
<!-- Modal ADD NOMINEE-->
<div class="modal fade" id="md_update_nominee" tabindex="-1" role="dialog" aria-labelledby="exampleModallabel" aria-hidden="true">
  <?php echo e(Form::open(array('route' => 'nominee.update', 'id' => 'form_update_nominee', 'class' => 'cls_from', 'enctype' => 'multipart/form-data'))); ?>

  <div class="modal-dialog modal-lg" role="document">
    <div class="modal-content">
      <div class="modal-header">
        <h5 class="modal-title" id="exampleModallabel">Update Nominee/Co-Owner</h5>
        <button type="button" class="close" data-dismiss="modal" aria-label="Close">
          <span aria-hidden="true"></span>
        </button>
      </div>
      <div class="modal-body">
        <div class ="card">
          <div class = "card-header">
            <strong> Nominee/Co-Owner</strong>
              </div>
            <div class ="card-body form-fieldset">
              <div class = "row">
                   <input type="hidden" name="<?php echo e($branch_labels['module']); ?>"  />
           <div class="col-sm-6">
            <label class="label-color">Type: <i style = "color:red;">*</i></label>
            <small class="form-errors pull-right req" value="*"><?php echo e($errors->first('nok_type',":message")); ?></small>
      
            <div class="input-group mb-3">
             
              <?php ($type_list = []); ?>

              <?php $__currentLoopData = EF::getNomineeType(); $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $rows): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                <?php ($type_list += [$rows => $rows]); ?>
              <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>

             <?php echo e(Form::select('nok_type', $type_list, '' , array('class' => 'form-control form-control-sm  cls_selection'))); ?>

            </div>    
          </div>
          
            <div class="col-sm-6">
              <label class="label-color">Relation: <i style = "color:red;">*</i></label>
            <small class="form-errors pull-right req" value="*"><?php echo e($errors->first('relation_ship',":message")); ?></small>
 
            <div class="input-group mb-3">
      
              <?php echo e(Form::Text('relation_ship', '', ['class' => 'form-control form-control-sm  cls_req', 'placeholder' => 'Nominee Relation' ,'readonly'=>'true', 'aria-label' => 'Default', 'aria-describedby' => 'inputGroup-sizing-default'])); ?>

            </div>
          </div>
        
        <input type="hidden" name="nok">
         <input type="hidden" name="user">

              </div>
            </div>
        
        </div>
          <div class ="card">
          <div class = "card-header">
            <strong> Personal Information</strong>
              </div>
            <div class ="card-body form-fieldset">
              <div class = "row">
                   <div class="col-sm-12">
                    <label class="label-color">CNIC: <i style = "color:red;"></i></label>
            <small class="form-errors pull-right req" value="*"><?php echo e($errors->first('cnic',":message")); ?></small>
            <div class="input-group mb-3">
      
              <?php echo e(Form::Text('cnic', '', ['class' => 'form-control form-control-sm ', 'data-mask' => '00000-0000000-0', 'data-mask-clearifnotmatch' => 'true' ,'placeholder' => '00000-0000000-0'  ,'readonly'=>'true' ,'aria-label' => 'Default', 'aria-describedby' => 'inputGroup-sizing-default'])); ?>

            </div>
          </div>
            

          <div class="col-sm-6">
            <label class="label-color">Name: <i style = "color:red;">*</i></label>
            <small class="form-errors pull-right req" value="*"><?php echo e($errors->first('full_name',":message")); ?></small>

            <div class="input-group mb-3">
        
              <?php echo e(Form::Text('full_name', '', ['class' => 'form-control form-control-sm  cls_fullname', 'placeholder' => 'Full name' , 'aria-label' => 'Default', 'aria-describedby' => 'inputGroup-sizing-default'])); ?>

            </div>
           
            
          </div>



          <div class="col-sm-6">
            <label class="label-color">Father Name: <i style = "color:red;">*</i></label>
            <small class="form-errors pull-right req" value="*"><?php echo e($errors->first('father_name',":message")); ?></small>

            <div class="input-group mb-3">
        
              <?php echo e(Form::Text('father_name', '', ['class' => 'form-control form-control-sm  cls_fullname', 'placeholder' => 'Father name' , 'aria-label' => 'Default', 'aria-describedby' => 'inputGroup-sizing-default'])); ?>

            </div>
          </div>

          <div class="col-sm-6">
              <small class="form-errors pull-right req" value="*"><?php echo e($errors->first('gender',":message")); ?></small>
               <label class="radio-inline" >
                <strong>Gender </strong>
                      <input type="radio" name="gender" value="Male" checked> Male
                </label>
                <label class="radio-inline">
                  <input type="radio" name="gender" value="Female"> Female
                </label>
            </div>

            <div class="col-sm-6">
              <small class="form-errors pull-right req" value="*"><?php echo e($errors->first('relation',":message")); ?></small>
               <label class="radio-inline" >
                <strong>Relation </strong>
                      <input type="radio" name="relation" value="S/O" checked> S / O 
                </label>

                <label class="radio-inline">
                  <input type="radio" name="relation" value="D/O"> D / O 
                </label>

                <label class="radio-inline">
                  <input type="radio" name="relation" value="W/O"> W / O 
                </label>
            </div>

          

  

          <div class="col-sm-6">
            <label class="label-color">Nationality:</label>
            <small class="form-errors pull-right req" value=""><?php echo e($errors->first('nationality',":message")); ?></small>

            <div class="input-group mb-3">
           
              <?php echo e(Form::Text('nationality', '', ['class' => 'form-control form-control-sm  cls_fullname', 'placeholder' => 'Nationality' , 'aria-label' => 'Default', 'aria-describedby' => 'inputGroup-sizing-default'])); ?> 

            </div>
          </div>
                <div class="col-sm-6">
               <label class="label-color">Passport:</label>
            <small class="form-errors pull-right req" value=""><?php echo e($errors->first('nationality',":message")); ?></small>

            <div class="input-group mb-3">
              <?php echo e(Form::Text('passport', '', ['class' => 'form-control form-control-sm cls_alpha_numeric', 'placeholder' => 'Passport' , 'aria-label' => 'Default', 'aria-describedby' => 'inputGroup-sizing-default'])); ?> 

            </div>
          </div>


          <div class="col-sm-6">
            <label class="label-color">Occupation:</label>
            <small class="form-errors pull-right req" value=""><?php echo e($errors->first('occupation',":message")); ?></small>

            <div class="input-group mb-3">
         
              <?php echo e(Form::Text('occupation', '', ['class' => 'form-control form-control-sm  cls_fullname', 'placeholder' => 'Occupation' , 'aria-label' => 'Default', 'aria-describedby' => 'inputGroup-sizing-default'])); ?> 

            </div>
          </div>

          <div class="col-sm-6">
            <label class="label-color">Dob:</label>
            <small class="form-errors pull-right req" value=""><?php echo e($errors->first('dob',":message")); ?></small>

            <div class="input-group mb-3">
     
              <?php echo e(Form::Date('dob', '', ['class' => 'form-control form-control-sm  cls_date', 'placeholder' => 'Date of birth' , 'aria-label' => 'Default', 'aria-describedby' => 'inputGroup-sizing-default'])); ?>

            </div>
          </div>

          <div class="col-sm-6">
            <label class="label-color">Contact: <i style = "color:red;">*</i></label>
            <small class="form-errors pull-right req" value="*"><?php echo e($errors->first('contact',":message")); ?></small>

            <div class="input-group mb-3">
             
              <?php echo e(Form::Text('contact', '', ['class' => 'form-control form-control-sm  cls_contact', 'placeholder' => 'Contact no' , 'aria-label' => 'Default', 'aria-describedby' => 'inputGroup-sizing-default','data-mask' => '0000-0000000', 'data-mask-clearifnotmatch' => 'true' ,'placeholder' => '0000-0000000'])); ?>

            </div>
          </div>
             <div class="col-sm-6">
               <label class="label-color">Other Contact: </label>
            <small class="form-errors pull-right req" value=""><?php echo e($errors->first('other_contact',":message")); ?></small>

            <div class="input-group mb-3">
            
              <?php echo e(Form::Text('other_contact', '', ['class' => 'form-control form-control-sm cls_contact', 'placeholder' => 'Other Contact' , 'aria-label' => 'Default', 'aria-describedby' => 'inputGroup-sizing-default'])); ?>

            </div>
          </div>


          <div class="col-sm-6">
            <label class="label-color">Temporary Address:</label>
            <small class="form-errors pull-right req" value=""><?php echo e($errors->first('temporary_address',":message")); ?></small>

            <div class="input-group mb-3">
    
              <?php echo e(Form::Textarea('temporary_address', '', ['class' => 'form-control form-control-sm ', 'placeholder' => 'Temporary address' , 'aria-label' => 'Default', 'aria-describedby' => 'inputGroup-sizing-default','rows' => 2])); ?>

            </div>
          </div>

           <div class="col-sm-6">
            <label class="label-color">Permanent Address:</label>
            <small class="form-errors pull-right req" value=""><?php echo e($errors->first('permanent_address',":message")); ?></small>

            <div class="input-group mb-3">
             
              <?php echo e(Form::textarea('permanent_address', '', ['class' => 'form-control form-control-sm ', 'placeholder' => 'Permanent address' , 'aria-label' => 'Default', 'aria-describedby' => 'inputGroup-sizing-default','rows' => 2])); ?>

            </div>
          </div>

           <div class="col-sm-12">
            <small class="form-errors pull-right req" value=""><?php echo e($errors->first('user_image',":message")); ?></small>

            <div class="input-group mb-3">
              <div class="input-group-prepend">
                <span class="input-group-text" id="inputGroup-sizing-default">
                  <i class="fa fa-camera "></i>
                </span>
              </div>
              <input type="file" name="user_image" class="form-control form-control-sm  btn-sm">
             <div class="input-group-prepend">
                <span class="input-group-text" id="inputGroup-sizing-default">
                  <i >PNG,JPG,JPEG</i>
                </span>
              </div>

            </div>
          </div>
              </div>
            </div>
        
        </div>
          <div class ="card">
          <div class = "card-header">
            <strong> Account Information</strong>
              </div>
            <div class ="card-body form-fieldset">
              <div class = "row">


                         <div class="col-sm-12">
                          <label class="label-color">Email:</label>
                  <small class="form-errors pull-right req" value=""><?php echo e($errors->first('email',":message")); ?></small>

                  <div class="input-group mb-3">
                  
                    <?php echo e(Form::Email('email', '', ['class' => 'form-control form-control-sm  cls_email', 'placeholder' => 'Email' , 'aria-label' => 'Default', 'aria-describedby' => 'inputGroup-sizing-default'])); ?> 

                  </div>
                </div>
              </div>
            </div>
        
        </div>
    
      </div>
      <div class="modal-footer">
        <button type="button" class="btn btn-secondary" data-dismiss="modal">Close</button>
        <button onClick="storeUser(event,this)" type="submit"  class="btn btn-primary cls_submit " content="update nominee">Update Nominee</button>
      </div>
    </div>
  </div>
  <?php echo e(Form::close()); ?>

</div>

<!-- END MODAL ADD NOMINEE --><?php /**PATH /var/www/skylite/resources/views/user/modals/update_nominee.blade.php ENDPATH**/ ?>