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Line 133... |
| 133 |
<span style="display:inline-block;width:55%;">
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133 |
<span style="display:inline-block;width:55%;">
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| 134 |
<input id='dob' name="dob" class='insuranceDetailField' type="text" style='color:#999;' value='Example: 18/08/1986'>
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<input id='dob' name="dob" class='insuranceDetailField' type="text" style='color:#999;' value='Example: 18/08/1986'>
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| 135 |
</span>
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135 |
</span>
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| 136 |
<input id="insuranceType" type="hidden" name="insuranceType" value="">
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<input id="insuranceType" type="hidden" name="insuranceType" value="">
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| 137 |
</div>
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</div>
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| - |
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<div id='insDetErr' style="display:none;border: 1px solid red;padding: 7px;text-align: center;color: red;font-size: 14px;margin: 0 -5px 0 -5px;background-color: lightyellow;box-shadow: 0 0 3px 0 red inset;">
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| - |
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</div>
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| 138 |
<div style="margin:13px 5px 13px 0;text-align: right;">
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<div style="margin:13px 5px 13px 0;text-align: right;">
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| 139 |
<input id='submitInsuranceDetails' type="button" value="Submit" style="height: 25px;width: 125px;background-color: skyblue;color: black;font-weight: bold;">
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<input id='submitInsuranceDetails' type="button" value="Submit" style="height: 25px;width: 125px;background-color: skyblue;color: black;font-weight: bold;">
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| 140 |
</div>
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</div>
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| 141 |
<div id="insuranceHelpInfo" style="border-top:1px solid #999;color:#777;font-size:13px;padding:5px;">
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<div id="insuranceHelpInfo" style="border-top:1px solid #999;color:#777;font-size:13px;padding:5px;">
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| 142 |
We need these details for the purpose of insurance.<br>
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144 |
We need these details for the purpose of insurance.<br>
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| Line 405... |
Line 407... |
| 405 |
<input type="text" id="guardianName" name="guardianName" class="searchbox right" >
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407 |
<input type="text" id="guardianName" name="guardianName" class="searchbox right" >
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| 406 |
</input>
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</input>
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| 407 |
</td>
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</td>
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| 408 |
</tr>
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410 |
</tr>
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| 409 |
<tr>
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411 |
<tr>
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| 410 |
<td class="label" align="right"><sup>*</sup>Date of Birth:</td>
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412 |
<td class="label" align="right"><sup>*</sup>Date of Birth (dd/mm/yyyy):</td>
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| 411 |
<td class="input">
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413 |
<td class="input">
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| 412 |
<input type="text" id="dob" name="dob" style='color:#999;' value='Example: 18/08/1986' class="searchbox right" >
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414 |
<input type="text" id="dob" name="dob" style='color:#999;' value='Example: 18/08/1986' class="searchbox right" >
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| 413 |
</input>
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415 |
</input>
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| 414 |
</td>
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416 |
</td>
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| 415 |
</tr>
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417 |
</tr>
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| - |
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418 |
<tr >
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| - |
|
419 |
<td colspan="2">
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| - |
|
420 |
<div id="insDetErr" style="display:none;border: 1px solid red;padding: 7px;text-align: center;color: red;font-size: 14px;margin: 0 -5px 0 -5px;background-color: lightyellow;box-shadow: 0 0 3px 0 red inset;">
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| - |
|
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</div>
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| - |
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</td>
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| - |
|
423 |
</tr>
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| 416 |
<tr id="insuranceHelpInfo">
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424 |
<tr id="insuranceHelpInfo">
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| 417 |
<td colspan="2" style="color:#777;font-size:13px;padding:5px;">
|
425 |
<td colspan="2" style="color:#777;font-size:13px;padding:5px;">
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| 418 |
We need the above details for the purpose of insurance.<br>
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426 |
We need the above details for the purpose of insurance.<br>
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| 419 |
If you do not wish to take insurance <a id="cancelInsurance" style="cursor:pointer">click here</a><br>
|
427 |
If you do not wish to take insurance <a id="cancelInsurance" style="cursor:pointer">click here</a><br>
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| 420 |
<hr>
|
428 |
<hr>
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