_3967f1-f7 > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){.kb-row-layout-id905_3967f1-f7 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}@media all and (max-width: 767px){.kb-row-layout-id905_3967f1-f7 > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id905_3967f1-f7 alignfull wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top kb-theme-content-width\">\n<style>.kadence-column905_3e358a-e3 > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column905_3e358a-e3 > .kt-inside-inner-col{flex-direction:column;}.kadence-column905_3e358a-e3 > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column905_3e358a-e3 > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column905_3e358a-e3{position:relative;}@media all and (max-width: 1024px){.kadence-column905_3e358a-e3 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column905_3e358a-e3 > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column905_3e358a-e3\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advancedheading.kt-adv-heading905_462fd6-93, .wp-block-kadence-advancedheading.kt-adv-heading905_462fd6-93[data-kb-block=\"kb-adv-heading905_462fd6-93\"]{text-align:center;font-style:normal;}.wp-block-kadence-advancedheading.kt-adv-heading905_462fd6-93 mark.kt-highlight, .wp-block-kadence-advancedheading.kt-adv-heading905_462fd6-93[data-kb-block=\"kb-adv-heading905_462fd6-93\"] mark.kt-highlight{font-style:normal;color:#f76a0c;-webkit-box-decoration-break:clone;box-decoration-break:clone;padding-top:0px;padding-right:0px;padding-bottom:0px;padding-left:0px;}.wp-block-kadence-advancedheading.kt-adv-heading905_462fd6-93 img.kb-inline-image, .wp-block-kadence-advancedheading.kt-adv-heading905_462fd6-93[data-kb-block=\"kb-adv-heading905_462fd6-93\"] img.kb-inline-image{width:150px;vertical-align:baseline;}<\/style>\n<h1 class=\"kt-adv-heading905_462fd6-93 wp-block-kadence-advancedheading has-theme-palette-3-color has-text-color\" data-kb-block=\"kb-adv-heading905_462fd6-93\">Ubezpieczenie na \u017cycie<\/h1>\n<\/div><\/div>\n\n<\/div><\/div>\n\n<style>.kb-row-layout-id905_bae1ef-cd > .kt-row-column-wrap{align-content:start;}:where(.kb-row-layout-id905_bae1ef-cd > .kt-row-column-wrap) > .wp-block-kadence-column{justify-content:start;}.kb-row-layout-id905_bae1ef-cd > .kt-row-column-wrap{column-gap:var(--global-kb-gap-md, 2rem);row-gap:var(--global-kb-gap-md, 2rem);max-width:1000px;margin-left:auto;margin-right:auto;padding-top:var(--global-kb-spacing-sm, 1.5rem);padding-right:var(--global-kb-spacing-sm, 1.5rem);padding-bottom:var(--global-kb-spacing-sm, 1.5rem);padding-left:var(--global-kb-spacing-sm, 1.5rem);grid-template-columns:minmax(0, 1fr);}.kb-row-layout-id905_bae1ef-cd > .kt-row-layout-overlay{opacity:0.30;}@media all and (max-width: 1024px){.kb-row-layout-id905_bae1ef-cd > .kt-row-column-wrap{grid-template-columns:minmax(0, 1fr);}}@media all and (max-width: 767px){.kb-row-layout-id905_bae1ef-cd > .kt-row-column-wrap{padding-top:12px;padding-right:0px;padding-bottom:12px;padding-left:0px;grid-template-columns:minmax(0, 1fr);}}<\/style><div class=\"kb-row-layout-wrap kb-row-layout-id905_bae1ef-cd alignfull wp-block-kadence-rowlayout\"><div class=\"kt-row-column-wrap kt-has-1-columns kt-row-layout-equal kt-tab-layout-inherit kt-mobile-layout-row kt-row-valign-top\">\n<style>.kadence-column905_3c4377-4f > .kt-inside-inner-col{padding-top:var(--global-kb-spacing-md, 2rem);padding-right:var(--global-kb-spacing-md, 2rem);padding-bottom:var(--global-kb-spacing-md, 2rem);padding-left:var(--global-kb-spacing-md, 2rem);}.kadence-column905_3c4377-4f > .kt-inside-inner-col{box-shadow:0px 0px 14px 0px rgba(0, 0, 0, 0.2);}.kadence-column905_3c4377-4f > .kt-inside-inner-col,.kadence-column905_3c4377-4f > .kt-inside-inner-col:before{border-top-left-radius:var(--kb-token--primitive--dimension--radius--sm);border-top-right-radius:var(--kb-token--primitive--dimension--radius--sm);border-bottom-right-radius:var(--kb-token--primitive--dimension--radius--sm);border-bottom-left-radius:var(--kb-token--primitive--dimension--radius--sm);}.kadence-column905_3c4377-4f > .kt-inside-inner-col{column-gap:var(--global-kb-gap-sm, 1rem);}.kadence-column905_3c4377-4f > .kt-inside-inner-col{flex-direction:column;}.kadence-column905_3c4377-4f > .kt-inside-inner-col > .aligncenter{width:100%;}.kadence-column905_3c4377-4f > .kt-inside-inner-col:before{opacity:0.3;}.kadence-column905_3c4377-4f{position:relative;}@media all and (max-width: 1024px){.kadence-column905_3c4377-4f > .kt-inside-inner-col{flex-direction:column;justify-content:center;}}@media all and (max-width: 767px){.kadence-column905_3c4377-4f > .kt-inside-inner-col{padding-top:15px;padding-right:20px;padding-bottom:15px;padding-left:20px;flex-direction:column;justify-content:center;}.kadence-column905_3c4377-4f > .kt-inside-inner-col,.kadence-column905_3c4377-4f > .kt-inside-inner-col:before{border-top-left-radius:0px;border-top-right-radius:0px;border-bottom-right-radius:0px;border-bottom-left-radius:0px;}}<\/style>\n<div class=\"wp-block-kadence-column kadence-column905_3c4377-4f\"><div class=\"kt-inside-inner-col\"><style>.wp-block-kadence-advanced-form3621-cpt-id .kb-adv-form-success{color:var(--global-palette9, #ffffff);background:var(--global-palette2, #2B6CB0);}<\/style><div class=\"wp-block-kadence-advanced-form wp-block-kadence-advanced-form3621-cpt-id kb-adv-form-label-style-normal kb-adv-form-input-size-standard kb-form-basic-style\"><form id=\"kb-adv-form-3621-cpt-id\" class=\"kb-advanced-form\" method=\"post\">\n<div class=\"kb-adv-form-field kb-adv-form-infield-type-input kb-field903_e4aa6a-db pol-half wp-block-kadence-advanced-form-select\"><label class=\"kb-adv-form-label\" for=\"field903_e4aa6a-db\">Rodzaj ubezpieczenia<span class=\"kb-adv-form-required\">*<\/span><\/label><select  name=\"field903_e4aa6a-db\" id=\"field903_e4aa6a-db\" required aria-required=\"true\"><option value=\"na \u017cycie\">na \u017cycie<\/option><option value=\"zdrowotne\">zdrowotne<\/option><option value=\"grupowe\">grupowe<\/option><option value=\"NNW\">NNW<\/option><\/select><\/div>\n\n<div class=\"kb-adv-form-field kb-adv-form-infield-type-input kb-field903_d9f55d-a7 pol-half wp-block-kadence-advanced-form-select\"><label class=\"kb-adv-form-label\" for=\"field903_d9f55d-a7\">Ubezpieczenie dla<span class=\"kb-adv-form-required\">*<\/span><\/label><select  name=\"field903_d9f55d-a7\" id=\"field903_d9f55d-a7\" required aria-required=\"true\"><option value=\"mnie\">mnie<\/option><option value=\"mnie i rodziny\">mnie i rodziny<\/option><option value=\"firmy \/ grupy\">firmy \/ grupy<\/option><\/select><\/div>\n\n<div class=\"kb-adv-form-field kb-field903_bb8e4f-41 wp-block-kadence-advanced-form-checkbox\"><fieldset class=\"kb-radio-check-item-wrap\" id=\"cb903_bb8e4f-41\" data-type=\"checkbox\" data-required=\"no\" ><legend class=\"kb-adv-form-label\">Cel ubezpieczenia<\/legend><div class=\"kb-radio-check-item\"><input class=\"kb-checkbox-style\" type=\"checkbox\"  id=\"field903_bb8e4f-41_0\" name=\"field903_bb8e4f-41[]\" value=\"Bezpiecze\u0144stwo finansowe bliskich w przypadku mojej \u015bmierci\"><label for=\"field903_bb8e4f-41_0\">Bezpiecze\u0144stwo finansowe bliskich w przypadku mojej \u015bmierci<\/label><\/div><div class=\"kb-radio-check-item\"><input class=\"kb-checkbox-style\" type=\"checkbox\"  id=\"field903_bb8e4f-41_1\" name=\"field903_bb8e4f-41[]\" value=\"Ochrona na wypadek niezdolno\u015bci do pracy\"><label for=\"field903_bb8e4f-41_1\">Ochrona na wypadek niezdolno\u015bci do pracy<\/label><\/div><div class=\"kb-radio-check-item\"><input class=\"kb-checkbox-style\" type=\"checkbox\"  id=\"field903_bb8e4f-41_2\" name=\"field903_bb8e4f-41[]\" value=\"Zgromadzenie kapita\u0142u dla dziecka\"><label for=\"field903_bb8e4f-41_2\">Zgromadzenie kapita\u0142u dla dziecka<\/label><\/div><div class=\"kb-radio-check-item\"><input class=\"kb-checkbox-style\" type=\"checkbox\"  id=\"field903_bb8e4f-41_3\" name=\"field903_bb8e4f-41[]\" value=\"Zabezpieczenie sp\u0142aty kredytu\"><label for=\"field903_bb8e4f-41_3\">Zabezpieczenie sp\u0142aty kredytu<\/label><\/div><div class=\"kb-radio-check-item\"><input class=\"kb-checkbox-style\" type=\"checkbox\"  id=\"field903_bb8e4f-41_4\" name=\"field903_bb8e4f-41[]\" value=\"Dodatkowy kapita\u0142 na emerytur\u0119\"><label for=\"field903_bb8e4f-41_4\">Dodatkowy kapita\u0142 na emerytur\u0119<\/label><\/div><div class=\"kb-radio-check-item\"><input class=\"kb-checkbox-style\" type=\"checkbox\"  id=\"field903_bb8e4f-41_5\" name=\"field903_bb8e4f-41[]\" value=\"Ochrona na wypadek inwalidztwa i ci\u0119\u017ckiej choroby\"><label for=\"field903_bb8e4f-41_5\">Ochrona na wypadek inwalidztwa i ci\u0119\u017ckiej choroby<\/label><\/div><\/fieldset><\/div>\n\n<div class=\"kb-adv-form-field kb-adv-form-text-type-input kb-adv-form-infield-type-input kb-field903_738b22-59 pol-half wp-block-kadence-advanced-form-text\"><label class=\"kb-adv-form-label\" for=\"field903_738b22-59\">Orientacyjna suma ubezpieczenia<\/label><input name=\"field903_738b22-59\" id=\"field903_738b22-59\" data-label=\"Orientacyjna suma ubezpieczenia\" type=\"text\" placeholder=\"\" value=\"\" data-type=\"text\" class=\"kb-field kb-text-field\" data-required=\"no\" \/><\/div>\n\n<div class=\"kb-adv-form-field kb-adv-form-text-type-input kb-adv-form-infield-type-input kb-field903_e6af90-66 pol-half wp-block-kadence-advanced-form-text\"><label class=\"kb-adv-form-label\" for=\"field903_e6af90-66\">Przewidywany okres dzia\u0142ania polisy w latach<\/label><input name=\"field903_e6af90-66\" id=\"field903_e6af90-66\" data-label=\"Przewidywany okres dzia\u0142ania polisy w latach\" type=\"text\" placeholder=\"\" value=\"\" data-type=\"text\" class=\"kb-field kb-text-field\" data-required=\"no\" \/><\/div>\n\n<div class=\"kb-adv-form-field kb-adv-form-text-type-input kb-adv-form-infield-type-input kb-field903_4e267d-a1 pol-half wp-block-kadence-advanced-form-text\"><label class=\"kb-adv-form-label\" for=\"field903_4e267d-a1\">Data urodzenia (RRRR-MM-DD)<span class=\"kb-adv-form-required\">*<\/span><\/label><input name=\"field903_4e267d-a1\" id=\"field903_4e267d-a1\" data-label=\"Data urodzenia (RRRR-MM-DD)\" type=\"text\" placeholder=\"\" value=\"\" data-type=\"text\" class=\"kb-field kb-text-field\" data-required=\"yes\" required aria-required=\"true\"\/><\/div>\n\n<div class=\"kb-adv-form-field kb-adv-form-text-type-input kb-adv-form-infield-type-input kb-field903_604894-7f pol-half wp-block-kadence-advanced-form-text\"><label class=\"kb-adv-form-label\" for=\"field903_604894-7f\">Wykonywany zaw\u00f3d<\/label><input name=\"field903_604894-7f\" id=\"field903_604894-7f\" data-label=\"Wykonywany zaw\u00f3d\" type=\"text\" placeholder=\"\" value=\"\" data-type=\"text\" class=\"kb-field kb-text-field\" data-required=\"no\" \/><\/div>\n\n<div class=\"kb-adv-form-field kb-field903_c4a756-19 wp-block-kadence-advanced-form-radio\"><fieldset class=\"kb-radio-check-item-wrap\" id=\"rb903_c4a756-19\" data-type=\"radio\" data-required=\"yes\" ><legend class=\"kb-adv-form-label\">Czy w ci\u0105gu ostatnich 5 lat by\u0142e\u015b diagnozowany z powodu powa\u017cnej choroby<span class=\"kb-adv-form-required\">*<\/span><\/legend><div class=\"kb-radio-check-item\"><input class=\"kb-radio-style\" type=\"radio\"  id=\"field903_c4a756-19_0\" name=\"field903_c4a756-19\"  value=\"tak\"><label for=\"field903_c4a756-19_0\">tak<\/label><\/div><div class=\"kb-radio-check-item\"><input class=\"kb-radio-style\" type=\"radio\"  id=\"field903_c4a756-19_1\" name=\"field903_c4a756-19\"  value=\"nie\"><label for=\"field903_c4a756-19_1\">nie<\/label><\/div><\/fieldset><\/div>\n\n<div class=\"kb-adv-form-field kb-field903_36db40-39 wp-block-kadence-advanced-form-radio\"><fieldset class=\"kb-radio-check-item-wrap\" id=\"rb903_36db40-39\" data-type=\"radio\" data-required=\"yes\" ><legend class=\"kb-adv-form-label\">Czy w ci\u0105gu ostatnich 5 lat by\u0142e\u015b hospitalizowany<span class=\"kb-adv-form-required\">*<\/span><\/legend><div class=\"kb-radio-check-item\"><input class=\"kb-radio-style\" type=\"radio\"  id=\"field903_36db40-39_0\" name=\"field903_36db40-39\"  value=\"tak\"><label for=\"field903_36db40-39_0\">tak<\/label><\/div><div class=\"kb-radio-check-item\"><input class=\"kb-radio-style\" type=\"radio\"  id=\"field903_36db40-39_1\" name=\"field903_36db40-39\"  value=\"nie\"><label for=\"field903_36db40-39_1\">nie<\/label><\/div><\/fieldset><\/div>\n\n<div class=\"kb-adv-form-field kb-field903_8ce261-6c wp-block-kadence-advanced-form-radio\"><fieldset class=\"kb-radio-check-item-wrap\" id=\"rb903_8ce261-6c\" data-type=\"radio\" data-required=\"yes\" ><legend class=\"kb-adv-form-label\">Czy w ci\u0105gu ostatnich 5 lat regularnie przyjmowa\u0142e\u015b leki przepisane przez lekarza<span class=\"kb-adv-form-required\">*<\/span><\/legend><div class=\"kb-radio-check-item\"><input class=\"kb-radio-style\" type=\"radio\"  id=\"field903_8ce261-6c_0\" name=\"field903_8ce261-6c\"  value=\"tak\"><label for=\"field903_8ce261-6c_0\">tak<\/label><\/div><div class=\"kb-radio-check-item\"><input class=\"kb-radio-style\" type=\"radio\"  id=\"field903_8ce261-6c_1\" name=\"field903_8ce261-6c\"  value=\"nie\"><label for=\"field903_8ce261-6c_1\">nie<\/label><\/div><\/fieldset><\/div>\n\n<div class=\"kb-adv-form-field kb-adv-form-text-type-input kb-adv-form-infield-type-input kb-field903_58e718-4d wp-block-kadence-advanced-form-textarea\"><label class=\"kb-adv-form-label\" for=\"field903_58e718-4d\">Dodatkowe informacje<\/label><textarea name=\"field903_58e718-4d\" id=\"field903_58e718-4d\" rows=\"3\"  data-label=\"Dodatkowe informacje\" placeholder=\"\" data-type=\"textarea\" class=\"kb-field kb-textarea-field\" data-required=\"no\" ><\/textarea><\/div>\n\n<div class=\"kb-adv-form-field kb-adv-form-text-type-input kb-adv-form-infield-type-input kb-field903_6c21fd-6a pol-half wp-block-kadence-advanced-form-text\"><label class=\"kb-adv-form-label\" for=\"field903_6c21fd-6a\">Imi\u0119<span class=\"kb-adv-form-required\">*<\/span><\/label><input name=\"field903_6c21fd-6a\" id=\"field903_6c21fd-6a\" data-label=\"Imi\u0119\" type=\"text\" placeholder=\"\" value=\"\" data-type=\"text\" class=\"kb-field kb-text-field\" data-required=\"yes\" required aria-required=\"true\"\/><\/div>\n\n<div class=\"kb-adv-form-field kb-adv-form-text-type-input kb-adv-form-infield-type-input kb-field903_4ae352-5e pol-half wp-block-kadence-advanced-form-text\"><label class=\"kb-adv-form-label\" for=\"field903_4ae352-5e\">Nazwisko<span class=\"kb-adv-form-required\">*<\/span><\/label><input name=\"field903_4ae352-5e\" id=\"field903_4ae352-5e\" data-label=\"Nazwisko\" type=\"text\" placeholder=\"\" value=\"\" data-type=\"text\" class=\"kb-field kb-text-field\" data-required=\"yes\" required aria-required=\"true\"\/><\/div>\n\n<div class=\"kb-adv-form-field kb-adv-form-text-type-input kb-adv-form-infield-type-input kb-field903_50b0c2-c7 pol-half wp-block-kadence-advanced-form-telephone\"><label class=\"kb-adv-form-label\" for=\"field903_50b0c2-c7\">Numer telefonu<span class=\"kb-adv-form-required\">*<\/span><\/label><input name=\"field903_50b0c2-c7\" id=\"field903_50b0c2-c7\" data-label=\"Numer telefonu\" type=\"tel\" placeholder=\"\" value=\"\" data-type=\"tel\" class=\"kb-field kb-tel-field\" data-required=\"yes\" required aria-required=\"true\"\/><\/div>\n\n<div class=\"kb-adv-form-field kb-adv-form-text-type-input kb-adv-form-infield-type-input kb-field903_6e0e02-f0 pol-half wp-block-kadence-advanced-form-email\"><label class=\"kb-adv-form-label\" for=\"field903_6e0e02-f0\">Adres e-mail<span class=\"kb-adv-form-required\">*<\/span><\/label><input name=\"field903_6e0e02-f0\" id=\"field903_6e0e02-f0\" data-label=\"Adres e-mail\" type=\"email\" placeholder=\"\" value=\"\" data-type=\"email\" class=\"kb-field kb-email-field\" data-required=\"yes\" required aria-required=\"true\"\/><\/div>\n\n<div class=\"kb-adv-form-field kb-field903_2633c9-54 wp-block-kadence-advanced-form-accept\"><fieldset class=\"kb-radio-check-item-wrap\" id=\"cb903_2633c9-54\" data-type=\"accept\" data-required=\"yes\" ><legend class=\"screen-reader-text\">Wyra\u017cam zgod\u0119 na przetwarzanie moich danych osobowych w celu przedstawienia oferty na zasadach oraz przez podmioty okre\u015blone w regulaminie.<\/legend><div class=\"kb-radio-check-item\"><input name=\"field903_2633c9-54\" id=\"field903_2633c9-54_0\" data-label=\"Wyra\u017cam zgod\u0119 na przetwarzanie moich danych osobowych w celu przedstawienia oferty na zasadach oraz przez podmioty okre\u015blone w regulaminie.\" type=\"checkbox\" value=\"accept\" data-type=\"accept\" class=\"kb-field kb-accept-field kb-checkbox-field\" data-required=\"yes\" required aria-required=\"true\" aria-label=\"Wyra\u017cam zgod\u0119 na przetwarzanie moich danych osobowych w celu przedstawienia oferty na zasadach oraz przez podmioty okre\u015blone w regulaminie.\"\/><label for=\"field903_2633c9-54_0\">Wyra\u017cam zgod\u0119 na przetwarzanie moich danych osobowych w celu przedstawienia oferty na zasadach oraz przez podmioty okre\u015blone w regulaminie.<span class=\"kb-adv-form-required\">*<\/span><\/label><\/div><\/fieldset><\/div>\n\n<style>ul.menu .kb-submit-field .kb-btn903_bbadcf-51.kb-button{width:initial;}.kb-submit-field.kb-field903_bbadcf-51{justify-content:flex-start;}<\/style><div class=\"kb-adv-form-field kb-submit-field kb-field903_bbadcf-51 wp-block-kadence-advanced-form-submit\"><button class=\"kb-button kt-button button kb-adv-form-submit-button kb-btn903_bbadcf-51 kt-btn-size-standard kt-btn-width-type-auto kb-btn-global-fill kt-btn-has-text-true kt-btn-has-svg-false\" type=\"submit\"><span class=\"kt-btn-inner-text\">Wy\u015blij<\/span><\/button><\/div>\n<input type=\"hidden\" name=\"_kb_adv_form_post_id\" value=\"3621\"><input type=\"hidden\" name=\"action\" value=\"kb_process_advanced_form_submit\"><input 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