@extends('layouts.admin')
@section('pageTitle')
  <title>Best Insurance | Incompleted Leads</title>
@stop
@section('pageCss')
<link rel="stylesheet" href="{{ URL::asset('assets/plugins/datepicker/datepicker3.css') }}">
@stop
@section('content')
<section class="content">
  <div class="box">
            <div class="box-body no-padding">
            </div>
             <div class="box">
             @if(isset($policy_prefix))
              {{--*/ $policy_number = $policy_prefix->policy_prefix.$information->policy_number /*--}}
            @else
              {{--*/ $policy_number = '' /*--}}
            @endif

            @if(isset($policy_prefix))
              {{--*/ $policy_pre = $policy_prefix->policy_prefix /*--}}
            @else
              {{--*/ $policy_pre = '' /*--}}
            @endif

            @if(isset($policy_prefix->product_name))
              {{--*/ $product_name = $policy_prefix->product_name /*--}}
            @else
              {{--*/ $product_name = '' /*--}}
            @endif

            @if(isset($information->insurer))
              {{--*/ $insurer = $information->insurer /*--}}
            @else
              {{--*/ $insurer = '' /*--}}
            @endif

            <!-- /.box-header -->
            <div class="box-body">
                <div class="box box-warning">
            <div class="box-header with-border">
              <h3 class="box-title">
                @if($policy_number != '')
                  {{$product_name.' - '.$policy_number}}
                @else
                  {{$information->title.' '.$information->fname.' '.$information->lname}}
                @endif
              </h3>
            </div>
            <!-- /.box-header -->
            <div class="box-body col-md-12">
              {!! Form::open(array('url' => 'account/update-incomplete-lead','id' => 'formValidation')) !!}
                <!-- text input -->
                <span class=" control-label "></span>
                <div class="form-group col-md-6 required">

                    <!-- Quote Id -->
                    {{ Form::hidden('id', $information->id)}}
                    <span class=" control-label "></span>
      
                    {!! Form::label('Type of Protection') !!}
                    {{ Form::select('typeofprotection', [
                        '0' => 'Select ',
                        'income_protection' => 'Income Protection',
                        'payment_protection' => 'Payment Protection',
                        'payment_protection_plus' => 'Payment Protection Plus'],$information->typeofprotection,
                       ['class' => 'form-control select2 select2-hidden-accessible']
                    ) }}
                </div>
                <div class="form-group col-md-6 required">
                <span class=" control-label "></span>
                    {!! Form::label('Insurer') !!}
                    {{ Form::select('insurer', [
                       '0' => 'Select',
                       'UKGI' => 'UKGI',
                       'Alpha' => 'Alpha',
                       'MMS' => 'MMS',
                       'Keystone' => 'Keystone'],$information->insurer,
                       ['class' => 'form-control select2 select2-hidden-accessible']
                    ) }}
                </div>
                <div class="form-group col-md-6 required">
                <span class=" control-label "></span>
                    {!! Form::label('Title') !!}
                    {{ Form::select('title', [
                       '0' => 'Select',
                       'Mr.' => 'Mr.',
                       'Ms.' => 'Ms.',
                       'Mrs.' => 'Mrs.',
                       'Dr.' => 'Dr.',
                       'Rev.' => 'Rev.',
                       'Miss.' => 'Miss'],$information->title,
                       ['class' => 'form-control select2 select2-hidden-accessible']
                    ) }}
                </div>
                <div class="form-group col-md-6 required">
                <span class=" control-label "></span>
                    {{ Form::label('First Name') }}
                    {{ Form::text('fname', $information->fname, 
                       array( 
                      'class'=>'form-control', 'required')) 
                    }}
                </div>
                <div class="form-group col-md-6 required">
                <span class=" control-label "></span>
                    {{ Form::label('Last Name') }}
                    {{ Form::text('lname', $information->lname, 
                       array( 
                      'class'=>'form-control', 'required')) 
                    }}
                </div>
                <div class="form-group col-md-6">
                    {{ Form::label('Date Of Birth') }}
                    {{ Form::text('dob', $information->dob, 
                       array( 'readOnly' => 'true',
                      'class'=>'form-control', 'required', 'id' => 'datepicker',
                      )) 
                    }}
                </div>
                <div class="form-group col-md-6">
                <!-- {{ Form::label('Employee Status')}} -->
                @if($information->emp_status == 'Employed')

                    {{ 'Employed ' }}
                    {{ Form::radio('emp_status', 'Employed',true) }}&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    {{ 'Self-Employed '}}
                    {{ Form::radio('emp_status', 'Self-Employed') }}&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    {{ 'Contractor ' }}
                    {{ Form::radio('emp_status', 'Contractor') }}

                @elseif($information->emp_status == 'Self-Employed')
                  
                    {{ Form::label('Employed') }}
                    {{ Form::radio('emp_status', 'Employed') }}&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    {{ Form::label('Self-Employed') }}
                    {{ Form::radio('emp_status', 'Self-Employed',true) }}&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    {{ Form::label('Contractor') }}
                    {{ Form::radio('emp_status', 'Contractor') }}

                @elseif($information->emp_status == 'Contractor')
                  
                    {{ Form::label('Employed') }}
                    {{ Form::radio('emp_status', 'Employed') }}&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    {{ Form::label('Self-Employed') }}
                    {{ Form::radio('emp_status', 'Self-Employed') }}&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    {{ Form::label('Contractor') }}
                    {{ Form::radio('emp_status', 'Contractor',true) }}
                @else

                    {{ Form::label('Employed') }}
                    {{ Form::radio('emp_status', 'Employed') }}&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    {{ Form::label('Self-Employed') }}
                    {{ Form::radio('emp_status', 'Self-Employed') }}&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
                    {{ Form::label('Contractor') }}
                    {{ Form::radio('emp_status', 'Contractor') }}
                @endif

                </div>
                <div class="form-group col-md-6">
                    {{ Form::label('Occupation') }}
                    {{ Form::text('occupation', $information->occupation, 
                       array(
                      'class'=>'form-control')) 
                    }}
                </div>
                <div class="form-group col-md-6">
                    {{ Form::label('Employer Name') }}
                    {{ Form::text('employer_name', $information->employer_name, 
                       array(
                      'class'=>'form-control')) 
                    }}
                </div>
                <div class="form-group col-md-6">
                    {{ Form::label('Premise Name') }}
                    {{ Form::text('premiseName', $information->lname, 
                       array( 
                      'class'=>'form-control', 'required')) 
                    }}
                </div>
                <div class="form-group col-md-6 required">
                <span class=" control-label "></span>
                    {{ Form::label('Address1') }}
                    {{ Form::text('address1', $information->address1, 
                       array(
                      'class'=>'form-control', 'required')) 
                    }}
                </div>
                <div class="form-group col-md-6 required">
                <span class=" control-label "></span>
                    {{ Form::label('Address2') }}
                    {{ Form::text('address2', $information->address2, 
                       array( 
                      'class'=>'form-control', 'required')) 
                    }}
                </div>
                <div class="form-group col-md-6">
                    {{ Form::label('Address3') }}
                    {{ Form::text('address3', $information->address3, 
                       array( 
                      'class'=>'form-control')) 
                    }}
                </div>
                <div class="form-group col-md-6">
                    {{ Form::label('Address4') }}
                    {{ Form::text('address4', $information->address4, 
                       array( 
                      'class'=>'form-control')) 
                    }}
                </div>
                <div class="form-group col-md-6 required">
                    {{ Form::label('Postcode') }}
                    <span class=" control-label "></span>
                    {{ Form::text('postcode', $information->postcode, 
                       array(
                      'class'=>'form-control', 'required')) 
                    }}
                </div>
                <div class="form-group col-md-6 required">
                <span class=" control-label "></span>
                    {{ Form::label('Email') }}
                    {{ Form::email('email', $information->email, 
                       array(
                      'class'=>'form-control', 'required')) 
                    }}
                </div>
                <div class="form-group col-md-6 required">
                <span class=" control-label "></span>
                    {{ Form::label('Telephone') }}
                    {{ Form::text('telephone', $information->telephone, 
                       array(
                      'class'=>'form-control', 'required')) 
                    }}
                </div>
                <div class="form-group col-md-6 required">
                <span class=" control-label "></span>
                    {{ Form::label('Insurance Startdate') }}
                    {{ Form::text('insurance_startdate', date('m/d/Y',strtotime($information->insurance_startdate)), 
                       array(
                      'class'=>'form-control', 
                      'id' => 'insurerStartdate','required')) 
                    }}
                </div>
                <div class="form-group col-md-6">
                    {{ Form::label('Type Of Cover') }}
                    {{ Form::select('typeofcover', [
                          '0' => 'select',
                          'ASU' => 'Unemployment, Accident &amp; Sickness',
                          'U' => 'Unemployment only',
                          'AS' => 'Accident &amp; Sickness only'

                    ],$information->typeofcover, 
                       array('class'=>'form-control')) 
                    }}
                </div>
                <div class="form-group col-md-6">
                    {{ Form::label('Monthly Commitment') }}
                    {{ Form::text('monthlycommitment', $information->monthlycommitment, 
                       array( 
                      'class'=>'form-control', 
                      'id' => '')) 
                    }}
                </div>
                <div class="form-group col-md-6 required">
                <span class=" control-label "></span>
                    {{ Form::label('Age') }}
                    {{ Form::text('age', $information->age, 
                       array( 
                      'class'=>'form-control', 'required', 
                      'id' => '')) 
                    }}
                </div>
                <div class="form-group col-md-6">
                    {{ Form::label('Monthly Benefit') }}
                    {{ Form::text('monthlybenefit', $information->monthlybenefit, 
                       array(
                      'class'=>'form-control', 
                      'id' => '')) 
                    }}
                </div>
                <div class="form-group col-md-6 required">
                <span class=" control-label "></span>
                    {{ Form::label('Monthly Cost including 6% IPT') }}
                    {{ Form::text('monthlycost',  number_format((float)str_replace(',','',$information->monthlycost), 2, '.', ''), 
                       array('class'=>'form-control', )) 
                    }}
                </div>
                <div class="form-group col-md-6">
                    {{ Form::label('cover') }}
                    {{ Form::text('cover', $information->cover, 
                       array(
                      'class'=>'form-control', 
                      'id' => '')) 
                    }}
                </div>
                <div class="form-group col-md-6">
                    {{ Form::label('Excess period') }}
                    {{ Form::select('excessperiod', [
                          '1' => 'Back to day 1',
                          '30' => '30 days',
                          '60' => '60 days',
                        ],$information->insurance_startdate, 
                       array(
                      'class'=>'form-control', 
                      'id' => '')) 
                    }}
                </div>
                <div class="form-group col-md-6">
                    {{ Form::label('Account Name') }}
                    {{ Form::text('accountname', $information->accountname, 
                       array( 
                      'class'=>'form-control', 
                      'id' => '')) 
                    }}
                </div>
                <div class="form-group col-md-6">
                    {{ Form::label('Account Number') }}
                    {{ Form::text('accountnumber', $information->accountnumber, 
                       array( 
                      'class'=>'form-control', 
                      'id' => '')) 
                    }}
                </div>
                <div class="form-group col-md-6">
                    {{ Form::label('Sortcode') }}
                    {{ Form::text('sortcode', $information->sortcode, 
                       array( 
                      'class'=>'form-control')) 
                    }}
                </div>
                <div class="form-group col-md-6 required">
                <span class=" control-label "></span>
                    {{ Form::label('Source') }}
                    {{ Form::text('affid', $information->affid, 
                       array('class'=>'form-control', 'required')) 
                    }}
                </div>
                <div class="form-group col-md-6">
                    {{ Form::label('Status') }}
                    {{ Form::select('status',[
                          '0' => 'Yet to contact',
                          'Call 15' => 'Call 15',
                          'Call Day 1-7' => 'Call Day 1-7',
                          'Call Day 8-21' => 'Call Day 8-21',
                          'Call Day 21 plus' => 'Call Day 21 plus',
                          'Quote sent' => 'Quote sent',
                          'Organised Call Back' => 'Organised Call Back',
                          'NLI' => 'NLI',
                          'Gone Elsewhere' => 'Gone Elsewhere',
                          'Invalid' => 'Invalid',
                          'Sold' => 'Sold'

                        ], $information->status, 
                         array( 
                        'class'=>'form-control')) 
                    }}
                </div>
                @if(isset($productQuestions) && $questions)

                @foreach($productQuestions as $key => $que)

                @if($que != '' && !empty($que))

                  <div class="form-group col-md-12">
                    <div class="col-md-12"> 
                     <label> {!! $que !!}  </label>
                      <br>
                      {{'- '.$questions->$key}}
                    </div>
                  </div>

                @endif
                @endforeach
                @endif
                <div class="form-group col-md-6">
                    {{ Form::label('Notes') }}
                    {{ Form::textArea('comment', $information->comment, 
                       array('class'=>'form-control','rows' => '4')) 
                    }}
                </div>
                
                <div class="form-group col-md-12">
                    {{ Form::submit('Submit',array('class'=>'btn btn-success','rows' => '4')) 
                    }}
                </div>
             
              </form>
            </div>
            <!-- /.box-body -->
          </div>
          </div>
            <!-- /.box-body -->
        </div>
    </div>
</section>

@stop
@section('pageBottomJs')
<style type="text/css">
   .error{
        color: red
    }
    /*required field asterisk symbol */
    .form-group.required .control-label:after {
      content:"*";
      color:red;
    }

</style>
<script src="{{ URL::asset('assets/plugins/datepicker/bootstrap-datepicker.js') }}"></script>
<script>
    $(document).ready(function () {

        $('#datepicker').datepicker({
          autoclose: true
        });
        $('#insurerStartdate').datepicker({
          autoclose: true

        });

         // form validation rules for select box
        $.validator.addMethod("valueNotEquals", function(value, element, arg){
          return arg != value;
        }, "This field is required.");

        $('#formValidation').validate({
          rules:{
            fname:{
              required:true
            },
            lname:{
              required:true
            },
            policy_number:{
              required:true
            },
            policyStartdate:{
              required:true
            },
            monthlybenefit:{
              required:true
            },
            monthlycost:{
              required:true
            },
            affid:{
              required:true
            },
            typeofprotection:{
              valueNotEquals:'0'
            },
            postcode:{
              maxlength:7
            },
            insurer:{
              valueNotEquals:'0'
            },
            title:{
              valueNotEquals:'0'
            }
          },
          messages:{
            fname:'* Please enter first name.',
            lname:'* Please enter last name.',
            policy_number:'* Please enter policy number.',
            policyStartdate:'* Please select policy start date.',
            monthlybenefit:'* Please enter monthly benifit amount.',
            monthlycost:'* Please enter monthly cost.',
            affid:'* Please enter source.',
            postcode:'* Please enter postcode and max length should be 7.',
            typeofprotection:'* Please select type of protection.',
            insurer:'* Please select insurer.',
            title : '* Please select title.'
           
          }
      });

        //date picker for insurer start date
        // $('#insurerStartdate').datepicker({
        //   autoclose: true,
        //   dateFormat:'YYYY-mm-dd'
        // });

    });
</script>
@stop