@extends('layouts.app')

@section('content')


    <!-- shop-checkout -->
    <div class="shop-checkout">
        <div class="shop-checkout-inner">

            <!-- shop-checkout-top -->
            <div class="shop-checkout-top">
                <div>
                    <h4>Total Premium</h4>

                    <div class="total">
                        @if(session()->has('quote_added') && session('quote_added')['insurance_code'] == 'IT')
                            <div class="original-value"><span>USD</span>{{ number_format(session('quote_added')['total_activation_fee'],2) }}</div>
                            <div class="original-conversion-value"><span>LKR</span>{{ number_format((session('quote_added')['total_activation_fee'] * $usd_conversion_rate),2) }}</div>
                        @else
                            <div class="original-value"><span>LKR</span>{{ number_format(session('quote_added')['total_activation_fee'],2) }}</div>
                        @endif
                            {{--@if (isset($calc_policy_data['mode']) && $calc_policy_data['mode'] == \App\Insurance\Calculations::ANNUALLY)
                                <div class="details blue-bg"> <!-- blue background -->
                                    <div class="amounts">
                                        <!-- detail-line -->
                                        <div class="detail-line">
                                            <div class="detail">
                                                {{ $calc_policy_data['policy_mode_desc'] }}
                                            </div>
                                            <div class="amount">
                                                <span class="currency">LKR</span>
                                                <span class="value">{{number_format($calc_policy_data[$calc_policy_data['mode']]['total_premium']['fixed'] ,2)}}</span>
                                                <span class="taxes">{{ $calc_policy_data['policy_mode_sub_desc'] }}</span>
                                            </div>
                                        </div>
                                        <!-- /detail-line -->
                                    </div>
                                </div>
                            @endif--}}
                        {{--<span class="currency">LKR</span>
                        <span class="value">{{number_format(session('quote_added')['total_activation_fee'] - session('quote_added')['discount_amount'] ,2)}}</span>--}}

                        {{--<span>LKR</span> {{ number_format(session('quote_added')['total_activation_fee'],2) }}</div>--}}
                    </div>
                        <div class="img-holder"><img src="{{asset('/images/fairfirst/store/visa-master.png')}}" alt=""/></div>

                </div>
            </div>
            <!-- /shop-checkout-top -->

                @if(session()->has('success'))
                    <div class="alert alert-success">
                        {{ session()->get('success') }}
                    </div>
                @endif

                @if(request()->route()->getActionName() == 'App\Http\Controllers\ProfileController@index'
            && (Auth::user() && Auth::user()->email && Auth::user()->isProfileCompleted != 1))
            <!-- section-title -->
            <div class="shop-checkout-section-title active">
                <h3>Customer Information</h3>
            </div>
            <!-- /section-title -->

            <!-- customer-information -->
            <div class="shop-checkout-form-section">
                <h2>My Profile</h2>

                <form class="ff-form" name="customer-info-frm" method="POST" action="{{ route('profile-create') }}">
                    {{ csrf_field() }}
                    <div class="form-section-top">
                        <div class="social-login">
                            <div>
                                <h4>Customer Information</h4>
                            </div>
                        </div>
                        <div class="form-part">
                            <div class="form-inner">

                                <!-- form-group -->
                                <div class="row form-group">
                                    <div class="col-lg-12 col-md-12 title {{ $errors->has('title') ? ' has-error' : '' }}">
                                        <div class="ff-label"><label>Title *</label></div>
                                        <select name="title" class="input-lg select2dropdown" required="required">
                                            <option {{ $data['title'] == 'Mr.'?'selected':'' }} value="Mr.">Mr</option>
                                            <option {{ $data['title'] == 'Mrs.'?'selected':'' }} value="Mrs.">Mrs
                                            </option>
                                            <option {{ $data['title'] == 'Miss.'?'selected':'' }} value="Miss.">Miss
                                            </option>
                                            <option {{ $data['title'] == 'Ms.'?'selected':'' }} value="Ms.">Ms</option>
                                            <option {{ $data['title'] == 'Dr.'?'selected':'' }} value="Dr.">Dr</option>
                                            <option {{ $data['title'] == 'Prof.'?'selected':'' }} value="Prof.">Prof
                                            </option>
                                            <option {{ $data['title'] == 'Rev.'?'selected':'' }} value="Rev.">Rev
                                            </option>
                                            <option {{ $data['title'] == 'Other.'?'selected':'' }} value="Other">Other
                                            </option>
                                        </select>
                                        @if ($errors->has('title'))
                                            <span class="help-block">
                                        <strong>{{ $errors->first('title') }}</strong>
                                    </span>
                                        @endif
                                    </div>
                                </div>
                                <!-- form-group -->


                                <!-- form-group -->
                                <div class="row form-group">
                                    <div class="col-lg-6 col-md-6 {{ $errors->has('surname') ? ' has-error' : '' }}">
                                        <div class="ff-label"><label>Surname *</label></div>
                                        <input type="text" name="surname" value="{{ $data['surname'] }}" autofocus
                                               class="form-control input-lg" required="required"
                                               placeholder="Your Surname"/>
                                        @if ($errors->has('surname'))
                                            <span class="help-block">
                                        <strong>{{ $errors->first('surname') }}</strong>
                                    </span>
                                        @endif
                                    </div>
                                    <div class="col-lg-6 col-md-6">
                                        <div class="ff-label {{ $errors->has('initials') ? ' has-error' : '' }}"><label>Initials
                                                *</label></div>
                                        <input type="text" name="initials" value="{{ $data['initials'] }}" autofocus
                                               class="form-control input-lg" required="required"
                                               placeholder="Your Initials"/>
                                        @if ($errors->has('initials'))
                                            <span class="help-block">
                                                <strong>{{ $errors->first('initials') }}</strong>
                                            </span>
                                        @endif
                                    </div>
                                </div>
                                <!-- form-group -->


                                <!-- form-group -->
                                <div class="row form-group">
                                    <div class="col-lg-12 col-md-12">
                                        <div class="ff-label {{ $errors->has('name_denoted_by_initials') ? ' has-error' : '' }}"
                                        "><label>Names Denoted by Initials *</label></div>
                                    <input type="text" name="name_denoted_by_initials"
                                           value="{{ $data['name_denoted_by_initials'] }}" autofocus
                                           class="form-control input-lg" required="required"
                                           placeholder="Your Names Denoted by Above Initials"/>
                                    @if ($errors->has('name_denoted_by_initials'))
                                        <span class="help-block">
                                        <strong>{{ $errors->first('name_denoted_by_initials') }}</strong>
                                    </span>
                                    @endif
                                </div>
                            </div>
                            <!-- form-group -->


                        </div>
                    </div>
            </div>


            <div class="form-section-bottom">

                <!-- form-group -->
                <div class="row form-group">
                    <div class="col-lg-6 col-md-6 form-element-gap">
                        <div class="ff-label {{ $errors->has('nic') ? ' has-error' : '' }}"><label>NIC number *</label>
                        </div>
                        <input type="text" name="nic" class="form-control input-lg" required="required"
                               value="{{ $data['nic'] }}" autofocus
                               placeholder="000000000V"/>
                        @if ($errors->has('nic'))
                            <span class="help-block">
                                        <strong>{{ $errors->first('nic') }}</strong>
                                    </span>
                        @endif
                    </div>
                    <div class="col-lg-6 col-md-6">
                        <div class="ff-label {{ $errors->has('email') ? ' has-error' : '' }}"><label>E Mail *</label>
                        </div>
                        <input type="email" name="email" value="{{ $data['email'] }}" autofocus
                               class="form-control input-lg" required="required"
                               placeholder="Your Email"/>
                        @if ($errors->has('email'))
                            <span class="help-block">
                                        <strong>{{ $errors->first('email') }}</strong>
                                    </span>
                        @endif
                    </div>
                </div>
                <!-- form-group -->

                <!-- form-group -->
                <div class="row form-group">
                    <div class="col-lg-12 col-md-12">
                        <div class="ff-label {{ $errors->has('address1') ? ' has-error' : '' }}"><label>Address 1
                                *</label></div>
                        <input type="text" name="address1" value="{{ $data['address1'] }}" autofocus
                               class="form-control input-lg" required="required"
                               placeholder="Address Line 1"/>
                        @if ($errors->has('address1'))
                            <span class="help-block">
                                        <strong>{{ $errors->first('address1') }}</strong>
                                    </span>
                        @endif
                    </div>

                </div>
                <!-- form-group -->

                <!-- form-group -->
                <div class="row form-group">
                    <div class="col-lg-6 col-md-6 form-element-gap">
                        <div class="ff-label"><label>Address 2</label></div>
                        <input type="text" name="address2" value="{{ $data['address2'] }}" class="form-control input-lg"
                               placeholder="Address Line 2"/>
                    </div>
                    <div class="col-lg-6 col-md-6">
                        <div class="ff-label"><label>Address 3</label></div>
                        <input type="text" name="address3" value="{{ $data['address3'] }}" class="form-control input-lg"
                               placeholder="Address Line 3"/>
                    </div>
                </div>
                <!-- form-group -->

                <!-- form-group -->
                <div class="row form-group">
                    <div class="col-lg-6 col-md-6 form-element-gap">
                        <div class="ff-label {{ $errors->has('city') ? ' has-error' : '' }}"><label>City *</label></div>
                        <select name="city" class="input-lg select2dropdown" required="required">
                            <option value="">-- Select Your City --</option>
                            @foreach ($cities as $key => $city)
                                <option value="{{strtoupper($city['city'])}}" {{ strtoupper($data['city']) == strtoupper($city['city']) ? 'selected="selected"' : '' }}>{{strtoupper($city['city'])}}</option>
                            @endforeach
                        </select>
                        @if ($errors->has('city'))
                            <span class="help-block">
                                        <strong>{{ $errors->first('city') }}</strong>
                                    </span>
                        @endif
                    </div>
                    <div class="col-lg-6 col-md-6">
                        <div class="ff-label {{ $errors->has('mobile') ? ' has-error' : '' }}"><label>Mobile *</label>
                        </div>
                        <input type="text" name="mobile" value="{{ $data['mobile'] }}" autofocus
                               class="form-control input-lg" required="required"
                               placeholder="Mobile Number"/>
                        @if ($errors->has('mobile'))
                            <span class="help-block">
                                        <strong>{{ $errors->first('mobile') }}</strong>
                                    </span>
                        @endif
                    </div>
                </div>
                <!-- form-group -->

                <!-- form-group -->
                <div class="row form-group">
                    <div class="col-lg-6 col-lg-offset-6 col-md-6 col-md-offset-6 btn-holder">
                        <input type="submit" name="cus-info-submit" value="Proceed" class="form-control input-lg"/>
                    </div>
                </div>
                <!-- form-group -->
            </div>

            </form>
        </div>
        <!-- /customer-information -->
        @endif

        @if(request()->route()->getActionName() == 'App\Http\Controllers\ProfileController@index'
        && (Auth::user() && Auth::user()->email && Auth::user()->isProfileCompleted == 1))
            @if(session('quote')['insurance_types'] == 'MT')
                @include('front.includes.vehicle-reg')
            @elseif(session('quote')['insurance_types'] == 'PT')
                @include('front.includes.pet-reg')
            @elseif(session('quote')['insurance_types'] == 'PA' || session('quote')['insurance_types'] == 'LS')
                @include('front.includes.pa-reg')
            @elseif(session('quote')['insurance_types'] == 'TR' || session('quote')['insurance_types'] == 'IT')
                @include('front.includes.travel-reg')
            @elseif(session('quote')['insurance_types'] == 'MB')
                @include('front.includes.mobile-reg')
            @elseif(session('quote')['insurance_types'] == 'CP')
                @include('front.includes.cyber-mobile-reg')
            @endif
        @endif


    </div>
    </div>

    <!-- /shop-checkout -->

@endsection