@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-md-6">
                        <label for="" class="form-label">Type of Report</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 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="text" placeholder="Policy Issue Date" name="" class="form-control" id="" />
                        <p></p>
                      </div>

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

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

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

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

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




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

        <div class="col-lg-12" >
            <div class="mb-12">
               <button class="btn btn-danger" onclick="add_labour()" type="button">Add More</button>
            </div>
            <p></p>
            </div> <!-- end col -->

            <div class="col-lg-12" hidden>

                <input type="text" name="txtinc2" id="txtinc2" value="1" />
                <p></p>
            </div>

            <div class="col-lg-12" >
                <h5>Add Labour</h5>
        <table class="table" id="table_captions2">
        <tr>
            <td>

            <label for="" class="form-label">Labor Name</label>
            <input type="text" id="" class="form-control" name="LaborName[]" placeholder="Labor Name">

            </td>

            <td>

            <label for="" class="form-label">Repairers Estimate</label>
            <input type="text" id="" class="form-control" name="[]" placeholder="Repairers Estimate">

            </td>

            <td>

            <label for="" class="form-label">Our Assessment</label>
            <input type="text" id="" class="form-control" name="[]" placeholder="Our Assessment">

            </td>

            <td>

            <label for="" class="form-label">Type</label>
           <select class="form-control" name="">
            <option value=""></option>
            <option value="Denting">Denting</option>
            <option value="Repairing">Repairing</option>
            <option value="Replacement">Replacement</option>
           </select>
            </td>
    </tr>
    </table>
            </div>



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

        <div class="col-lg-12" >
            <div class="mb-12">
               <button class="btn btn-danger" onclick="add_more()" type="button">Add More</button>
            </div>
            <p></p>
            </div> <!-- end col -->

            <div class="col-lg-12" hidden>

                <input type="text" name="txtinc1" id="txtinc1" value="1" />
                <p></p>
            </div>

            <div class="col-lg-12" >
        <h5>Add Parts</h5>
        <table class="table" id="table_captions">
        <tr>
            <td>

            <label for="" class="form-label">Part Name</label>
            <input type="text" id="" class="form-control" name="PartName[]" placeholder="Part Name">

            </td>



            <td>

            <label for="" class="form-label">Price in Rs.</label>
            <input type="text" id="" class="form-control" name="PriceRs[]" placeholder="Price in Rs.">

            </td>

            <td>

            <label for="" class="form-label">Quantity</label>
            <input type="text" id="" class="form-control" name="Quantity[]" placeholder="Quantity">

            </td>

            <td>

            <label for="" class="form-label">Depreciation</label>
            <input type="text" id="" class="form-control" name="Depreciation[]" placeholder="Depreciation" >

        </td>

        <td>

            <label for="" class="form-label">Type</label>
            <select class="form-control" name="type[]">
                <option value=""></option>
                <option value="(SD)">(SD)</option>
            </select>

        </td>
    </tr>
    </table>
            </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>
                        <input type="text" placeholder="Sales Tax on Labour %" name="" class="form-control" id="" />
                        <p></p>
                      </div>



                      <div class="col-md-6">
                        <label for="" class="form-label">GST On Parts %</label>
                        <input type="text" placeholder="GST On Parts %" name="" class="form-control" id="" />
                        <p></p>
                      </div>




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

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


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



                      <div class="col-md-6">
                       <label for="" class="form-label">Labor Settled / Not Settled</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 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="" id=""></textarea>
                        <p></p>
                      </div>



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

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


           <script>
            var inc = 2;
                          function add_more()
                          {
                            $('#table_captions').append(
                            '<tr>'+
            '<td><label for="" class="form-label">Part Name</label>'+
            '<input type="text" id="" class="form-control" name="PartName[]" placeholder="Part Name"></td>'+



            '<td>'+

            '<label for="" class="form-label">Price in Rs.</label>'+
            '<input type="text" id="" class="form-control" name="PriceRs[]" placeholder="Price in Rs.">'+

            '</td>'+

           '<td>'+

            '<label for="" class="form-label">Quantity</label>'+
            '<input type="text" id="" class="form-control" name="Quantity[]" placeholder="Quantity">'+

            '</td>'+

            '<td>'+

            '<label for="" class="form-label">Depreciation</label>'+
            '<input type="text" id="" class="form-control" name="Depreciation[]" placeholder="Depreciation">'+

        '</td>'+

        '<td>'+

            '<label for="" class="form-label">Type</label>'+
            '<select class="form-control" name="type[]">'+
                '<option value=""></option>'+
                '<option value="(SD)">(SD)</option>'+
            '</select>'+

        '</td>'+
        '<td>'+

                                '<button type="button" onclick="add_more_delete()" class="btn btn-danger">Delete</button>'+
                                '</td>'+
    '</tr>'
                            );
                            document.getElementById("txtinc1").value = inc++;
                          }

                          function add_more_delete() {
                            document.getElementById("txtinc1").value = --inc;
                            // event.target will be the input element.
                            var td = event.target.parentNode;
                            var tr = td.parentNode; // the row to be removed
                            tr.parentNode.removeChild(tr);
                          }




                           var inc2 = 2;
                          function add_labour()
                          {
                            $('#table_captions2').append(
                            '<tr>'+
                                '<td>'+

                                '<label for="" class="form-label">Labour Name</label>'+
                                '<input type="text" id="" class="form-control" name="LabourName[]" placeholder="Labour Name">'+

                                '</td>'+

                                '<td>'+

            '<label for="" class="form-label">Repairers Estimate</label>'+
            '<input type="text" id="" class="form-control" name="[]" placeholder="Repairers Estimate">'+

            '</td>'+

            '<td>'+

            '<label for="" class="form-label">Our Assessment</label>'+
            '<input type="text" id="" class="form-control" name="[]" placeholder="Our Assessment">'+

            '</td>'+

            '<td>'+

            '<label for="" class="form-label">Type</label>'+
           '<select class="form-control" name="">'+
            '<option value=""></option>'+
            '<option value="Denting">Denting</option>'+
            '<option value="Repairing">Repairing</option>'+
            '<option value="Replacement">Replacement</option>'+
           '</select>'+
            '</td>'+

                            '<td>'+

                                '<button type="button" onclick="add_more_delete2()" class="btn btn-danger">Delete</button>'+
                                '</td>'+
                        '</tr>'
                            );
                            document.getElementById("txtinc2").value = inc2++;
                          }

                          function add_more_delete2() {
                            document.getElementById("txtinc2").value = --inc2;
                            // event.target will be the input element.
                            var td = event.target.parentNode;
                            var tr = td.parentNode; // the row to be removed
                            tr.parentNode.removeChild(tr);
                          }


                    </script>


          @endsection('main-section')