@extends('admin/layout')
@section('content')
	<div class="row-fluid">
		<div class="span12">
			<div class="widgetcontent">
				<div class="double-scroll">
					<div class="card shadow mb-4">
						<div class="card-header py-3">
							<h6 class="m-0 font-weight-bold text-primary">{{__("Booking")}}</h6>
						</div>
						<div class="card-body">
							<div class="table-responsive">
								<h1>Lead Id: {{$lead_id}}</h1>
								@if (count($errors) > 0)
									<div class="alert alert-danger">
										<strong>Whoops!</strong> There were some problems with your input.<br>

										@foreach ($errors->all() as $error)
											<p>{{ $error }}</p>
										@endforeach

									</div>
								@endif
								@if (Session::has('message'))
									<div class="alert alert-info">{{ Session::get('message') }}</div>
								@endif

								<form action="{{url('/operations/motor/save/'.$lead_id)}}" method="post"
									  class="stdform stdform2">
									<div class="row-fluid">
										<input type="hidden" name="lead_id" id="lead_id" value="{{$lead_id}}">
										<input type="hidden" name="utm_source"
											   value="{{@$childLeadRawData->utm_source}}">
										<input type="hidden" name="utm_medium"
											   value="{{@$childLeadRawData->utm_medium}}">
										<input type="hidden" name="utm_term" value="{{@$childLeadRawData->utm_term}}">
										<input type="hidden" name="utm_campaign"
											   value="{{@$childLeadRawData->utm_campaign}}">
										<div class="span6">
											<div class="widgetcontent bordered shadowed nopadding">
												<h4 class="widgettitle nomargin shadowed">Insurer Selected</h4>
												<p>
													<label for="insurer_id">Insurer Name</label>
																		 <span class="field">
																				 <select name="insurer_id"
																						 id="insurer_id"
																						 class="select-insurer-id"
																						 required>
																						 <option
																							 value="">Choose</option>
																					 @foreach($companies as $company)
																						 <option
																							 value="{{$company->company_id}}" {{(old('insurer_id')==$company->company_id?'selected':'')}}>{{$company->company_name}}</option>
																					 @endforeach
																				 </select>
																		 </span>
												</p>
												<p>
													<label for="policy_type">Policy Type</label>
																		 <span class="field">
																				 <select name="policy_type"
																						 id="policy_type" required>
																						 <option
																							 value="">Choose</option>
																					 																					 @foreach($policy_types as $p_key=>$policy_type)
																						 <option
																							 value="{{$p_key}}" {{(old('policy_type')==$p_key)?'selected':''}}>{{$policy_type}}</option>
																					 @endforeach
																				 </select>
																		 </span>
												</p>
												<p>
													<label for="plan_type">Plan Type</label>
																		 <span class="field">
																				 <select name="plan_type" id="plan_type"
																						 required>
																						 <option
																							 value="">Choose</option>
																					 																					 @foreach($plan_types as $p_key=>$plany_type)
																						 <option
																							 value="{{$p_key}}" {{(old('plan_type')==$p_key)?'selected':''}}>{{$plany_type}}</option>
																					 @endforeach
																				 </select>
																		 </span>
												</p>
												<p>
													<label for="policy_number">Policy Number</label>
																		 <span class="field">
																						 <input type="text"
																								name="policy_number"
																								id="policy_number"
																								value="{{old('policy_number')}}"
																								required minlength="8">
																				 </span>
												</p>
												<p>
													<label for="final_premium">Total Premium</label>
																		 <span class="field">
																				 <input type="text" name="final_premium"
																						id="final_premium"
																						value="{{old('final_premium')}}"
																						required class="numberonly"
																						maxlength="7" max="1000000">
																		 </span>
												</p>
												<p>
													<label for="od_premium">Net OD Premium</label>
																		 <span class="field">
																				 <input type="text" name="od_premium"
																						id="od_premium"
																						value="{{old('od_premium')}}"
																						required class="numberonly"
																						maxlength="7"
																						max="1000000">
																		 </span>
												</p>
												<p>
													<label for="tp_premium">Net TP Premium</label>
																		 <span class="field">
																				 <input type="text" name="tp_premium"
																						id="tp_premium"
																						value="{{old('tp_premium')}}"
																						required class="numberonly"
																						maxlength="7"
																						max="1000000">
																		 </span>
												</p>
												<p>
													<label for="dop">Date Of Payment</label>
																		 <span class="field">
																		 <input type="text" name="policy_booking_date"
																				class=""
																				id="policy_booking_date"
																				value="{{old('policy_booking_date')}}"
																				required/>
																 </span>
												</p>
												<p>
													<label for="dop">Policy Start Date</label>
																		 <span class="field">
																				 <input type="text"
																						id="policy_start_date"
																						name="policy_start_date"
																						class=" readonly"
																						value="{{old('policy_start_date')}}"
																						>
																 </span>
												</p>
											</div>
										</div><!--span6-->
										<div class="span6">
											<div class="widgetcontent bordered shadowed nopadding">
												<h4 class="widgettitle nomargin shadowed">Proposer</h4>
												<p>
													<label for="name">Name</label>
																		 <span class="field">
																		 <input type="text" name="name" id="name"
																				value="{{old('name')}}"
																				class="alpha_dash" required
																				minlength="3">
																 </span>
												</p>
												<p>
													<label for="email">Email</label>
																		 <span class="field">
																		 <input type="email" name="email" id="email"
																				value="{{old('email')}}" required
																				minlength="6">
																 </span>
												</p>
												<p>
													<label for="mobile">Mobile</label>
																		 <span class="field">
																		 <input type="text" name="mobile" id="mobile"
																				value="{{old('mobile')}}"
																				class="numberonly length" maxlength="10"
																				minlength="10" required>
																 </span>
												</p>
											</div>
										</div><!--span6-->
										<div class="span6">
											<div class="widgetcontent bordered shadowed nopadding">
												<h4 class="widgettitle nomargin shadowed">Car</h4>
												<p>
													<label for="vehicle_number">Registration Number</label>
																		 <span class="field">
																		 <input type="text" class=""
																				value="{{old('vehicle_number')}}"
																				name="vehicle_number"
																				id="vehicle_number" required
																				minlength="8">
																 </span>
												</p>
												<p>
													<label for="veh_make">Vehicle Manufacturer</label>
																		 <span class="field">
																 <select name="veh_make" id="veh_make" required>
																		 <option value="">Select</option>
																	 @foreach($vehicle_manufacturers as $vehicle_manufacturer)
																		 <option
																			 value="{{$vehicle_manufacturer['manf_id']}}" {{(old('veh_make')==$vehicle_manufacturer['manf_id'])?'selected':''}}>{{$vehicle_manufacturer['manf_name']}}</option>
																	 @endforeach
																 </select>
														 </span>
												</p>
												<p>
													<label for="registration_date">Registration Date</label>
																		 <span class="field">
																 <input type="text" id="registration_date"
																		name="registration_date"
																		value="{{old('registration_date')}}"
																		required>
														 </span>
												</p>
												<p>
													<label for="manufacturing_date">Manufacturing Date</label>
																		 <span class="field">
																 <input type="text" id="manufacturing_date"
																		name="manufacturing_date"
																		value="{{old('manufacturing_date')}}"
																		required>
														 </span>
												</p>
											</div>
										</div>
										<div class="span6">
											<div class="widgetcontent bordered shadowed nopadding">
												<h4 class="widgettitle nomargin shadowed">Others</h4>
																							</div>
										</div>
										<div class="span12">
											<div class="span12">
												<input type="hidden" name="_token" value="{{csrf_token()}}">
												<button type="submit" class="btn btn-primary">Submit</button>
											</div>

										</div>
									</div><!--row-fluid-->
								</form>
							</div>
						</div>
					</div>
				</div>

			</div>
			<div class="divider15"></div>

		</div><!--span8-->

	</div><!--row-fluid-->

@endsection
@pushOnce('inlinescripts')
<script>

	$('#policy_booking_date').daterangepicker({
		singleDatePicker: true,
		showDropdowns: true,
		minYear: "{{date('Y', strtotime('-1 year'))}}",
		maxYear: "{{date('Y', strtotime('+1 year'))}}",
		locale: {
			format: 'YYYY-mm-dd'
		}
	}, function (start, end, label) {
		var years = moment().diff(start, 'years');
		//alert("You are " + years + " years old!");
	});

	$('#policy_start_date').daterangepicker({
		singleDatePicker: true,
		showDropdowns: true,
		minYear: "{{date('Y', strtotime('-1 year'))}}",
		maxYear: "{{date('Y', strtotime('+1 year'))}}",
		locale: {
			format: 'YYYY-mm-dd'
		}
	}, function (start, end, label) {
		var years = moment().diff(start, 'years');
		//alert("You are " + years + " years old!");
	});

	$('#registration_date').daterangepicker({
		singleDatePicker: true,
		showDropdowns: true,
		maxYear: "{{date('Y', strtotime('+1 year'))}}",
		locale: {
			format: 'YYYY-mm-dd'
		}
	}, function (start, end, label) {
		var years = moment().diff(start, 'years');
		//alert("You are " + years + " years old!");
	});

	$('#manufacturing_date').daterangepicker({
		singleDatePicker: true,
		showDropdowns: true,
		maxYear: "{{date('Y', strtotime('+1 year'))}}",
		locale: {
			format: 'YYYY-mm-dd'
		}
	}, function (start, end, label) {
		var years = moment().diff(start, 'years');
		//alert("You are " + years + " years old!");
	});

	$('#issuance_date').daterangepicker({
		singleDatePicker: true,
		showDropdowns: true,
		maxYear: "{{date('Y', strtotime('+1 year'))}}",
		locale: {
			format: 'YYYY-mm-dd'
		}
	}, function (start, end, label) {
		var years = moment().diff(start, 'years');
		//alert("You are " + years + " years old!");
	});

</script>
@endPushOnce