@extends('layout.main')



            @section('main-section')


                <div class="content">

                    <!-- Start Content-->
                    <div class="container-fluid">

                        <!-- start page title -->
                        <div class="row">
                            <div class="col-12">
                                <div class="page-title-box">
                                    <div class="page-title-right">
                                        <ol class="breadcrumb m-0">
                                            <li class="breadcrumb-item"><a href="javascript: void(0);">EFU</a></li>

                                            <li class="breadcrumb-item active">Edit Form</li>
                                        </ol>
                                    </div>
                                    <h4 class="page-title">EFU Property Management Portal</h4>
                                </div>
                            </div>
                        </div>
                        <!-- end page title -->




                        <div class="row">
                            <div class="col-12">
                                <div class="card">
                                    <div class="card-body">
                                        <h4 class="header-title">Edit Application</h4>
                                        <p class="sub-header">
                                          abcd
                                        </p>
                                        <form action="{{url('/edit_store')}}" method="POST">
                                            @csrf

                                            @foreach ($edit as $e)


                                        <div class="row">

                                            <div class="col-lg-6">
                                            <div class="mb-6">
                                                <label for="" class="form-label">Job Id</label>
                                                <input type="text" id="" class="form-control" name="_JobId" placeholder="" value="{{$e->_Claim_Id}}" readonly>
                                            </div>
                                            <p></p>
                                    </div> <!-- end col -->

                                            <div class="col-lg-6">


                                                <div class="mb-6">
                                                    <label for="" class="form-label">Location</label>
                                                    <input type="text" id="" class="form-control" name="_Location" placeholder="Location" value="{{$e->_Location}}" >
                                                </div>
                                                <p></p>
                                        </div> <!-- end col -->

                                        <div class="col-lg-6">


                                            <div class="mb-6">
                                                <label for="" class="form-label">Claim Type </label>
                                                <input type="text" id="" class="form-control" name="_ClaimType" placeholder="Business Line" value="{{$e->_ClaimType}}" >
                                            </div>
                                            <p></p>
                                    </div> <!-- end col -->

                                    <div class="col-lg-6">


                                        <div class="mb-6">
                                            <label for="" class="form-label">Date of Intimation:</label>
                                            <input type="date" value="{{$e->_DateOfIntimation}}" id="" class="form-control" name="_DateOfIntimation" placeholder="Date of Intimation">
                                        </div>
                                        <p></p>
                                </div> <!-- end col -->

                                            <div class="col-lg-6">


                                                    <div class="mb-6">
                                                        <label for="" class="form-label">Branch</label>

                                                        <select id="selectize-select" name="_Branch" class="form-control">
                                                            <option value="{{$e->_Branch}}">{{$e->_Branch}}</option>
                                                            @foreach ($branches  as $branch)

                                                            <option value="{{$branch->_BranchName}}">{{$branch->_BranchName}}</option>

                                                            @endforeach
                                                        </select>
                                                    </div>
                                                    <p></p>
                                            </div> <!-- end col -->



                                              <div class="col-lg-6">


                                                    <div class="mb-6">
                                                        <label for="" class="form-label">Emails for updates - CC:</label>
                                                        <input type="text" id="" class="form-control" name="_EmailsForupdatesCC" placeholder="Emails for updates - CC" value="{{$e->_EmailsForupdatesCC}}">
                                                    </div>
                                                    <p></p>
                                            </div> <!-- end col -->


                                              <div class="col-lg-6">


                                                    <div class="mb-6">
                                                        <label for="" class="form-label">Claim Specification :</label>
                                                        <select id="selectize-select" class="form-control" name="_ClaimSpecification">
                                                            <option value="{{$e->_ClaimSpecification}}">{{$e->_ClaimSpecification}}</option>
                                                            @foreach ($claimSpec as $cj )
                                                            <option value="{{$cj->_ClaimSpecification}}">{{$cj->_ClaimSpecification}}</option>
                                                            @endforeach
                                                        </select>
                                                    </div>
                                                    <p></p>
                                            </div> <!-- end col -->

                                              <div class="col-lg-6">


                                                    <div class="mb-6">
                                                        <label for="" class="form-label">Insured :</label>
                                                        <input type="text" value="{{$e->_Insured}}" id="" class="form-control" name="_Insured" placeholder="Insured / Participant">
                                                    </div>
                                                    <p></p>
                                            </div> <!-- end col -->

                                              <div class="col-lg-6">


                                                    <div class="mb-6">
                                                        <label for="" class="form-label">Corporate Insured Access:</label>

                                                        <select id="selectize-select" class="form-control" name="_Corporate_Insured_BrokerAccess" required>
                                                            <option value="{{$e->_Corporate_Insured_BrokerAccess}}">{{$e->_Corporate_Insured_BrokerAccess}}</option>
                                                            @foreach ($insured as $cnc )
                                                            <option value="{{$cnc->_InsuredName}}">{{$cnc->_InsuredName}}</option>
                                                            @endforeach
                                                        </select>
                                                    </div>
                                                    <p></p>
                                            </div> <!-- end col -->

                                            <div class="col-lg-6">


                                                <div class="mb-6">
                                                    <label for="" class="form-label">Policy Type :</label>
                                                    <select id="selectize-select" class="form-control" name="_Policy_Type">
                                                        <option value="{{$e->_Policy_Type}}">{{$e->_Policy_Type}}</option>
                                                        @foreach ($policyTypes  as $pt)

                                                            <option value="{{$pt->_PolicyType}}">{{$pt->_PolicyType}}</option>

                                                            @endforeach
                                                    </select>
                                                </div>
                                                <p></p>
                                        </div> <!-- end col -->

                                              <div class="col-lg-6">


                                                    <div class="mb-6">
                                                        <label for="" class="form-label">Policy No :</label>
                                                        <input type="text" value="{{$e->_Policy_No}}" id="" class="form-control" name="_Policy_No" placeholder="Policy No ">
                                                    </div>
                                                    <p></p>
                                            </div> <!-- end col -->

                                              <div class="col-lg-6">


                                                    <div class="mb-6">
                                                        <label for="" class="form-label">Loss No. :</label>
                                                        <input type="text" value="{{$e->_Loss_No}}" id="" class="form-control" name="_Loss_No" placeholder="Loss No.">
                                                    </div>
                                                    <p></p>
                                            </div> <!-- end col -->

                                              <div class="col-lg-6">


                                                    <div class="mb-6">
                                                        <label for="" class="form-label">Contact Details :</label>
                                                        <input type="text" value="{{$e->_ContactDetails}}" id="" class="form-control" name="_ContactDetails" placeholder="Contact Details">
                                                    </div>
                                                    <p></p>
                                            </div> <!-- end col -->



                                              <div class="col-lg-12">


                                                    <div class="mb-12">
                                                        <label for="" class="form-label">Description of interest :</label>
                                                        <textarea id="" class="form-control" name="_DescriptionOfInterest" placeholder="Description of interest">{{$e->_DescriptionOfInterest}}</textarea>
                                                    </div>
                                                    <p></p>
                                            </div> <!-- end col -->

                                              <div class="col-lg-6">


                                                    <div class="mb-6">
                                                        <label for="" class="form-label">Assign to Surveyor Company :</label>
                                                        <select id="selectize-select" class="form-control" name="_AssignToSurveyorCompany">
                                                            <option value="{{$e->_AssignToSurveyorCompany}}">{{$e->_AssignToSurveyorCompany}}</option>
                                                            @foreach ($surveyors  as $suv)

                                                            <option value="{{$suv->_SurveyorCompanyName}}">{{$suv->_SurveyorCompanyName}}</option>

                                                            @endforeach
                                                        </select>
                                                     </div>
                                                     <p></p>
                                            </div> <!-- end col -->

                                            <div class="col-lg-12">


                                                <div class="mb-12">
                                                    <label for="" class="form-label">Message for Surveyor :</label>
                                                    <textarea id="" class="form-control" name="_MessageForSurveyor" placeholder="Message for Surveyor">{{$e->_MessageForSurveyor}}</textarea>
                                                </div>
                                                <p></p>
                                        </div> <!-- end col -->

                                        <div class="col-lg-12">


                                            <div class="mb-12">
                                                <button type="submit" class="btn btn-success" id="sa-success">Submit</button>
                                            </div>
                                            <p></p>
                                    </div> <!-- end col -->



                        </div>
                        <!-- end row -->
                        @endforeach
                    </form>

                    </div> <!-- container -->

                </div> <!-- content -->


@endsection('main-section')