@extends('layouts.admin')
@section('pageTitle')
  <title>Best Insurance | Completed Leads</title>
@stop
@section('pageCss')
<link rel="stylesheet" href="{{ URL::asset('assets/plugins/datepicker/datepicker3.css') }}">
@stop
@section('content')
<section class="content mtablock">
    <div class="box">
            <div class="box box-warning ">
              <div class="box-header with-border text-center">
                <h2 class="box-title " > <b>Policy Cancellation </b></h2>
              </div>
            </div>
            <div class="form-group box-body no-padding ">
                <form action="{{url('cancelled')}}" method="POST"  id="cancelled_window_form">
                    {!!csrf_field()!!}
                    <input type="hidden" name="lead_id" value="{{$lead_id}}">

                       <div class="form-group col-md-12">
                          <!-- Quote Id -->
                          <!-- <i class="fa fa-star" aria-hidden="true"></i> -->
                          <div class="col-md-3"><b>
                          <span class=" control-label ">&nbsp;&nbsp;&nbsp;</span>
                           Cancel Period*</b> </div>
                          <div class="col-md-4">
                              <select name="cancel_period"  id="cancel_period" >
                                <option value="">Select Cancel Period</option>
                                @foreach($cancellation_periods as $cancellation_period_code)
                                @if(old('cancel_period') == $cancellation_period_code->cancell_code)
                                    <option selected value="{{$cancellation_period_code->cancell_code}}">{{$cancellation_period_code->cancell_reason}}</option>
                                @else
                                    <option value="{{$cancellation_period_code->cancell_code}}">{{$cancellation_period_code->cancell_reason}}</option>
                                @endif
                                @endforeach
                              </select>
                              @if($errors->has('cancel_period'))
                                  <div class="error">{{ $errors->first('cancel_period') }}</div>
                              @endif
                          </div>
                       </div>

                      @if($payment_type!="BNPOLDFinance")
                      <div class="form-group col-md-12">
                          <!-- Quote Id -->
                          <!-- <i class="fa fa-star" aria-hidden="true"></i> -->
                          <div class="col-md-3"><b>
                          <span class=" control-label ">&nbsp;&nbsp;&nbsp;</span>
                           Cancel Code*</b> </div>
                          <div class="col-md-4">
                              <select name="cancel_code"  id="cancel_code" >
                                <option value="">Select Cancel Code</option>
                                @foreach($cancellation_codes as $cancellation_code)
                                @if(old('cancel_code') == $cancellation_code->cancell_code)
                                    <option selected value="{{$cancellation_code->cancell_code}}">{{$cancellation_code->cancell_reason}}</option>
                                @else
                                    <option value="{{$cancellation_code->cancell_code}}">{{$cancellation_code->cancell_reason}}</option>
                                @endif
                                @endforeach
                              </select>
                              @if($errors->has('cancel_code'))
                                  <div class="error">{{ $errors->first('cancel_code') }}</div>
                              @endif
                          </div>
                       </div>
                       @endif
                       @if($payment_type=="BNPOLDFinance")
                          <div class="form-group col-md-12">
                          <!-- Quote Id -->
                          <!-- <i class="fa fa-star" aria-hidden="true"></i> -->
                          <div class="col-md-3"><b>
                          <span class=" control-label ">&nbsp;&nbsp;&nbsp;</span>
                           Cancel Reason Type*</b> </div>
                          <div class="col-md-4">
                              <select name="cancel_code"  id="cancel_code" >
                                <option value="">Select Cancel Reason Type</option>
                                <option value="1">BrokerError</option>
                                <option value="2">ChangeCustomerDetails</option>
                                <option value="3">CustomerPaidInFull</option>
                                <option value="4">CustomerSoldVehicle</option>
                                <option value="5">Deceased</option>
                                <option value="6">Default</option>
                                <option value="7">DuplicateAgreement</option>
                                <option value="8">FailedInsurerValidation</option>
                                <option value="9">FirstPaymentDefault</option>
                                <option value="10">HouseSale</option>
                                <option value="11">NoProofOfNoClaim</option>
                                <option value="12">PolicyNotTakenUp</option>
                                <option value="13">RenewalNotTakenUp</option>
                                <option value="14">Other</option>
                               

                               
                                    
                              </select>
                              @if($errors->has('cancel_code'))
                                  <div class="error">{{ $errors->first('cancel_code') }}</div>
                              @endif
                          </div>
                       </div>
                       @endif
                       
                       <div class="form-group col-md-12">

                          <div class="col-md-3"><b>
                          <span class=" control-label ">&nbsp;&nbsp;&nbsp;</span>
                           Cancel Date*</b> </div>
                          <div class="col-md-4">
                              <input type="date" required name="cancel_date" id="cancel_date" value="{{old('cancel_date')}}">
                              @if($errors->has('cancel_date'))
                                  <div class="error">{{ $errors->first('cancel_date') }}</div>
                              @endif
                          </div>
                       </div>

                        <div class="form-group col-md-12">

                          <div class="col-md-3"><b>
                          <span class=" control-label ">&nbsp;&nbsp;&nbsp;</span>
                           Cancellation Approve Date* </b> </div>
                          <div class="col-md-4">
                              <input type="date" required name="cancellation_approve_date" id="cancellation_approve_date" readonly >
                              @if($errors->has('cancellation_approve_date'))
                                  <div class="error">{{ $errors->first('cancellation_approve_date') }}</div>
                              @endif
                          </div>
                       </div>

                        <div class="form-group col-md-12">

                          <div class="col-md-3"><b>
                          <span class=" control-label ">&nbsp;&nbsp;&nbsp;</span>
                           Reason* </b> </div>
                          <div class="col-md-4">
                              <textarea rows="5" id="reason" name="reason">{!!old('reason')!!}</textarea>
                              @if($errors->has('reason'))
                                  <div class="error">{{ $errors->first('reason') }}</div>
                              @endif
                          </div>
                       </div>

                       <div class="form-group col-md-12">

                          <div class="col-md-3"><b>
                          <span class=" control-label ">&nbsp;&nbsp;&nbsp;</span>
                           Manual Cancellation (Skip the API)* </b> </div>
                          <div class="col-md-4">
                              <input type="checkbox" name="manual_cancellation" id="manual_cancellation">
                          </div>
                       </div>

                     <div class="form-group col-md-12 text-center">
                         <input  type="submit" value="Submit" class="btn btn-success"/>
                     </div>
                    <!--button id="btnCancelEmailSending"  class="subbtn">Submit & Email</button>-->
                  </form>
            </div>
        </div>
    <!-- </div> -->
</section>