@extends('layouts.template')

@section('content')
<style>
    .steps{
        text-align: left;
        padding: 15px;
        margin: 20px 0 20px 0;
        pointer-events: none;
        text-decoration: none;
    }
    .steps>span{
        font-size:14px;
        font-weight:100;
    }
    .upper{
        text-transform: uppercase;
    }
</style>
    <div class="row page-titles">
        <div class="col-md-5 col-12 align-self-center">
            <h3 class="text-themecolor mb-0">File Claim</h3>
            <ol class="breadcrumb mb-0 p-0 bg-transparent">
                <li class="breadcrumb-item"><a href="javascript:void(0)">Home</a></li>
                <li class="breadcrumb-item active">File Claim</li>
            </ol>
        </div>
    </div>

    <div class="container-fluid">
        <div class="row">
            <div class="col-12">
                <div class="card">
                    <div class="card-body">
                        <div class="col-md-12">
                            <div class="row">
                                <div class="col-md-3">
                                    <a href="#" class="btn btn-info btn-lg btn-block steps">1. <span>Claim Details</span></a>
                                </div>
                                <div class="col-md-3">
                                    <a href="" class="btn btn-default btn-lg btn-block steps">2. <span>Nature of Claim</span></a>
                                </div>
                                <div class="col-md-3">
                                    <a href="" class="btn btn-default btn-lg btn-block steps">3. <span>Claim Requirements</span></a>
                                </div>
                            </div>
                        </div>
                        
                        <div class="col-md-12">
                            <section>
                                <form method="POST" action="{{ route('file-claim.details') }}" class="my-form">
                                    @csrf
                                    <input type="hidden" value={{ $code }} name="code">
                                    <div class="row">
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label>Assured Name :</label>
                                                <textarea class="form-control upper" name="assured">{{ old('assured') }}</textarea>
                                                @if ($errors->has('assured'))
                                                    <span class="text-danger">
                                                        <strong>{{ $errors->first('assured') }}</strong>
                                                    </span>
                                                @endif
                                            </div>
                                        </div>
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label>Assured Address :</label>
                                                <textarea class="form-control upper" name="address">{{ old('address') }}</textarea>
                                                @if ($errors->has('address'))
                                                    <span class="text-danger">
                                                        <strong>{{ $errors->first('address') }}</strong>
                                                    </span>
                                                @endif    
                                            </div>
                                        </div>
                                    </div>
                                    <div class="row">
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label>Assured Email Address :</label>
                                                <input type="email" class="form-control" name="email_address" value="{{ old('email_address') }}"> 
                                                <span> <input type="checkbox" name="send_to_assured" value="true" @if(Auth::user()->user_type == 'Adjuster') checked @endif> Send notifications to this email </span> <br>
                                                @if ($errors->has('email_address'))
                                                    <span class="text-danger">
                                                        <strong>{{ $errors->first('email_address') }}</strong>
                                                    </span>
                                                @endif 
                                            </div>
                                        </div>
                                       
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label>Assured Mobile Number :</label>
                                                <div class="input-group mb-2">
                                                    <div class="input-group-prepend">
                                                        <div class="input-group-text">+63</div>
                                                    </div>
                                                    <input type="number" class="form-control" name="mobile" value="{{ old('mobile') }}">
                                                </div>
                                                @if ($errors->has('mobile'))
                                                    <span class="text-danger">
                                                        <strong>{{ $errors->first('mobile') }}</strong>
                                                    </span>
                                                @endif  
                                            </div>
                                        </div>
                                    </div>
                                    @if(Auth::user()->user_type == 'Adjuster' || Auth::user()->user_type == 'Staff' || Auth::user()->user_type == 'Encoder')
                                    <div class="row">
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label>Third Party Email Address : <small>(Optional)</small></label>
                                                <input type="email" class="form-control" name="tp_email_address" value="{{ old('tp_email_address') }}"> 
                                                <span> <input type="checkbox" name="send_to_tp" value="true" @if(Auth::user()->user_type == 'Adjuster')  @endif> Send notifications to this email </span> <br>
                                                @if ($errors->has('tp_email_address'))
                                                    <span class="text-danger">
                                                        <strong>{{ $errors->first('tp_email_address') }}</strong>
                                                    </span>
                                                @endif 
                                            </div>
                                        </div>
                                       
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label>Third Party Mobile Number : <small>(Optional)</small></label>
                                                <div class="input-group mb-2">
                                                    <div class="input-group-prepend">
                                                        <div class="input-group-text">+63</div>
                                                    </div>
                                                    <input type="number" class="form-control" name="tp_mobile" value="{{ old('tp_mobile') }}">
                                                </div>
                                                @if ($errors->has('tp_mobile'))
                                                    <span class="text-danger">
                                                        <strong>{{ $errors->first('tp_mobile') }}</strong>
                                                    </span>
                                                @endif  
                                            </div>
                                        </div>
                                    </div>
                                    @endif
                                    <div class="row">
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label>Policy No. : <small>(Ex. PC-HO-000001)</small></label>
                                                <input type="text" class="form-control upper" name="policy_no" value="{{ old('policy_no') }}"> 
                                                @if ($errors->has('policy_no'))
                                                    <span class="text-danger">
                                                        <strong>{{ $errors->first('policy_no') }}</strong>
                                                    </span>
                                                @endif 
                                            </div>
                                        </div>
                                        @php
                                            $min = date('Y-m-d', strtotime('-3 years'));
                                        @endphp
                                        <div class="col-md-3">
                                            <div class="form-group">
                                                <label>Inception Date :</label>
                                                <input type="date" class="form-control" name="inception_date" value="{{ old('inception_date') }}">
                                                @if ($errors->has('inception_date'))
                                                    <span class="text-danger">
                                                        <strong>{{ $errors->first('inception_date') }}</strong>
                                                    </span>
                                                @endif 
                                            </div>
                                        </div>
                                        <div class="col-md-3">
                                            <div class="form-group">
                                                <label>Expiry Date :</label>
                                                <input type="date" class="form-control" name="expiry_date" value="{{ old('expiry_date') }}">
                                                @if ($errors->has('expiry_date'))
                                                    <span class="text-danger">
                                                        <strong>{{ $errors->first('expiry_date') }}</strong>
                                                    </span>
                                                @endif 
                                            </div>
                                        </div>
                                    </div>
                                    <div class="row">
                                        <div class="col-md-6">
                                            <div class="form-group">
                                                <label>Policy Type :</label>
                                                <select class="select2 form-control custom-select" style="width: 100%; height:36px;" id="policyType" name="policy_type">
                                                    <option value="" selected disabled>Select</option>
                                                    @foreach($policy as $pol)
                                                    <option data-classification="{{ $pol->classification }}" value="{{ $pol->policy_type_id }}" {{ old('policy_type')==$pol->policy_type_id ? 'selected' : '' }}>{{ $pol->policy_type_desc }}</option>
                                                    @endforeach
                                                </select>
                                                @if ($errors->has('policy_type'))
                                                    <span class="text-danger">
                                                        <strong>{{ $errors->first('policy_type') }}</strong>
                                                    </span>
                                                @endif 
                                            </div>
                                        </div>
                                        @if(Auth::user()->user_type=='Adjuster' || Auth::user()->user_type=='Group Manager')
                                        <div class="col-md-6" id="divdealership">
                                            <div class="form-group">
                                                <label>Dealership/Repair Shop :</label>
                                                <select class="select2 form-control custom-select" style="width: 100%; height:36px;" name="dealer_repairshop">
                                                    <option value="" selected disabled>Choose here...</option>
                                                    @foreach($dealers as $dealer)
                                                    <option value="{{ $dealer->dealership_id }}">{{ $dealer->dealership_name }}</option>
                                                    @endforeach
                                                </select>
                                                @if ($errors->has('dealer_repairshop'))
                                                    <span class="text-danger">
                                                        <strong>{{ $errors->first('dealer_repairshop') }}</strong>
                                                    </span>
                                                @endif  
                                            </div>
                                        </div>
                                        @endif
                                    </div>
                                    
                                    <div style="float:right">
                                        <button type="submit" class="btn btn-primary btnSubmit">Save</button>
                                    </div>
                                </form>
                            </section>
                            
                        </div>
                    </div>
                </div>
            </div>
            
            
        </div>
        
    </div>

<script src="{{ asset('assets/libs/jquery/dist/jquery.min.js') }}"></script>
<script>
    $(document).ready(function(){
        $("#divdealership").hide();

        

            $('#policyType').on('change',function(){
                var classification = $(this).find(':selected').data('classification');
                if(classification == 'Motor'){
                    $("#divdealership").show();
                }else{
                    $("#divdealership").hide();
                }
            });

    });
</script>

@endsection