@extends('layouts.frontend')
@section('title', 'Personale Details')
@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="insuranceForm" class="form-horizontal"  id="insuranceForm" action="{{ url('personal-details-continue') }}" method="post">
       {{ csrf_field() }}
        <div class="bg">

          <div class="steps-tabs">
            <ul >
              <li class="active">Personal Details <i class="fa fa-chevron-right" aria-hidden="true"></i></li>
              <li >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>

          <!--personal fields added-->

          <div class="form-group">
            <!-- <label class="control-label col-sm-4">Home Post Code</label>
            <div class="col-sm-4 padding-right-none">
              <input name="postcode" class="form-control required " id="postcode" title="Please enter postcode" value="" maxLength="8" />
              <label for="postcode" generated="true" class="error"style="display:none"></label>
              <div class="clearfix"></div>
              <div class="small-btn2 margin-top-5">
                <a href="javascript:void(0)" id="btnPO">Find Address</a>
                <div class="ajxLoader"></div>
              </div>
            </div> -->
            <label class="control-label col-sm-4">Home Post Code</label>
            <div class="col-sm-4 padding-right-none">
              <input name="postcode" class="form-control required " id="postcode" title="Please enter postcode" value="{{ old('postcode',  isset($personal_data->postcode) ? $personal_data->postcode : null) }}" maxLength="8" />
              <label for="postcode" generated="true" class="error"style="display:none"></label>
              <div class="clearfix"></div>
              <div class="small-btn2 margin-top-5"><a href="javascript:void(0)" id="btnPO">Find Address</a> <div class="ajxLoader"></div></div>
            </div>
          </div>

          <div class="form-group" id="POAddress" style="display:none;">
            <label class="control-label col-sm-4">Highlight the address that matches your selection and click &quot;Select&quot;</label>

            <div class="col-sm-4 padding-right-none">
              <div class="address-results"></div>
              <div class="small-btn2 margin-top-5"><a href="javascript:void(0)" id="btnPOFetch">Select</a>
              </div>
            </div>
          </div>
          @if($personal_data->postcode != '')
          <div class="form-group"  id="tblFullAddress" style="display:block; ">
          @else
          <div class="form-group"  id="tblFullAddress" style="display:none; ">
          @endif

            <label class="control-label col-sm-4">Address Information</label>
            <div class="col-sm-4 padding-right-none">
              <p id="CompleteAddress">
                @if($complete_address != '')
                    {!!$complete_address!!}
                @endif
              </p>
            </div>

            <input type="hidden" name="formattedPO" class="" id="fullPO" value="" title="Address Information Required: Please Select Your Address"/>
            <input type="hidden" name="premise" class="" id="popremise" value="{{ $personal_data->premiseName }}" />
            <input type="hidden" name="line1" class="" id="poline1" value="{{ $personal_data->address1 }}" />
            <input type="hidden" name="line2" class="" id="poline2" value="{{ $personal_data->address2 }}" />
            <input type="hidden" name="line3" class="" id="poline3" value="{{ $personal_data->address3 }}" />
            <input type="hidden" name="line4" class="" id="poline4" value="{{ $personal_data->address4 }}" />
            <input type="hidden" name="town" class="" id="potown" value="{{ $personal_data->postaltown }}" />
            <input type="hidden" name="county" class="" id="pocounty" value="{{ $personal_data->county }}" />
          </div>

          <div class="form-group">
            <label class="control-label col-sm-4">Email</label>
            <div class="col-sm-4 padding-right-none">
              <input name="email" type="text" class="form-control required" id="email" title="Please enter email" value="{{ old('email',  isset($personal_data->email) ? $personal_data->email : '') }}" maxLength=100 />
              <label for="email" generated="true" class="error"></label>
            </div>
          </div>
          <div class="form-group">
            <label class="control-label col-sm-4">Contact Number</label>
            <div class="col-sm-4 padding-right-none">
              <input name="telephone" class="form-control required" id="telephone" title="Please enter phone" value="{{ old('telephone',  isset($personal_data->telephone) ? $personal_data->telephone : '') }}" maxlength="11" />
              <label for="telephone" generated="true" class="error" style="display:none;width:190px;"></label>

            </div>
          </div>

          <div class="form-group">
            <label class="control-label col-sm-4">Employment Status</label>
            <div class="col-sm-8">
              <div class="radio">
                <div class="radio-inline padding-left-none">
                  <input name="emp_status" type="radio" id="emp1"  onclick="showEmployer()" value="Employed" {{ ($personal_data->emp_status == 'Employed' ? "checked":"") }} />
                  <label for="employed">Employed</label>
                </div>
                <div class="radio-inline">
                  <input type="radio" name="emp_status" id="emp2" value="Self-Employed"  onclick="showEmployer()" {{ ($personal_data->emp_status == 'Self-Employed' ? "checked":"") }} />
                  <label for="employed">Self Employed</label>
                </div>
                <div class="radio-inline">
                  <input type="radio" name="emp_status" id="emp3" value="Contract Worker"  onclick="showEmployer()" {{ ($personal_data->emp_status == 'Contract Worker' ? "checked":"") }} />
                  <label for="employed">Contractor</label>
                </div>
              </div>
            </div>
          </div>

          <div class="form-group" id="showEmployer">
            <label class="control-label col-sm-4">Name of your employer</label>
            <div class="col-sm-4 padding-right-none">
              <input name="employer_name" class="form-control required" id="employer_name" title="Please Enter Employer" value="{{ (isset($personal_data->employer_name) ? $personal_data->employer_name:"") }}" maxLength="50"/>
              <label for="employer_name" generated="true" class="error" style="display:none;"></label>
            </div>
          </div>

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

          @if ($product_details->id != $best_mortgage && $product_details->id != $best_loan)
              <div class="form-group">
                <label class="control-label col-sm-4"> When would you like this Insurance to start? </label>
                <div class="col-sm-8 padding-left-none">
                  <div class="col-sm-3 padding-right-none">
                    @if ($insurance_startdate[2] == '00')
                        <input type="hidden" id="insurance_start_day" value="{{ date('d') }}">
                    @else
                        <input type="hidden" id="insurance_start_day" value="{{ $insurance_startdate[2] }}">
                    @endif

                    @if ($insurance_startdate[1] == '00')
                        <input type="hidden" id="insurance_start_month" value="{{ date('m') }}">
                    @else
                        <input type="hidden" id="insurance_start_month" value="{{ $insurance_startdate[1] }}">
                    @endif

                    @if ($insurance_startdate[2] == '0000')
                        <input type="hidden" id="insurance_start_year" value="{{ date('Y') }}">
                    @else
                        <input type="hidden" id="insurance_start_year" value="{{ $insurance_startdate[0] }}">
                    @endif

                    <select class="form-control required" id="insurance_dd" name="insurance_dd"  title="Select Insurance Day">
                              <option value="">DD</option>
                                                            <option value="01">01 </option>
                                                            <option value="02">02 </option>
                                                            <option value="03">03 </option>
                                                            <option value="04">04 </option>
                                                            <option value="05">05 </option>
                                                            <option value="06">06 </option>
                                                            <option value="07">07 </option>
                                                            <option value="08">08 </option>
                                                            <option value="09">09 </option>
                                                            <option value="10">10 </option>
                                                            <option value="11">11 </option>
                                                            <option value="12">12 </option>
                                                            <option value="13">13 </option>
                                                            <option value="14">14 </option>
                                                            <option value="15">15 </option>
                                                            <option value="16">16 </option>
                                                            <option value="17">17 </option>
                                                            <option value="18">18 </option>
                                                            <option value="19">19 </option>
                                                            <option value="20">20 </option>
                                                            <option value="21">21 </option>
                                                            <option value="22">22 </option>
                                                            <option value="23">23 </option>
                                                            <option value="24">24 </option>
                                                            <option value="25">25 </option>
                                                            <option value="26">26 </option>
                                                            <option value="27">27 </option>
                                                            <option value="28">28 </option>
                                                            <option value="29">29 </option>
                                                            <option value="30">30 </option>
                                                            <option value="31">31 </option>
                                                        </select>
                  </div>

                  <div class="col-sm-3 padding-right-none">
                    <select class="form-control required" id="insurance_mm"  name="insurance_mm"  title="Select Insurance Month">
                      <option value="">MM</option>
                      <option value="01">Jan</option>
                      <option value="02">Feb</option>
                      <option value="03">Mar</option>
                      <option value="04">Apr</option>
                      <option value="05">May</option>
                      <option value="06">Jun</option>
                      <option value="07">Jul</option>
                      <option value="08">Aug</option>
                      <option value="09">Sept</option>
                      <option value="10">Oct</option>
                      <option value="11">Nov</option>
                      <option value="12">Dec</option>
                    </select>
                  </div>

                  <div class="col-sm-3 padding-right-none">
                    <select name="insurance_yy" id="insurance_yy" class="form-control required" title="Select Insurance Year">
                      <option value="">YYYY</option>
                      <option value="2025">2025</option>
                    </select>
                  </div>

                  <div class="col-sm-12">
                    <label for="insurance_dd" generated="true" class="error1 col-sm-8"></label>
                    <label for="insurance_mm" generated="true" class="error1 col-sm-8"></label>
                    <label for="insurance_yy" generated="true" class="error1 col-sm-8"></label>
                  </div>

                </div>
              </div>


              @if ($product_details->id != $simple_income && $product_details->id != $instaprotect)
                <div class="form-group">
                  <label class="control-label col-sm-4"><i class="fa fa-question-circle" aria-hidden="true"> </i> Are you transferring cover from another provider? </label>

                  <div class="col-sm-4 padding-right-none">
                    <div class="radio">
                      <div class="radio-inline padding-left-none">
                        <input name="transfer" id="transfer1" type='radio' value='Yes' onclick="javascript:currentprovider()" {{ ($personal_data->transfer == 'Yes' ? "checked":"") }} />
                        <label for="employed">Yes</label>
                      </div>
                      <div class="radio-inline">
                        <input type='radio' value='No' name="transfer"  id="transfer2" onclick="javascript:currentprovider()" {{ ($personal_data->transfer == 'No' || $personal_data->transfer == '' ? "checked":"") }} />
                        <label for="employed">No</label>
                      </div>
                    </div>
                  </div>
                </div>

                <div id="transfercover" class="form-group">
                    <label class="control-label col-sm-4">Name of the current provider</label>
                    <div class="col-sm-4 padding-right-none">
                      <input name="current_provider" class="form-control required" id="current_provider"  title="Please Enter Current Provider"  value="{{ $personal_data->current_provider }}" maxlength="35">
                    </div>
                    <div class="clearfix"></div>
                    <br>
                    <label class="control-label col-sm-4">Date on which the current policy was incepted </label>
                    <div class="col-sm-4 padding-right-none">
                      <input name="current_policy_date" class="form-control required" id="current_policy_date" value="{{ $personal_data->current_policy_date }}"   title="Please Enter Policy Date">
                    </div>

                </div>

              @endif

          @endif

          <div class="form-group" >
            <div class="col-sm-12">
              <p>{{$product_details->product_info1}}</p>
              <ul class="links">
                <li><a target="_blank" href="{{ URL::asset('assets/policydocuments') }}/{{$product_details->policy_wordings_doc}}" >Policy Wordings</a> <i class="fa fa-file-pdf-o" aria-hidden="true"></i></li>
                <li><a target="_blank" href="{{ URL::asset('assets/policydocuments') }}/{{$product_details->keyfacts_doc}}">Key Facts Document</a> <i class="fa fa-file-pdf-o" aria-hidden="true"></i></li>
                <li><a target="_blank" href="{{ URL::asset('assets/policydocuments') }}/{{$product_details->intial_disclosure_doc}}">Intial Disclosure Document</a> <i class="fa fa-file-pdf-o" aria-hidden="true"></i></li>
              </ul>
              <p>{{$product_details->product_info2}}</p>
            </div>
          </div>

          <div class="form-group" id="declaration">

            <label class="control-label col-sm-12 text-left"><strong>Declaration</strong></label>
            <div class="col-sm-12">
              <div style="height:125px;overflow:auto;border:5px solid #ccc;-moz-border-radius:5px;padding-left:10px;">
                {!!$product_details->disclaimer!!}
              </div><br />

              <input type="checkbox" name="declaration_confirm" id="declaration_confirm"  class="required"    {{ ($personal_data->marketingOptOut == 'Y' ? "checked":"") }} />
                {{$product_details->self_decleration}}

              <div class="clearfix"></div>
              <label for="declaration_confirm" generated="true" class="error"style="display:none;"></label>

            </div>

          </div>

          <div class="form-group">

            <label class="control-label col-sm-12 text-left">
              <strong>
                <i class="fa fa-unlock-alt" aria-hidden="true"></i>
       Keeping you informed
              </strong>
            </label>
            <div class="col-sm-12">
              <p>We would like to keep you informed about products, services and additional benefits that we believe may be of interest to you. If you want us to do this, please tick this box.
                <input type=checkbox value='Y' name="marketingOptOut" id="marketingOptOut" class="required" {{ ($personal_data->marketingOptOut == 'Y' ? "checked":"") }} />
              </p>
              <label for="marketingOptOut" generated="true" class="error"style="display:none;"></label>
            </div>

          </div>

        </div><!-- class bg end-->

        <input type="hidden" name="product_id" id="product_id" value="{{ $product_details->id}}">
        <input type="hidden" name="quot_id" id="quot_id" value="{{ $quote_details['id']}}">

        <div class="form-btns">
            <button type="submit" class="medium-btn btn-default" >Continue</button>
        </div>
      </form>
    </div>


    <input type="hidden"  id="instaprotect" value="{{ $instaprotect}}">
    <input type="hidden"  id="best_mortgage" value="{{ $best_mortgage}}">
    <input type="hidden"  id="best_loan" value="{{ $best_loan}}">

    <input type="hidden" id="current_year" value="{{ $current_year }}">
    <input type="hidden" id="current_month" value="{{ $current_month }}">
    <input type="hidden" id="current_date" value="{{ $current_date }}">


    <div class="col-md-3 padding-none right-col border-left-none">
      @include('slices.frontend.get-a-quot.right_top')
      @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/personal_details_add.js') }}"></script>
@stop