@extends('layouts.frontend')
@section('title', 'Cover page')
@section('content')
<div class="clearfix"></div>
<section class="inner-content">
  <div class="clearfix"></div>
  <div class="container">
    <div class="form-block col-md-9 padding-left-none">
      <h2 class="product-title">{{ $product_details->product_name}}</h2>
      @if(Session::get('success'))
        <div class="alert alert-success">
          {{Session::get('success')}}
        </div>
      @endif
        @if(Session::get('failure'))
          <div class="alert alert-danger">
            {{Session::get('failure')}}
          </div>
      @endif
      <form name="underwritingForm" id="underwritingForm" action="{{url('continue-cover-post')}}" method="post">
      <input type="hidden" name="_token" value="{{ csrf_token() }}">
        <div class="bg cover-questions">
          <div class="steps-tabs">
            <ul >
              <li >Personal Details <i class="fa fa-chevron-right" aria-hidden="true"></i></li>
              <li class="active">Cover <i class="fa fa-chevron-right" aria-hidden="true"></i></li>
              <li >Bank Details <i class="fa fa-chevron-right" aria-hidden="true"></i></li>
              <li >Confirmation <i class="fa fa-chevron-right" aria-hidden="true"></i></li>
            </ul>
          </div>
          @foreach ($questions as $key=>$value)
            @if(isset($value) && $value != '')
              <div class="fornRow">
                <table width="100%" border="0" cellspacing="0" cellpadding="0">
                  <tr>
                    <td width="29" align="left" valign="middle" class="blue">

                        <a href="javascript:void(0)" onmouseout="UnTip()" onmouseover="Tip('Please provide accurate answers. Any information not disclosed may result in your claim being disallowed by the insurer')" class="hintanchor"><img src="{{ asset('assets/images/help-2.gif') }}" width="21" height="21" /></a>            </td>
                        <td width="421" align="left" valign="middle" class="blue">
                            <strong>{!! $value !!}</strong>
                        </td>
                        <td width="148" align="left" valign="middle"><table border="0" cellspacing="4" cellpadding="4">
                          <tr>
                            <td width="105" align="left" valign="middle">
                              <input name="{{ $key }}" id="{{ $key }}_opt1" type='radio' value='Yes' class="required" title="Please Answer this question" {{ (isset($underwriting_questions_data) && $underwriting_questions_data->$key  == 'Yes' ? "checked":"") }}/> Yes
                            </td>

                            <td width="100" align="left" valign="middle">
                              <input  name="{{ $key }}" id="{{ $key }}_opt2" type='radio' value='No' {{ (isset($underwriting_questions_data) && $underwriting_questions_data->$key  == 'No' ? "checked":"") }}/>No
                            </td>
                          </tr>
                          <tr>
                            <td align="left" valign="middle" colspan="2">
                              <label for="{{ $key }}" generated="true" class="error" style="display:none;">Please Answer this question</label>
                            </td>
                          </tr>
                    </table></td>
                  </tr>
                </table>
                @if($key == 'question2' && $personal_data->product_id != 13)
                <div id="question2_Nomsg" style="display: none;">
                  <table width="100%" border="0" cellspacing="0" cellpadding="5" style="padding-left:25px; ">
                      <tr>
                      <div id="seconderrormsg">
                      <td style="color:#FF0000;">
                          <strong>Please enter the relevant details below</strong>
                      </td>
                      </div>
                      </tr>
                      <tr>
                      <td>
                          <textarea rows="3" cols="30" id="desc" name="desc" class="medical_desc_box" title="Please Enter Text" onKeyDown="limitText(this.form.desc,this.form.countdown,1000);" onKeyUp="limitText(this.form.desc,this.form.countdown,1000);" ></textarea>
                              <font size="1"><input readonly type="text" id="countdown" class="countdown_box" name="countdown" size="3" value="1000"> characters left.</font>
                      </td>
                      </tr>
                  </table>
                </div>
                @endif
              </div>
            @endif

          @endforeach
          <div id="error_msg" >
            <table width="100%" border="0" cellspacing="0" cellpadding="0">
              <tr>
                <td width="5%" align="left" valign="middle">&nbsp;

                </td>
                <td width="226" class="error_validate" align="left" valign="middle" style="color:red;font-weight:bold;"><span id="err_display"></span></td>
                <td width="288" align="left" valign="middle">&nbsp;</td>
              </tr>
            </table>
          </div>

          <br clear="all" />

        </div> <!-- bg cover-questions end -->

        <input type="hidden" id="hidden_product_id" name="hidden_product_id" value="{{ $personal_data->product_id }}">
        <input type="hidden" id="hidden_quote_id" name="hidden_quote_id" value="{{ $personal_data->quote_id }}">

        <div class="form-btns">
            <div class="medium-btn2 pull-left"><a href="{{ url('personal-details-continue') }}/{{ $personal_data->quote_id }}/{{ $personal_data->product_id }}">Back</a></div>
            <button type="submit" class="medium-btn btn-default pull-right" >Continue</button>
        </div>
      </form>
    </div> <!-- Left side content -->

    <div class="col-md-3 padding-none right-col border-left-none">
      @include('slices.frontend.get-a-quot.right_bottom')

    </div>

  </div>
</section>

<div class="clearfix"></div>
@endsection
@section('page-script')
<script type="text/javascript" src="https://code.jquery.com/jquery-2.0.0.js"></script>
<script src="https://ajax.aspnetcdn.com/ajax/jquery.validate/1.11.1/jquery.validate.js"></script>
<script src="{{ URL::asset('assets/js/get-a-quote/cover_page.js') }}"></script>
@stop