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Rev 30601 Rev 31430
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                    data-customeraddressid="$customerBillingAddressObj.getId()"
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                    data-customeraddressid="$customerBillingAddressObj.getId()"
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                    type="submit">Submit
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                    type="submit">Submit
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            </button>
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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>
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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="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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        <h4 class="modelHeaderCustom" style="font-size: 22px;">Insurance Information</h4>
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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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    </div>
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    <div class="row iteminsurancedetails">
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    <div class="row iteminsurancedetails">
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        <div class="row col-lg-3">
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        <div class="row col-lg-3">
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            <div class="col-lg-6">
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            <div class="col-lg-6">
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                <h4>*Ram(GB):</h4>
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                <h4>*Ram(GB):</h4>
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            </div>
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            </div>