@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">Attend Stage</h3>
                    <div class="card-body">

                    <div class="row">

                      <div id="" class="form-text text-danger">
                          <h5 class="text-success">Claim Attend Info</h5>
                          <p></p>
                        </div>

                    <div class="col-md-12">
                            <button class="btn btn-warning">Upload Photos / Documents</button>
                        <p></p>
                      </div>

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

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

                      <div class="col-md-6">
                       <label for="" class="form-label">Surveyor</label>
                         <select class="form-control">
                            <option value="">Please Select</option>
                            <option value="Insurer">Insurer</option>
                            <option value="Takaful">Takaful</option>
                            <option value="Other">Other</option>
                        </select>
                        <p></p>
                      </div>


                       <div class="col-md-6">
                       <label for="" class="form-label">Workshop</label>
                         <select class="form-control">
                            <option value="">Please Select</option>
                            <option value="Insurer">Insurer</option>
                            <option value="Takaful">Takaful</option>
                            <option value="Other">Other</option>
                        </select>
                        <p></p>
                      </div>





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

                      <div class="col-md-6">
                       <label for="" class="form-label">Urgent PLR (Optional)</label>
                         <select class="form-control">
                            <option value="">Please Select</option>
                            <option value="Insurer">Insurer</option>
                            <option value="Takaful">Takaful</option>
                            <option value="Other">Other</option>
                        </select>
                        <p></p>
                      </div>

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



                       <div class="col-md-6">
                       <div class="form-check form-switch mb-2">
                             <input class="form-check-input" type="checkbox" id="flexSwitchCheckDefault" name="headlight[]" />
                             <label class="form-check-label" for="flexSwitchCheckDefault"
                            >Plus Parts in Estimate</label>
                       </div>
                        <p></p>
                      </div>



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

                      <div class="col-md-6">

                         <div class="form-check form-switch mb-2">
                             <input class="form-check-input" type="checkbox" value="Select Parts Status" id="flexSwitchCheckDefault" name="headlight[]" />
                             <label class="form-check-label" for="flexSwitchCheckDefault"
                            >Plus Parts in Assessment</label>
                       </div>

                        <p></p>
                      </div>



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


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

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

          @endsection('main-section')