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<script>
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$(function () {
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var date = new Date();
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var currentDate = date.getDate();
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var currentMonth = date.getMonth();
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var currentYear = date.getFullYear();
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$('input[name="dateOfBirth"]').daterangepicker(
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{
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maxDate: new Date(currentYear - 18, currentMonth, currentDate),
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startDate: new Date(currentYear - 18, currentMonth, currentDate),
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singleDatePicker: true
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});
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$('input[name="dgmfgdate"]').daterangepicker({
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minDate: new Date(currentYear, currentMonth - 6, currentDate),
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maxDate: new Date(currentYear, currentMonth, currentDate),
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singleDatePicker: true,
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});
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formLoaded();
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});
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</script>
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<section class="wrapper">
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<div class="row">
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<div class="col-lg-12">
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<h3 class="page-header"><i class="icon_document_alt"></i>Create Insurance</h3>
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<ol class="breadcrumb">
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<li><i class="fa fa-home"></i><a href="${rc.contextPath}/dashboard">Home</a></li>
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<li><i class="icon_document_alt"></i>CREATE INSURANCE</li>
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</ol>
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</div>
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</div>
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<div class="col-lg-8">
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<div class="row" style="background: white; font-size: 14px;">
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<div class="col-lg-4" style="border-left: 1px solid #f0f0f0;">
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<h4>ORDER DETAILS</h4>
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<div class="row">
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<div class="col-lg-4">
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<p class="bold-details">Order ID</p>
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</div>
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<div class="col-lg-6">
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<p class="normal-details">#$fofoOrder.getId()
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($fofoOrderItems.size() item)</p>
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</div>
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</div>
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<div class="row">
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<div class="col-lg-4">
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<p class="bold-details">Order Date</p>
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</div>
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<div class="col-lg-6">
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<script>
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document.getElementById('createTimestamp').appendChild(
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document.createTextNode(new Date(
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'$fofoOrder.getCreateTimestamp()')
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.toLocaleString("en-US", $options)))
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</script>
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<p class="normal-details" id="createTimestamp"></p>
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</div>
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</div>
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<div class="row">
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<div class="col-lg-4">
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<p class="bold-details">Amount Paid</p>
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</div>
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<div class="col-lg-6">
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<p class="normal-details">
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<span class="normal-details">₹ </span>$fofoOrder.getTotalAmount()
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</p>
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</div>
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</div>
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</div>
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<div class="col-lg-4" style="border-left: 1px solid #f0f0f0;">
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<h4>BILLING DETAILS</h4>
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<p class="bold-details">$customerBillingAddressObj.getName()</p>
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<p class="normal-details">$customerBillingAddress</p>
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#if($fofoOrder.getCustomerGstNumber() &&
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$fofoOrder.getCustomerGstNumber() != "")
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<p class="bold-details">
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GST Number <span class="normal-details extra-margin">$fofoOrder.getCustomerGstNumber()</span>
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</p>
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#end
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<p class="bold-details">
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Phone <span class="normal-details extra-margin">$customerBillingAddressObj.getPhoneNumber()</span>
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</p>
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</div>
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</div>
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<div>
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<div class="row">
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<h4 class="modelHeaderCustom" style="font-size: 22px;">Customer
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Information</h4>
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</div>
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</div>
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<div class="row">
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<div class="col-lg-2 form-group">
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<input placeholder="Mobile Number" type="number" name="mobile"
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class="form-control phone input-sm" value="$customer.getMobileNumber()" readonly>
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</div>
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<div class="col-lg-3 form-group">
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<input placeholder="First Name" name="firstName" type="text"
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class="form-control input-sm firstName" value="$customer.getFirstName()" required readonly>
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</div>
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#if($customer.getLastName())
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<div class="col-lg-3 form-group">
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<input placeholder="Last Name" name="lastName" type="text"
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class="form-control input-sm lastName" value="$customer.getLastName()" readonly>
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</div>
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#else
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<div class="col-lg-3 form-group">
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<input placeholder="Last Name" name="lastName" type="text"
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value="" class="form-control input-sm lastName" readonly>
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</div>
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#end
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#if($customer.getEmailId())
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<div class="col-lg-2 form-group">
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<input name="emailId" type="email"
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class="form-control input-sm email" value="$customer.getEmailId()"
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placeholder="Email(xyz@gmail.com)" readonly>
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</div>
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#else
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<div class="col-lg-2 form-group">
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<input name="emailId" type="email" value=""
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class="form-control input-sm email"
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placeholder="Email(xyz@gmail.com)">
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</div>
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#end
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<div class="col-lg-2 form-group">
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<button class="btn btn-block btn-primary customer-details-update" data-customerid="$customer.getId()"
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type="submit">Submit
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</button>
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</div>
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</div>
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amit.gupta |
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<div>
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<div class="row">
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<h4 class="modelHeaderCustom" style="font-size: 22px;">Address
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Information</h4>
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</div>
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</div>
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<div class="row">
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#if($customerBillingAddressObj.getName())
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<div class="col-lg-2 form-group">
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<input placeholder="First Name" name="firstName"
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type="text" value="$customerBillingAddressObj.getName()" class="form-control input-sm" readonly>
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</div>
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#else
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<div class="col-lg-2 form-group">
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<input placeholder="First Name" name="firstName"
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type="text" value="" class="form-control input-sm">
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</div>
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#end
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#if($customerBillingAddressObj.getLastName())
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<div class="col-lg-2 form-group">
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<input placeholder="Last Name" name="lastName"
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type="text" value="$customerBillingAddressObj.getLastName()" class="form-control input-sm"
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readonly>
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</div>
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#else
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<div class="col-lg-2 form-group">
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<input placeholder="Last Name" id="lastName" name="lastName"
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type="text" value="" class="form-control input-sm">
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</div>
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#end
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#if($customerBillingAddressObj.getPhoneNumber())
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<div class="col-lg-2 form-group">
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<input placeholder="Mobile Number"
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name="alternatePhone" type="text" value="$customerBillingAddressObj.getPhoneNumber()"
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class="form-control input-sm" readonly>
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</div>
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#else
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<div class="col-lg-2 form-group">
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<input placeholder="Mobile Number"
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name="alternatePhone" type="text" value=" "
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class="form-control input-sm">
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</div>
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#end
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#if($customerBillingAddressObj.getLine1())
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<div class="col-lg-3 form-group">
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<input placeholder="Address Line 1" name="line1"
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type="text" size="50" value="$customerBillingAddressObj.getLine1()" class="form-control input-sm"
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readonly>
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</div>
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#else
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<div class="col-lg-3 form-group">
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<input placeholder="Address Line 1" name="line1"
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type="text" size="50" value="" class="form-control input-sm">
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</div>
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#end
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#if($customerBillingAddressObj.getLine2())
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<div class="col-lg-3 form-group">
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<input placeholder="Address Line 2" name="line2"
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type="text" value="$customerBillingAddressObj.getLine2()" class="form-control input-sm" readonly>
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</div>
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#else
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<div class="col-lg-3 form-group">
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<input placeholder="Address Line 2" name="line2"
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type="text" value="" class="form-control input-sm">
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</div>
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#end
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#if($customerBillingAddressObj.getLandmark())
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<div class="col-lg-3 form-group">
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<input placeholder="Landmark" name="landmark"
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type="text" value="$customerBillingAddressObj.getLandmark()" class="form-control input-sm"
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readonly>
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</div>
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#else
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<div class="col-lg-3 form-group">
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<input placeholder="Landmark" name="landmark"
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type="text" value="" class="form-control input-sm">
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</div>
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#end
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#if($customerBillingAddressObj.getPinCode())
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<div class="col-lg-2 form-group">
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<input placeholder="Pin Code" name="pinCode"
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type="number" value="$customerBillingAddressObj.getPinCode()" class="form-control input-sm"
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readonly>
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</div>
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#else
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<div class="col-lg-2 form-group">
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<input placeholder="Pin Code" name="pinCode"
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type="number" value="" class="form-control input-sm">
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</div>
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#end
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#if($customerBillingAddressObj.getCity())
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<div class="col-lg-2 form-group">
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<input placeholder="City" id="city" name="city" type="text"
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value="$customerBillingAddressObj.getCity()" class="form-control input-sm" readonly>
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</div>
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#else
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<div class="col-lg-2 form-group">
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<input placeholder="City" id="city" name="city" type="text"
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value="" class="form-control input-sm">
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</div>
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#end
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<div class="col-lg-2 form-group">
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<select class="form-control input-sm" name="state"
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placeholder="State">
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<option value="" disabled selected>State</option>
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#foreach($stateName in $stateNames) #if($customerBillingAddressObj.getState() ==
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$stateName)
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<option value="$stateName" selected>$stateName</option> #else
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<option value="$stateName">$stateName</option> #end #end
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</select>
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</div>
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<div class="col-lg-2 form-group">
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<button class="btn btn-block btn-primary customer-address-details-update"
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data-customeraddressid="$customerBillingAddressObj.getId()"
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type="submit">Submit
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</button>
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</div>
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</div>
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<div>
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<div class="row">
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<h4 class="modelHeaderCustom" style="font-size: 22px;">Insurance
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Information</h4>
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</div>
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</div>
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<div class="row mk_insurance_row">
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<div class="col-lg-3 form-group">
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<label for="gender">Gender</label> <select
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class="form-control input-sm" id="gender" name="gender"
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placeholder="Gender">
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<option value="" disabled selected>Gender</option>
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<option value="1" selected>Male</option>
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<option value="2" selected>Female</option>
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</select>
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</div>
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<div class="col-lg-3 form-group">
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<label for="dateOfBirth">Date Of Birth</label> <input
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placeholder="Date Of Birth" id="dateOfBirth" name="dateOfBirth"
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type="text" value="" class="form-control">
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</div>
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</div>
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309 |
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311 |
<div class="row iteminsurancedetails">
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<div class="row col-lg-3">
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<div class="col-lg-6">
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<h4>*Ram(GB):</h4>
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</div>
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<div class="col-lg-6 form-group">
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<input type="number" class="dgram form-control input-sm"
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name="ram" value="0">
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</div>
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</div>
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<div class="row col-lg-4">
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<div class="col-lg-6">
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<h4>*Memory(GB):</h4>
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</div>
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<div class="col-lg-5 form-group">
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<input type="number" class="dgmemory form-control input-sm"
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name="memory" value="0">
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</div>
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</div>
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<div class="col-lg-4">
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331 |
<div class="col-lg-3">
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<h4>*Mfg Date:</h4>
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</div>
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334 |
<div class="col-lg-6 form-group">
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335 |
<input placeholder="Mfg Date" id="dgmfgdate" name="dgmfgdate"
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336 |
type="text" value="" class="form-control input-sm dgmfgdate">
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337 |
</div>
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338 |
</div>
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339 |
</div>
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340 |
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<div #foreach( $plan in $plans.entrySet())>
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<div #foreach( $pl in $plan.getValue())>
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|
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<div class="col-lg-3">
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|
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<div class="thumbnail">
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|
346 |
<img class="card-img-top" src="logosmapping.mobile_insurance_providers[$pl.getProviderId()]"
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|
347 |
alt="$pl.getProviderName()">
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|
348 |
<div class="caption" style="padding:9px 0 0">
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|
349 |
<div style="margin:0 0 -2px -2px">
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|
350 |
<button class="btn btn-lg btn-default mk_insurance_plan_select" style="width:100%"
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|
351 |
data-key="$pl.getProductId()"
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|
352 |
data-amount="$pl.getPremium()"
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|
|
353 |
>$pl.getDuration() Rs.<span class="currency">@ $pl.getPremium()</span>
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|
354 |
</button>
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|
355 |
</div>
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|
356 |
</div>
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|
357 |
</div>
|
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|
358 |
</div>
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|
359 |
</div>
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|
360 |
</div>
|
|
|
361 |
|
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|
362 |
#end
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</div>
|
| 30601 |
amit.gupta |
364 |
#end
|
|
|
365 |
</div>
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|
| 30601 |
amit.gupta |
367 |
</div>
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| 29707 |
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|
| 30601 |
amit.gupta |
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<div class="col-lg-4 row">
|
|
|
370 |
<div class="col-lg-1"></div>
|
|
|
371 |
<div id="payment-details"
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|
|
372 |
style="background: white; background-color: white;"
|
|
|
373 |
class="col-lg-10">
|
|
|
374 |
<h4 class="modelHeaderCustom" style="font-size: 22px;">Payment
|
|
|
375 |
Details</h4>
|
|
|
376 |
|
|
|
377 |
<div id="payment-option-id-amount-container"
|
|
|
378 |
paymentOptionSize=$paymentOptions.size()>
|
|
|
379 |
#set($a = 0) #set($b = $paymentOptions.size() - 1) #set($range =
|
|
|
380 |
[$a..$b]) #foreach($index in $range)
|
|
|
381 |
<div class="row">
|
|
|
382 |
#set($paymentOption = $paymentOptions[$index])
|
|
|
383 |
#if($paymentOption.getName() == 'ONLINE')
|
|
|
384 |
<div class="col-lg-7">
|
|
|
385 |
<h4>$paymentOption.getName() :</h4>
|
|
|
386 |
</div>
|
|
|
387 |
<div class="col-lg-5">
|
|
|
388 |
<input type="number" id="paymentOptionIdAmount${index}"
|
|
|
389 |
name="paymentOptionIdAmount${index}"
|
|
|
390 |
class="form-control paymentOptionAmount amount input-sm"
|
|
|
391 |
value="$pendingOrderItem.getSellingPrice()"
|
|
|
392 |
paymentOptionId="$paymentOption.getId()" readonly>
|
|
|
393 |
</div>
|
|
|
394 |
#else
|
|
|
395 |
<div class="col-lg-7">
|
|
|
396 |
<h4>$paymentOption.getName() :</h4>
|
|
|
397 |
</div>
|
|
|
398 |
<div class="col-lg-5">
|
|
|
399 |
<input type="number" id="paymentOptionIdAmount${index}"
|
|
|
400 |
name="paymentOptionIdAmount${index}"
|
|
|
401 |
class="form-control paymentOptionAmount amount input-sm"
|
|
|
402 |
value="" paymentOptionId="$paymentOption.getId()">
|
|
|
403 |
</div>
|
|
|
404 |
#end
|
|
|
405 |
</div>
|
|
|
406 |
#end
|
|
|
407 |
</div>
|
|
|
408 |
|
|
|
409 |
<div class="row">
|
|
|
410 |
<div class="col-lg-7">
|
|
|
411 |
<h4>Total Amount :</h4>
|
|
|
412 |
</div>
|
|
|
413 |
<div class="col-lg-5">
|
|
|
414 |
<input type="number"
|
|
|
415 |
class="netPayableAmount form-control input-sm" name="" id="totalamount"
|
|
|
416 |
value="0" readonly>
|
|
|
417 |
</div>
|
|
|
418 |
</div>
|
|
|
419 |
|
|
|
420 |
<div class="row">
|
|
|
421 |
<div class="form-group col-lg-10">
|
|
|
422 |
|
|
|
423 |
<button class="btn btn-block btn-primary insurance-checkout"
|
|
|
424 |
type="submit">Create Insurance
|
|
|
425 |
</button>
|
|
|
426 |
</div>
|
|
|
427 |
</div>
|
|
|
428 |
|
|
|
429 |
</div>
|
|
|
430 |
</div>
|
|
|
431 |
</div>
|
| 29707 |
tejbeer |
432 |
</section>
|