@extends('layout.main')


@section('main-section')


 <!-- Content wrapper -->
          <div class="content-wrapper">
            <!-- Content -->
            <div class="container-xxl flex-grow-1 container-p-y">




                            <div class="row g-12">
                <div class="col-md-12">
                  <div class="card">
                    <h3 class="card-header text-warning">Motor PLR Stage</h3>
                    <div class="card-body">


                        <div class="row">
                                            <div class="col-lg-12">
                                                <div class="card">
                                                    <div class="card-body">
                                                        <h4 class="header-title mb-3">Case Information</h4>

                                                        <h5 class="font-family-primary fw-semibold">Ref. No. {{$assignData->_ReferenceNo}}</h5>

                                                        <p class="mb-2"><span class="fw-semibold me-2">Assign Branch </span> {{$assignData->_OurBranch}}</p>
                                                        <p class="mb-2"><span class="fw-semibold me-2">Policy No. </span> {{$assignData->_PolicyPMDNo}}</p>
                                                        <p class="mb-2"><span class="fw-semibold me-2">Loss No. </span> {{$assignData->_LossBenefitNo}}</p>
                                                        <p class="mb-2"><span class="fw-semibold me-2">Insured </span> {{$assignData->_InsuredParticipant}}</p>
                                                        <p class="mb-2"><span class="fw-semibold me-2">Surveyor </span> {{$assignData->_AssignTeamMember}}</p>

                                                    </div>
                                                </div>
                                            </div> <!-- end col -->




                                        </div>
                                        <!-- end row -->

                                        <p></p>

                    <form action="{{url('/motorPlrFormPost')}}" method="post">
                        @csrf
                    <div class="row">


                    <div class="col-lg-6" hidden>
                    <div class="mb-6">
                    <label for="" class="form-label">Job Id</label>
                    <input type="text" id="_JobId" class="form-control" name="_JobId" placeholder="" value="{{$assignData->_Id}}" readonly>
                    <input type="text" id="_user_email" class="form-control" name="_user_email" placeholder="" value="{{session()->get('user_email')}}" readonly>

                    </div>
                    <p></p>
                     </div> <!-- end col -->

                          <div class="col-md-6">
                        <label for="" class="form-label">Type of Report</label>
                         <select class="form-control" name="typeofreport">

                            <option value="Own Damage">Own Damage</option>
                            <option value="Third Party">Third Party</option>
                            <option value="Total Loss">Total Loss</option>
                        </select>
                        <p></p>
                      </div>

                        <div id="" class="form-text text-danger">
                          <h5 class="text-danger">Policy Details </h5>
                          <p></p>
                        </div>

                      <div class="col-md-6">
                        <label for="" class="form-label">Policy Issue Date</label>
                        <input type="date" placeholder="Policy Issue Date" name="pidate" class="form-control" id="" />
                        <p></p>
                      </div>

                       <div class="col-md-6">
                        <label for="" class="form-label">Policy Expiry Date</label>
                        <input type="date" placeholder="Policy Expiry Date" name="pedate" class="form-control" id="" />
                        <p></p>
                      </div>

                       <div class="col-md-6">
                        <label for="" class="form-label">Sum Insured</label>
                        <input type="text" placeholder="Sum Insured" name="SumInsured" class="form-control" id="" value="0" />
                        <p></p>
                      </div>

                       <div class="col-md-6">
                        <label for="" class="form-label">Deductibles</label>
                        <input type="text" placeholder="Deductibles" name="Deductibles" class="form-control" id="" value="0" />
                        <p></p>
                      </div>

                      <div class="col-md-6">
                        <label for="" class="form-label">CV4</label>

                          <select class="form-control" name="cv4">
                                <option value="No">No</option>
                                <option value="Yes">Yes</option>
                        </select>
                        <p></p>
                      </div>


                       <div id="" class="form-text text-danger">
                          <h5 class="text-danger">Details of Driver</h5>
                          <p></p>
                        </div>

                      <div class="col-md-6">
                        <label for="" class="form-label">Drivers Name</label>
                        <input type="text" placeholder="Drivers Name" name="DriversName" class="form-control" id="" />
                        <p></p>
                      </div>

                      <div class="col-md-6">
                        <label for="" class="form-label">License #</label>
                        <input type="text" placeholder="License #" name="Licenseno" class="form-control" id="" />
                        <p></p>
                      </div>

                      <div class="col-md-6" hidden>
                        <label for="" class="form-label">License Issuance Date</label>
                        <input type="date" placeholder="License Issuance Date" name="LicenseIssuanceDate" class="form-control" id="" />
                        <p></p>
                      </div>

                      <div class="col-md-6">
                        <label for="" class="form-label">License Expiry Date</label>
                        <input type="date" placeholder="License Expiry Date" name="LicenseExpiryDate" class="form-control" id="" />
                        <p></p>
                      </div>



                     <div id="" class="form-text text-danger">
                          <h5 class="text-danger">Details of Incident</h5>
                          <p></p>
                        </div>


                      <div class="col-md-6">
                        <label for="" class="form-label">Police Report/FIR</label>
                        <input type="text" placeholder="Police Report/FIR" name="PoliceReportFIR" class="form-control" id="" />
                        <p></p>
                      </div>

                      <div class="col-md-6">
                        <label for="" class="form-label">Place of Loss</label>
                        <input type="text" placeholder="Place of Loss" name="PlaceofLoss" class="form-control" id="" />
                        <p></p>
                      </div>


                       <div class="col-md-12">
                        <label for="" class="form-label">Circumstances of Loss</label>
                        <textarea class="form-control" placeholder="Circumstances of Loss" name="CircumstancesofLoss" id=""></textarea>
                        <p></p>
                      </div>




          <div class="clearfix">
            <hr />
        </div>


                     <div id="" class="form-text text-danger">
                          <h5 class="text-danger">Click to Add Labour and Parts</h5>
                          <p></p>
                        </div>

            <div class="col-md-12">
            <a href="{{ url('/addLabourParts') }}/{{ $assignData->_Id }}" target="_blank" class="btn btn-danger">Click me!</a>
            </div>


         <div class="clearfix">
            <hr />
        </div>



            <div id="" class="form-text text-danger">
                          <h5 class="text-danger">Particular of Assessment </h5>
                          <p></p>
                        </div>

                        <div class="col-md-6">
                        <label for="" class="form-label">Sales Tax on Labour %</label>

                        <select class="form-control" name="SalesTaxonLabour">
                            <option value="5 (F)">Federal - 5%</option>
                            <option value="15 (S)">Sindh - 15%</option>
                            <option value="15 (K)">KPK - 15%</option>
                            <option value="15 (B)">Balochistan - 15%</option>
                            <option value="16 (P)">Punjab - 16%</option>
                         </select>
                        <p></p>
                      </div>



                      <div class="col-md-6">
                        <label for="" class="form-label">GST On Parts %</label>
                        <select class="form-control" name="GSTOnParts">
                            <option value="18">18</option>
                         </select>
                        <p></p>
                      </div>




                      <div class="col-md-6">
                        <label for="" class="form-label">Market Value</label>
                        <input type="text" placeholder="Market Value" name="MarketValue" class="form-control" id="" value="0" />
                        <p></p>
                      </div>

                      <div class="col-md-6">
                        <label for="" class="form-label">Underinsurance Percentage</label>
                        <input type="text" placeholder="Underinsurance Percentage" name="UnderinsurancePercentage" class="form-control" id="" value="0" />
                        <p></p>
                      </div>


                       <div class="col-md-6">
                        <label for="" class="form-label">Lump Sum</label>
                        <input type="text" placeholder="Lump Sum" name="LumpSum" class="form-control" id="" value="0" />
                        <p></p>
                      </div>



                      <div class="col-md-6">
                       <label for="" class="form-label">Labor Settled / Not Settled</label>
                         <select class="form-control" name="LaborSettledNotSettled">
                            <option value="">Please Select</option>
                            <option value="Approval Required">Approval Required</option>
                            <option value="Send to FSR">Send to FSR</option>

                        </select>
                        <p></p>
                      </div>





             <div id="" class="form-text text-danger">
                          <h5 class="text-danger">Further Remarks</h5>
                          <p></p>
                        </div>

                      <div class="col-md-12">
                        <label for="" class="form-label">Remarks</label>
                        <textarea class="form-control" placeholder="Remarks" name="Remarks" id=""></textarea>
                        <p></p>
                      </div>



                      <div class="col-md-12">
                        <button type="submit" class="btn btn-success">Submit</button>
                      </div>

                    </div>
                    </form>
                    </div>
                  </div>
                </div>
             </div>
            </div>
          </div>


                    @endsection('main-section')