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Rev 29707 Rev 30601
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1 
<script>
 1 
<script>
2 
$(function() {
 2 
    $(function () {
3 
		var date = new Date();
 3 
        var date = new Date();
4 
	    var currentDate = date.getDate();
 4 
        var currentDate = date.getDate();
5 
		var currentMonth = date.getMonth();
 5 
        var currentMonth = date.getMonth();
6 
		var currentYear = date.getFullYear();
 6 
        var currentYear = date.getFullYear();
7 
		$('input[name="dateOfBirth"]').daterangepicker(
 7 
        $('input[name="dateOfBirth"]').daterangepicker(
8 
 
 - 
 
9 
		{
 8 
                {
10 
 
 - 
 
11 
			maxDate : new Date(currentYear - 18, currentMonth, currentDate),
 9 
                    maxDate: new Date(currentYear - 18, currentMonth, currentDate),
12 
			startDate : new Date(currentYear - 18, currentMonth, currentDate),
 10 
                    startDate: new Date(currentYear - 18, currentMonth, currentDate),
13 
 
 - 
 
14 
			singleDatePicker : true
 11 
                    singleDatePicker: true
15 
		}, dateRangeCallback);
 12 
                });
16 
 
 - 
 
17 
		$('input[name="dgmfgdate"]').daterangepicker({
 13 
        $('input[name="dgmfgdate"]').daterangepicker({
18 
			minDate : new Date(currentYear, currentMonth - 6, currentDate),
 14 
            minDate: new Date(currentYear, currentMonth - 6, currentDate),
19 
			maxDate : new Date(currentYear, currentMonth, currentDate),
 15 
            maxDate: new Date(currentYear, currentMonth, currentDate),
20 
 
 - 
 
21 
			singleDatePicker : true,
 16 
            singleDatePicker: true,
22 
		}, function(start, end) {
 - 
 
23 
 
 - 
 
24 
			startMoment = start;
 - 
 
25 
			mfgDate = start.format(moment.HTML5_FMT.DATETIME_LOCAL_SECONDS);
 - 
 
26 
 
 - 
 
27 
		});
 17 
        });
28 
		formLoaded();
 18 
        formLoaded();
29 
	});
 19 
    });
30 
 
 20 
 
31 
</script>
 21 
</script>
32 
 
 22 
 
33 
<section class="wrapper">
 23 
<section class="wrapper">
34 
	<div class="row">
 24 
    <div class="row">
35 
		<div class="col-lg-12">
 25 
        <div class="col-lg-12">
36 
			<h3 class="page-header"><i class="icon_document_alt"></i>Create Insurance</h3>
 26 
            <h3 class="page-header"><i class="icon_document_alt"></i>Create Insurance</h3>
37 
			<ol class="breadcrumb">
 27 
            <ol class="breadcrumb">
38 
				<li><i class="fa fa-home"></i><a href="${rc.contextPath}/dashboard">Home</a></li>
 28 
                <li><i class="fa fa-home"></i><a href="${rc.contextPath}/dashboard">Home</a></li>
39 
				<li><i class="icon_document_alt"></i>CREATE INSURANCE</li>
29 
                <li><i class="icon_document_alt"></i>CREATE INSURANCE</li>
40 
			</ol>
 30 
            </ol>
41 
		</div>
 31 
        </div>
42 
	</div>
 32 
    </div>
43 
 
 33 
 
44 
 
 34 
 
45 
 
 35 
 
46 
<div class="col-lg-8">
 36 
<div class="col-lg-8">
47 
	<div class="row" style="background: white; font-size: 14px;">
 37 
    <div class="row" style="background: white; font-size: 14px;">
48 
		<div class="col-lg-4" style="border-left: 1px solid #f0f0f0;">
 38 
        <div class="col-lg-4" style="border-left: 1px solid #f0f0f0;">
49 
			<h4>ORDER DETAILS</h4>
 39 
            <h4>ORDER DETAILS</h4>
50 
			<div class="row">
 40 
            <div class="row">
51 
				<div class="col-lg-4">
 41 
                <div class="col-lg-4">
52 
					<p class="bold-details">Order ID</p>
 42 
                    <p class="bold-details">Order ID</p>
53 
				</div>
 43 
                </div>
54 
				<div class="col-lg-6">
 44 
                <div class="col-lg-6">
55 
					<p class="normal-details">#$fofoOrder.getId()
 45 
                    <p class="normal-details">#$fofoOrder.getId()
56 
						($fofoOrderItems.size() item)</p>
 46 
                        ($fofoOrderItems.size() item)</p>
57 
				</div>
 47 
                </div>
58 
			</div>
 48 
            </div>
59 
			<div class="row">
 49 
            <div class="row">
60 
				<div class="col-lg-4">
 50 
                <div class="col-lg-4">
61 
					<p class="bold-details">Order Date</p>
 51 
                    <p class="bold-details">Order Date</p>
62 
				</div>
 52 
                </div>
63 
				<div class="col-lg-6">
 53 
                <div class="col-lg-6">
64 
					<script>
 54 
                    <script>
65 
						document.getElementById('createTimestamp').appendChild(
 55 
                        document.getElementById('createTimestamp').appendChild(
66 
								document.createTextNode(new Date(
 56 
                                document.createTextNode(new Date(
67 
										'$fofoOrder.getCreateTimestamp()')
 57 
                                        '$fofoOrder.getCreateTimestamp()')
68 
										.toLocaleString("en-US", $options)))
 58 
                                        .toLocaleString("en-US", $options)))
69 
					</script>
 59 
                    </script>
70 
					<p class="normal-details" id="createTimestamp"></p>
 60 
                    <p class="normal-details" id="createTimestamp"></p>
71 
				</div>
 61 
                </div>
72 
			</div>
 62 
            </div>
73 
			<div class="row">
 63 
            <div class="row">
74 
				<div class="col-lg-4">
 64 
                <div class="col-lg-4">
75 
					<p class="bold-details">Amount Paid</p>
 65 
                    <p class="bold-details">Amount Paid</p>
76 
				</div>
 66 
                </div>
77 
				<div class="col-lg-6">
 67 
                <div class="col-lg-6">
78 
					<p class="normal-details">
 68 
                    <p class="normal-details">
79 
						<span class="normal-details">&#8377; </span>$fofoOrder.getTotalAmount()
 69 
                        <span class="normal-details">&#8377; </span>$fofoOrder.getTotalAmount()
80 
					</p>
 70 
                    </p>
81 
				</div>
 71 
                </div>
82 
			</div>
 72 
            </div>
83 
		</div>
 73 
        </div>
84 
 
 74 
 
85 
		<div class="col-lg-4" style="border-left: 1px solid #f0f0f0;">
 75 
        <div class="col-lg-4" style="border-left: 1px solid #f0f0f0;">
86 
			<h4>BILLING DETAILS</h4>
 76 
            <h4>BILLING DETAILS</h4>
87 
			<p class="bold-details">$customerBillingAddressObj.getName()</p>
 77 
            <p class="bold-details">$customerBillingAddressObj.getName()</p>
88 
			<p class="normal-details">$customerBillingAddress</p>
 78 
            <p class="normal-details">$customerBillingAddress</p>
89 
			#if($fofoOrder.getCustomerGstNumber() &&
 79 
            #if($fofoOrder.getCustomerGstNumber() &&
90 
			$fofoOrder.getCustomerGstNumber() != "")
 80 
                $fofoOrder.getCustomerGstNumber() != "")
91 
			<p class="bold-details">
 81 
                <p class="bold-details">
92 
				GST Number <span class="normal-details extra-margin">$fofoOrder.getCustomerGstNumber()</span>
 82 
                    GST Number <span class="normal-details extra-margin">$fofoOrder.getCustomerGstNumber()</span>
93 
			</p>
 83 
                </p>
94 
			#end
 84 
            #end
95 
			<p class="bold-details">
 85 
            <p class="bold-details">
96 
				Phone <span class="normal-details extra-margin">$customerBillingAddressObj.getPhoneNumber()</span>
 86 
                Phone <span class="normal-details extra-margin">$customerBillingAddressObj.getPhoneNumber()</span>
97 
			</p>
 87 
            </p>
98 
		</div>
 88 
        </div>
99 
 
 89 
 
100 
 
 90 
 
101 
	</div>
 91 
    </div>
102
92 
 
103
93 
 
104 
		<div>
 94 
    <div>
105 
	         <div class="row">
 95 
        <div class="row">
106 
				<h4 class="modelHeaderCustom" style="font-size: 22px;">Customer
96 
            <h4 class="modelHeaderCustom" style="font-size: 22px;">Customer
107 
					Information</h4>
 97 
                Information</h4>
108 
			</div>
 98 
        </div>
109 
		</div>
 99 
    </div>
110
100 
 
111 
		<div class="row">
 101 
    <div class="row">
112
102 
 
113 
           <div class="col-lg-2 form-group">
 103 
        <div class="col-lg-2 form-group">
114 
				<input placeholder="Mobile Number" type="number" name="mobile"
 104 
            <input placeholder="Mobile Number" type="number" name="mobile"
115 
					class="form-control phone input-sm" value = "$customer.getMobileNumber()" readonly>
 105 
                   class="form-control phone input-sm" value="$customer.getMobileNumber()" readonly>
116 
			</div>
 106 
        </div>
117 
			<div class="col-lg-3 form-group">
 107 
        <div class="col-lg-3 form-group">
118 
				<input placeholder="First Name" name="firstName"  type="text"
 108 
            <input placeholder="First Name" name="firstName" type="text"
119 
					class="form-control input-sm firstName" value = "$customer.getFirstName()"  required readonly>
 109 
                   class="form-control input-sm firstName" value="$customer.getFirstName()" required readonly>
120 
			</div>
 110 
        </div>
121 
			#if($customer.getLastName())
 111 
        #if($customer.getLastName())
122 
			<div class="col-lg-3 form-group">
 112 
            <div class="col-lg-3 form-group">
123 
				<input placeholder="Last Name" name="lastName" type="text"
113 
                <input placeholder="Last Name" name="lastName" type="text"
124 
					class="form-control input-sm lastName" value = "$customer.getLastName()"  readonly>
 114 
                       class="form-control input-sm lastName" value="$customer.getLastName()" readonly>
125 
			</div>
 115 
            </div>
126 
			#else
 116 
        #else
127 
			<div class="col-lg-3 form-group">
 117 
            <div class="col-lg-3 form-group">
128 
				<input placeholder="Last Name" name="lastName" type="text"
118 
                <input placeholder="Last Name" name="lastName" type="text"
129 
					value="" class="form-control input-sm lastName"  readonly>
 119 
                       value="" class="form-control input-sm lastName" readonly>
130 
			</div>
 120 
            </div>
131 
			#end
 121 
        #end
132
122 
 
133 
			#if($customer.getEmailId())
 123 
        #if($customer.getEmailId())
134 
			<div class="col-lg-2 form-group">
 124 
            <div class="col-lg-2 form-group">
135 
				<input name="emailId" type="email"
125 
                <input name="emailId" type="email"
136 
					class="form-control input-sm email" value="$customer.getEmailId()"
 126 
                       class="form-control input-sm email" value="$customer.getEmailId()"
137 
					placeholder="Email(xyz@gmail.com)" readonly>
 127 
                       placeholder="Email(xyz@gmail.com)" readonly>
138 
			</div>
 128 
            </div>
139 
			#else
 129 
        #else
140 
				<div class="col-lg-2 form-group">
 130 
            <div class="col-lg-2 form-group">
141 
				<input  name="emailId" type="email" value=""
 131 
                <input name="emailId" type="email" value=""
142 
					class="form-control input-sm email"
 132 
                       class="form-control input-sm email"
143 
					placeholder="Email(xyz@gmail.com)">
 133 
                       placeholder="Email(xyz@gmail.com)">
144 
			</div>
 134 
            </div>
145
135 
 
146 
			#end
 136 
        #end
147
137 
 
148 
			<div class="col-lg-2 form-group">
 138 
        <div class="col-lg-2 form-group">
149 
			<button class="btn btn-block btn-primary customer-details-update" data-customerid = "$customer.getId()"
 139 
            <button class="btn btn-block btn-primary customer-details-update" data-customerid="$customer.getId()"
150 
				type="submit">Submit</button>
 140 
                    type="submit">Submit
151 
			</div>
 141 
            </button>
152
142 
        </div>
153 
	</div>
 143 
 
154
144 
    </div>
155 
		<div>
 145 
 
156 
	         <div class="row">
 146 
    <div>
157 
				<h4 class="modelHeaderCustom" style="font-size: 22px;">Address
147 
        <div class="row">
158 
					Information</h4>
 148 
            <h4 class="modelHeaderCustom" style="font-size: 22px;">Address
159 
			</div>
 149 
                Information</h4>
160 
		</div>
 150 
        </div>
161
151 
    </div>
162
152 
 
163 
		<div class="row">
 153 
 
164
154 
    <div class="row">
165 
		    #if($customerBillingAddressObj.getName())
 155 
 
166 
			<div class="col-lg-2 form-group">
 156 
        #if($customerBillingAddressObj.getName())
167 
				<input placeholder="First Name"  name="firstName"
157 
            <div class="col-lg-2 form-group">
168 
					type="text" value="$customerBillingAddressObj.getName()" class="form-control input-sm" readonly>
 158 
                <input placeholder="First Name" name="firstName"
169 
			</div>
 159 
                       type="text" value="$customerBillingAddressObj.getName()" class="form-control input-sm" readonly>
170 
			#else
 160 
            </div>
171 
			<div class="col-lg-2 form-group">
 161 
        #else
172 
				<input placeholder="First Name"  name="firstName"
162 
            <div class="col-lg-2 form-group">
173 
					type="text" value="" class="form-control input-sm">
 163 
                <input placeholder="First Name" name="firstName"
174 
			</div>
 164 
                       type="text" value="" class="form-control input-sm">
175
165 
            </div>
176 
			#end
 166 
 
177
167 
        #end
178 
			#if($customerBillingAddressObj.getLastName())
 168 
 
179 
			<div class="col-lg-2 form-group">
 169 
        #if($customerBillingAddressObj.getLastName())
180 
				<input placeholder="Last Name"  name="lastName"
170 
            <div class="col-lg-2 form-group">
181 
					type="text" value="$customerBillingAddressObj.getLastName()" class="form-control input-sm" readonly>
 171 
                <input placeholder="Last Name" name="lastName"
182 
			</div>
 172 
                       type="text" value="$customerBillingAddressObj.getLastName()" class="form-control input-sm"
183 
			#else
 173 
                       readonly>
184
174 
            </div>
185 
			<div class="col-lg-2 form-group">
 175 
        #else
186 
				<input placeholder="Last Name" id="lastName" name="lastName"
176 
 
187 
					type="text" value="" class="form-control input-sm">
 177 
            <div class="col-lg-2 form-group">
188 
			</div>
 178 
                <input placeholder="Last Name" id="lastName" name="lastName"
189 
			#end
 179 
                       type="text" value="" class="form-control input-sm">
190
180 
            </div>
191 
			#if($customerBillingAddressObj.getPhoneNumber())
 181 
        #end
192 
			<div class="col-lg-2 form-group">
 182 
 
193 
				<input placeholder="Mobile Number"
 183 
        #if($customerBillingAddressObj.getPhoneNumber())
194 
					name="alternatePhone" type="text" value="$customerBillingAddressObj.getPhoneNumber()"
 184 
            <div class="col-lg-2 form-group">
195 
					class="form-control input-sm" readonly>
 185 
                <input placeholder="Mobile Number"
196 
			</div>
 186 
                       name="alternatePhone" type="text" value="$customerBillingAddressObj.getPhoneNumber()"
197 
			#else
 187 
                       class="form-control input-sm" readonly>
198 
				<div class="col-lg-2 form-group">
 188 
            </div>
199 
				<input placeholder="Mobile Number"
189 
        #else
200 
					name="alternatePhone" type="text" value=" "
 190 
            <div class="col-lg-2 form-group">
201 
					class="form-control input-sm">
 191 
                <input placeholder="Mobile Number"
202 
			</div>
 192 
                       name="alternatePhone" type="text" value=" "
203
193 
                       class="form-control input-sm">
204 
			#end
 194 
            </div>
205
195 
 
206 
			#if($customerBillingAddressObj.getLine1())
 196 
        #end
207 
			<div class="col-lg-3 form-group">
 197 
 
208 
				<input placeholder="Address Line 1"  name="line1"
198 
        #if($customerBillingAddressObj.getLine1())
209 
					type="text" size="50" value="$customerBillingAddressObj.getLine1()" class="form-control input-sm" readonly>
 199 
            <div class="col-lg-3 form-group">
210 
			</div>
 200 
                <input placeholder="Address Line 1" name="line1"
211 
			#else
 201 
                       type="text" size="50" value="$customerBillingAddressObj.getLine1()" class="form-control input-sm"
212 
				<div class="col-lg-3 form-group">
 202 
                       readonly>
213 
				<input placeholder="Address Line 1"  name="line1"
203 
            </div>
214 
					type="text" size="50" value="" class="form-control input-sm">
 204 
        #else
215 
			</div>
 205 
            <div class="col-lg-3 form-group">
216 
			#end
 206 
                <input placeholder="Address Line 1" name="line1"
217
207 
                       type="text" size="50" value="" class="form-control input-sm">
218
208 
            </div>
219 
			#if($customerBillingAddressObj.getLine2())
 209 
        #end
220 
			<div class="col-lg-3 form-group">
 210 
 
221 
				<input placeholder="Address Line 2"  name="line2"
211 
 
222 
					type="text" value="$customerBillingAddressObj.getLine2()" class="form-control input-sm" readonly>
 212 
        #if($customerBillingAddressObj.getLine2())
223 
			</div>
 213 
            <div class="col-lg-3 form-group">
224 
			#else
 214 
                <input placeholder="Address Line 2" name="line2"
225 
			<div class="col-lg-3 form-group">
 215 
                       type="text" value="$customerBillingAddressObj.getLine2()" class="form-control input-sm" readonly>
226 
				<input placeholder="Address Line 2"  name="line2"
216 
            </div>
227 
					type="text" value="" class="form-control input-sm">
 217 
        #else
228 
			</div>
 218 
            <div class="col-lg-3 form-group">
229 
			#end
 219 
                <input placeholder="Address Line 2" name="line2"
230
220 
                       type="text" value="" class="form-control input-sm">
231 
			#if($customerBillingAddressObj.getLandmark())
 221 
            </div>
232 
			<div class="col-lg-3 form-group">
 222 
        #end
233 
					<input placeholder="Landmark" name="landmark"
223 
 
234 
						type="text" value="$customerBillingAddressObj.getLandmark()" class="form-control input-sm" readonly>
 224 
        #if($customerBillingAddressObj.getLandmark())
235 
			</div>
 225 
            <div class="col-lg-3 form-group">
236 
			#else
 226 
                <input placeholder="Landmark" name="landmark"
237 
			<div class="col-lg-3 form-group">
 227 
                       type="text" value="$customerBillingAddressObj.getLandmark()" class="form-control input-sm"
238 
			<input placeholder="Landmark"  name="landmark"
228 
                       readonly>
239 
				type="text" value="" class="form-control input-sm">
 229 
            </div>
240 
			</div>
 230 
        #else
241 
			#end
 231 
            <div class="col-lg-3 form-group">
242
232 
                <input placeholder="Landmark" name="landmark"
243
233 
                       type="text" value="" class="form-control input-sm">
244 
			#if($customerBillingAddressObj.getPinCode())
 234 
            </div>
245 
			<div class="col-lg-2 form-group">
 235 
        #end
246 
					<input placeholder="Pin Code" name="pinCode"
236 
 
247 
						type="number" value="$customerBillingAddressObj.getPinCode()" class="form-control input-sm" readonly>
 237 
 
248 
				</div>
 238 
        #if($customerBillingAddressObj.getPinCode())
249 
			#else
 239 
            <div class="col-lg-2 form-group">
250
240 
                <input placeholder="Pin Code" name="pinCode"
251 
				<div class="col-lg-2 form-group">
 241 
                       type="number" value="$customerBillingAddressObj.getPinCode()" class="form-control input-sm"
252 
				<input placeholder="Pin Code" name="pinCode"
242 
                       readonly>
253 
					type="number" value="" class="form-control input-sm">
 243 
            </div>
254 
			</div>
 244 
        #else
255 
			#end
 245 
 
256
246 
            <div class="col-lg-2 form-group">
257 
			#if($customerBillingAddressObj.getCity())
 247 
                <input placeholder="Pin Code" name="pinCode"
258 
			<div class="col-lg-2 form-group">
 248 
                       type="number" value="" class="form-control input-sm">
259 
				<input placeholder="City" id="city" name="city" type="text"
249 
            </div>
260 
					value="$customerBillingAddressObj.getCity()" class="form-control input-sm" readonly>
 250 
        #end
261 
			</div>
 251 
 
262 
			#else
 252 
        #if($customerBillingAddressObj.getCity())
263 
				<div class="col-lg-2 form-group">
 253 
            <div class="col-lg-2 form-group">
264 
				<input placeholder="City" id="city" name="city" type="text"
254 
                <input placeholder="City" id="city" name="city" type="text"
265 
					value="" class="form-control input-sm">
 255 
                       value="$customerBillingAddressObj.getCity()" class="form-control input-sm" readonly>
266 
			</div>
 256 
            </div>
267
257 
        #else
268 
			#end
 258 
            <div class="col-lg-2 form-group">
269 
			<div class="col-lg-2 form-group">
259 
                <input placeholder="City" id="city" name="city" type="text"
270 
				<select class="form-control input-sm"  name="state"
260 
                       value="" class="form-control input-sm">
271 
					placeholder="State">
 261 
            </div>
272 
					<option value="" disabled selected>State</option>
 262 
 
273 
					#foreach($stateName in $stateNames) #if($customerBillingAddressObj.getState() ==
 263 
        #end
274 
					$stateName)
 264 
        <div class="col-lg-2 form-group">
275 
					<option value="$stateName" selected>$stateName</option> #else
 265 
            <select class="form-control input-sm" name="state"
276 
					<option value="$stateName">$stateName</option> #end #end
 266 
                    placeholder="State">
277 
 
 267 
                <option value="" disabled selected>State</option>
278 
				</select>
 268 
                #foreach($stateName in $stateNames) #if($customerBillingAddressObj.getState() ==
279 
			</div>
 269 
                    $stateName)
280
270 
                    <option value="$stateName" selected>$stateName</option> #else
281
271 
                    <option value="$stateName">$stateName</option> #end #end
282
272 
 
283 
			<div class="col-lg-2 form-group">
 273 
            </select>
284 
			<button class="btn btn-block btn-primary customer-address-details-update" data-customeraddressid ="$customerBillingAddressObj.getId()"
274 
        </div>
285 
				type="submit">Submit</button>
 275 
 
286 
			</div>
 276 
 
287 
		</div>
 277 
        <div class="col-lg-2 form-group">
288
278 
            <button class="btn btn-block btn-primary customer-address-details-update"
289
279 
                    data-customeraddressid="$customerBillingAddressObj.getId()"
290
280 
                    type="submit">Submit
291 
		<div>
 281 
            </button>
292 
			<div class="row">
 282 
        </div>
293 
				<h4 class="modelHeaderCustom" style="font-size: 22px;">Insurance
 283 
    </div>
294 
					Information</h4>
 284 
 
295 
			</div>
 285 
 
296 
		</div>
 286 
    <div>
297
287 
        <div class="row">
298 
		<div class="row mk_insurance_row" >
 288 
            <h4 class="modelHeaderCustom" style="font-size: 22px;">Insurance
299 
			<div class="col-lg-3 form-group">
 289 
                Information</h4>
300 
				<label for="gender">Gender</label> <select
 290 
        </div>
301 
					class="form-control input-sm" id="gender" name="gender"
 291 
    </div>
302 
					placeholder="Gender">
 292 
 
303 
					<option value="" disabled selected>Gender</option>
 293 
    <div class="row mk_insurance_row">
304 
					<option value="1" selected>Male</option>
 294 
        <div class="col-lg-3 form-group">
305 
					<option value="2" selected>Female</option>
 295 
            <label for="gender">Gender</label> <select
306 
				</select>
 296 
                class="form-control input-sm" id="gender" name="gender"
307 
			</div>
 297 
                placeholder="Gender">
308 
			<div class="col-lg-3 form-group">
 298 
            <option value="" disabled selected>Gender</option>
309 
				<label for="dateOfBirth">Date Of Birth</label> <input
 299 
            <option value="1" selected>Male</option>
310 
					placeholder="Date Of Birth" id="dateOfBirth" name="dateOfBirth"
 300 
            <option value="2" selected>Female</option>
311 
					type="text" value="" class="form-control">
 301 
        </select>
312 
			</div>
 302 
        </div>
313 
		</div>
 303 
        <div class="col-lg-3 form-group">
314 
 
 304 
            <label for="dateOfBirth">Date Of Birth</label> <input
315 
 
 305 
                placeholder="Date Of Birth" id="dateOfBirth" name="dateOfBirth"
316 
     <div class="row iteminsurancedetails">
 306 
                type="text" value="" class="form-control">
317 
			<div class="row col-lg-3">
 307 
        </div>
318 
				<div class="col-lg-6">
 308 
    </div>
319 
					<h4>*Ram(GB):</h4>
 309 
 
320 
				</div>
 310 
 
321 
				<div class="col-lg-6 form-group">
 311 
    <div class="row iteminsurancedetails">
322 
					<input type="number" class="dgram form-control input-sm"
 312 
        <div class="row col-lg-3">
323 
						name="ram" value="0">
 313 
            <div class="col-lg-6">
324 
				</div>
 314 
                <h4>*Ram(GB):</h4>
325 
			</div>
 315 
            </div>
326 
			<div class="row col-lg-4">
 316 
            <div class="col-lg-6 form-group">
327 
				<div class="col-lg-6">
 317 
                <input type="number" class="dgram form-control input-sm"
328 
					<h4>*Memory(GB):</h4>
 318 
                       name="ram" value="0">
329 
				</div>
 319 
            </div>
330 
				<div class="col-lg-5 form-group">
 320 
        </div>
331 
					<input type="number" class="dgmemory form-control input-sm"
 321 
        <div class="row col-lg-4">
332 
						name="memory" value="0">
 322 
            <div class="col-lg-6">
333 
				</div>
 323 
                <h4>*Memory(GB):</h4>
334 
			</div>
 324 
            </div>
335 
			<div class="col-lg-4">
 325 
            <div class="col-lg-5 form-group">
336 
				<div class="col-lg-3">
 326 
                <input type="number" class="dgmemory form-control input-sm"
337 
					<h4>*Mfg Date:</h4>
 327 
                       name="memory" value="0">
338 
				</div>
 328 
            </div>
339 
				<div class="col-lg-6 form-group">
 329 
        </div>
340 
					<input placeholder="Mfg Date" id="dgmfgdate" name="dgmfgdate"
 330 
        <div class="col-lg-4">
341 
						type="text" value="" class="form-control input-sm dgmfgdate">
 331 
            <div class="col-lg-3">
342 
				</div>
 332 
                <h4>*Mfg Date:</h4>
343 
			</div>
 333 
            </div>
344 
		</div>
 334 
            <div class="col-lg-6 form-group">
345 
 
 335 
                <input placeholder="Mfg Date" id="dgmfgdate" name="dgmfgdate"
346 
 
 336 
                       type="text" value="" class="form-control input-sm dgmfgdate">
347 
 
 337 
            </div>
348 
		<div  #foreach( $plan in $plans.entrySet())>
338 
        </div>
349 
		<div  #foreach( $pl in $plan.getValue())>
 339 
    </div>
350 
		  <div class="col-lg-3">
 340 
 
351 
				<div class="thumbnail">
 341 
 
352 
					<img class="card-img-top" src="logosmapping.mobile_insurance_providers[$pl.getProviderId()]" alt="$pl.getProviderName()">
 342 
        <div  #foreach( $plan in $plans.entrySet())>
353 
		      		<div class="caption" style="padding:9px 0 0">
 343 
        <div  #foreach( $pl in $plan.getValue())>
354 
					    <div style="margin:0 0 -2px -2px">
 344 
        <div class="col-lg-3">
355 
					    	<button class="btn btn-lg btn-default mk_insurance_plan_select" style="width:100%"
345 
            <div class="thumbnail">
356 
					    		data-key="$pl.getProductId()"
 346 
                <img class="card-img-top" src="logosmapping.mobile_insurance_providers[$pl.getProviderId()]"
357 
					    		data-amount="$pl.getPremium()"
 347 
                     alt="$pl.getProviderName()">
358 
					    	>$pl.getDuration() Rs.<span class="currency">@ $pl.getPremium()</span>
 348 
                <div class="caption" style="padding:9px 0 0">
359 
					    	</button>
 349 
                    <div style="margin:0 0 -2px -2px">
360 
					    </div>
 350 
                        <button class="btn btn-lg btn-default mk_insurance_plan_select" style="width:100%"
361 
					</div>
 351 
                                data-key="$pl.getProductId()"
362 
				</div>
 352 
                                data-amount="$pl.getPremium()"
363 
			</div>
 353 
                        >$pl.getDuration() Rs.<span class="currency">@ $pl.getPremium()</span>
364 
		</div>
 354 
                        </button>
365 
		</div>
 355 
                    </div>
366
356 
                </div>
367 
		#end
357 
            </div>
368 
	</div>
 358 
        </div>
369 
		#end
359 
    </div>
370 
</div>
 360 
    </div>
371 
 
 361 
 
- 
 
 362 
    #end
372 
</div>
 363 
</div>
- 
 
 364 
#end
- 
 
 365 
    </div>
373 
 
 366 
 
374 
<div class="col-lg-4 row">
 - 
 
375 
	<div class="col-lg-1"></div>
 - 
 
376 
	<div id="payment-details"
 - 
 
377 
		style="background: white; background-color: white;"
 - 
 
378 
		class="col-lg-10">
 - 
 
379 
		<h4 class="modelHeaderCustom" style="font-size: 22px;">Payment
 - 
 
380 
			Details</h4>
 - 
 
381
- 
 
382 
		<div id="payment-option-id-amount-container"
 - 
 
383 
			paymentOptionSize=$paymentOptions.size()>
 - 
 
384 
			#set($a = 0) #set($b = $paymentOptions.size() - 1) #set($range =
 - 
 
385 
			[$a..$b]) #foreach($index in $range)
 - 
 
386 
			<div class="row">
 - 
 
387 
				#set($paymentOption = $paymentOptions[$index])
 - 
 
388 
				#if($paymentOption.getName() == 'ONLINE')
 - 
 
389 
				<div class="col-lg-7">
 - 
 
390 
					<h4>$paymentOption.getName() :</h4>
 - 
 
391 
				</div>
 - 
 
392 
				<div class="col-lg-5">
 - 
 
393 
					<input type="number" id="paymentOptionIdAmount${index}"
 - 
 
394 
						name="paymentOptionIdAmount${index}"
 - 
 
395 
						class="form-control paymentOptionAmount amount input-sm"
 - 
 
396 
						value="$pendingOrderItem.getSellingPrice()"
 - 
 
397 
						paymentOptionId="$paymentOption.getId()" readonly>
 - 
 
398 
				</div>
 - 
 
399 
				#else
 - 
 
400 
				<div class="col-lg-7">
 - 
 
401 
					<h4>$paymentOption.getName() :</h4>
 - 
 
402 
				</div>
 - 
 
403 
				<div class="col-lg-5">
 - 
 
404 
					<input type="number" id="paymentOptionIdAmount${index}"
 - 
 
405 
						name="paymentOptionIdAmount${index}"
 - 
 
406 
						class="form-control paymentOptionAmount amount input-sm"
 - 
 
407 
						value="" paymentOptionId="$paymentOption.getId()">
 - 
 
408 
				</div>
 - 
 
409 
				#end
 - 
 
410 
			</div>
 - 
 
411 
			#end
 - 
 
412 
	</div>
 - 
 
413
- 
 
414 
		<div class="row">
 - 
 
415 
			<div class="col-lg-7">
 - 
 
416 
				<h4>Total Amount :</h4>
 - 
 
417 
			</div>
 - 
 
418 
			<div class="col-lg-5">
 - 
 
419 
				<input type="number"
 - 
 
420 
					class="netPayableAmount form-control input-sm" name="" id="totalamount"
 - 
 
421 
					value="0" readonly>
 - 
 
422 
			</div>
 - 
 
423 
		</div>
 - 
 
424
- 
 
425 
			<div class="row">
 - 
 
426 
		<div class="form-group col-lg-10">
 - 
 
427
- 
 
428 
			<button class="btn btn-block btn-primary insurance-checkout"
 - 
 
429 
				type="submit">Create Insurance</button>
 - 
 
430 
		</div>
 - 
 
431 
  </div>
 367 
    </div>
432
- 
 
433 
	</div>
 - 
 
434 
	</div>
 - 
 
435 
	</div>
 - 
 
436
- 
 
437 
 
 368 
 
- 
 
 369 
    <div class="col-lg-4 row">
- 
 
 370 
        <div class="col-lg-1"></div>
- 
 
 371 
        <div id="payment-details"
- 
 
 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>
438
428 
 
- 
 
 429 
        </div>
- 
 
 430 
    </div>
- 
 
 431 
    </div>
439 
</section>
 432 
</section>
440 

            433