@extends('layouts.app')

@section('content')
<div class="col-12">

</div>
<div class="col-12">
    <div class="card">
        <div class="card-header pl-5">
            <h5 class="title ">New Insurance</h5>
            <nav aria-label="breadcrumb">
                <ol class="breadcrumb"style="background-color: white; padding-left: 2px">
                    <li class="breadcrumb-item"><a href="{{ route('home') }}">Home</a></li>
                    <li class="breadcrumb-item"><a href="{{ route('insurance') }}">Insurance</a></li>
                    <li class="breadcrumb-item active" aria-current="page">New</li>
                </ol>
            </nav>
        </div>
        <div class="card-body all-icons">
            <form method="POST" action="{{ route('insurance.store') }}" enctype="multipart/form-data" onsubmit="formSubmit()">
                @csrf
                <div class="row  pr-5 pl-5">

                    <div class="col-12 mb-2">
                        <strong>Company Information</strong>
                    </div>

                    <div class="col-12">
                        <div class="form-group">
                            <label>Company Name</label>
                            <input type="text" class="form-control @if ($errors->has('company_name')) is-invalid @endif" placeholder="required" name="company_name" value="{{ old('company_name') }}">
                            @if ($errors->has('company_name'))
                                <div class="invalid-feedback">
                                    <strong>{{ $errors->first('company_name') }}</strong>
                                </div>
                            @endif
                        </div>
                    </div>

                    <div class="col-12">
                        <div class="form-group">
                            <label>Address</label>
                            <input type="text" class="form-control @if ($errors->has('address')) is-invalid @endif" placeholder="required" name="address" value="{{ old('address') }}">
                            @if ($errors->has('address'))
                                <div class="invalid-feedback">
                                    <strong>{{ $errors->first('address') }}</strong>
                                </div>
                            @endif
                        </div>
                    </div>

                    <div class="col-12">
                        <div class="form-group">
                            <label>Email</label>
                            <input type="text" class="form-control @if ($errors->has('email')) is-invalid @endif" placeholder="required" name="email" value="{{ old('email') }}">
                            @if ($errors->has('email'))
                                <div class="invalid-feedback">
                                    <strong>{{ $errors->first('email') }}</strong>
                                </div>
                            @endif
                        </div>
                    </div>

                    <div class="col-12">
                        <div class="form-group">
                            <label>Telephone Number</label>
                            <input type="text" class="form-control @if ($errors->has('telephone_number')) is-invalid @endif" placeholder="optional" name="telephone_number" value="{{ old('telephone_number') }}">
                            @if ($errors->has('telephone_number'))
                                <div class="invalid-feedback">
                                    <strong>{{ $errors->first('telephone_number') }}</strong>
                                </div>
                            @endif
                        </div>
                    </div>

                    <div class="col-12">
                        <div class="form-group">
                            <label>Mobile Number</label>
                            <input type="text" class="form-control @if ($errors->has('mobile_number')) is-invalid @endif" placeholder="required" name="mobile_number" value="{{ old('mobile_number') }}">
                            @if ($errors->has('mobile_number'))
                                <div class="invalid-feedback">
                                    <strong>{{ $errors->first('mobile_number') }}</strong>
                                </div>
                            @endif
                        </div>
                    </div>


                    <div class="col-12 mb-2 mt-4">
                        <strong>Agent Information</strong>
                    </div>

                    <div class="col-12">
                        <div class="form-group">
                            <label>Agent First Name</label>
                            <input type="text" class="form-control @if ($errors->has('agent_first_name')) is-invalid @endif" placeholder="required" name="agent_first_name" value="{{ old('agent_first_name') }}">
                            @if ($errors->has('agent_first_name'))
                                <div class="invalid-feedback">
                                    <strong>{{ $errors->first('agent_first_name') }}</strong>
                                </div>
                            @endif
                        </div>
                    </div>

                    <div class="col-12">
                        <div class="form-group">
                            <label>Agent Last Name</label>
                            <input type="text" class="form-control @if ($errors->has('agent_last_name')) is-invalid @endif" placeholder="required" name="agent_last_name" value="{{ old('agent_last_name') }}">
                            @if ($errors->has('agent_last_name'))
                                <div class="invalid-feedback">
                                    <strong>{{ $errors->first('agent_last_name') }}</strong>
                                </div>
                            @endif
                        </div>
                    </div>

                    <div class="col-12">
                        <div class="form-group">
                            <label>Agent Designation</label>
                            <input type="text" class="form-control @if ($errors->has('agent_designation')) is-invalid @endif" placeholder="required" name="agent_designation" value="{{ old('agent_designation') }}">
                            @if ($errors->has('agent_designation'))
                                <div class="invalid-feedback">
                                    <strong>{{ $errors->first('agent_designation') }}</strong>
                                </div>
                            @endif
                        </div>
                    </div>

                    <div class="col-12">
                        <div class="form-group">
                            <label>Agent Email</label>
                            <input type="text" class="form-control @if ($errors->has('agent_email')) is-invalid @endif" placeholder="required" name="agent_email" value="{{ old('agent_email') }}">
                            @if ($errors->has('agent_email'))
                                <div class="invalid-feedback">
                                    <strong>{{ $errors->first('agent_email') }}</strong>
                                </div>
                            @endif
                        </div>
                    </div>

                    <div class="col-12">
                        <div class="form-group">
                            <label>Agent Telephone Number</label>
                            <input type="text" class="form-control @if ($errors->has('agent_telephone_number')) is-invalid @endif" placeholder="optional" name="agent_telephone_number" value="{{ old('agent_telephone_number') }}">
                            @if ($errors->has('agent_telephone_number'))
                                <div class="invalid-feedback">
                                    <strong>{{ $errors->first('agent_telephone_number') }}</strong>
                                </div>
                            @endif
                        </div>
                    </div>

                    <div class="col-12">
                        <div class="form-group">
                            <label>Agent Mobile Number</label>
                            <input type="text" class="form-control @if ($errors->has('agent_mobile_number')) is-invalid @endif" placeholder="required" name="agent_mobile_number" value="{{ old('agent_mobile_number') }}">
                            @if ($errors->has('agent_mobile_number'))
                                <div class="invalid-feedback">
                                    <strong>{{ $errors->first('agent_mobile_number') }}</strong>
                                </div>
                            @endif
                        </div>
                    </div>

                    <div class="col-12">
                        <button type="submit" class="d-block d-md-none ml-auto btn btn-md btn-primary btn-block">
                            <span class="icon text-white-50">
                                <i class="fas fa-save"></i>
                            </span>
                            &nbsp;Save
                        </button>
                        <button type="submit" class="d-none d-md-block ml-auto btn btn-md btn-primary btn-block" style="width: 155px">
                            <span class="icon text-white-50">
                                <i class="fas fa-save"></i>
                            </span>
                            &nbsp;Save
                        </button>
                    </div>

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

@section('script')
    <script>
        notif = {
            misc: {
            navbar_menu_visible: 0
            },

            showNotification: function(from, align, color, msg) {

            $.notify({
                icon: "now-ui-icons ui-1_bell-53",
                message: msg

            }, {
                type: color,
                timer: 8000,
                placement: {
                from: from,
                align: align
                }
            });
            }
        };
        @if(session()->has('message.level'))
            notif.showNotification('top','right', '{{ session('message.level') }}', '{{ session('message.content') }}')
        @endif

        $(".selector").flatpickr();

        function formSubmit() {
            loader();
            return true;
        }
    </script>

@endsection

@endsection