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| <HTML><HEAD><TITLE>Calculez votre cotisation avec Comparmut.fr</TITLE>
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<script language="JavaScript"><!--
function test(garantie) {
if(garantie[0].checked || garantie[1].checked || garantie[2].checked || garantie[3].checked)
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alert("Merci de choisir le niveau de votre garantie !")
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<TR>
<TD width="231" align=left bgcolor="#99CC00" class="text"><FONT
style="FONT-SIZE: 11pt" face="Tahoma"
color="#FFFFFF"><strong>Garanties/Formules</strong></FONT></TD>
<TD width="90" align=left bgcolor="#99CC00" class="text4"><font color="#FFFFFF">
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</font><FONT color="#FFFFFF"><B>Niveau 1</B></FONT></TD>
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<B>Niveau 1+</B></FONT></TD>
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<B>Niveau 2</B></FONT></TD>
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<B>Niveau 3</B></FONT></TD>
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<TD align=left style="FONT-SIZE: 11pt" face="Tahoma"
color="#FFFFFF" class="text"><strong><font color="#FFFFFF">Option
Facultative 1</font></strong></TD>
<TD colspan="4" align=left valign="middle" class="text4"><font color="#FFFFFF">
<input name="option" type="radio" value="" />
Pas d'option
<input name="option" type="radio" value="renfort" />
Renfort optique et dentaire
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<TD align=left style="FONT-SIZE: 11pt" face="Tahoma"
color="#FFFFFF" class="text"><strong><font color="#FFFFFF">Option
Facultative 2</font></strong></TD>
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Pas d'option
<input name="option1" type="radio" value="medecine" />
Médecine naturelle</font></TD>
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