@extends('layouts.default', ['appTopMenu' => true])
@php

use App\Models\Masters\Master_model;

@endphp
 @section('title','rti application form') 
@push('scripts')
<!--<script src="{{ asset('js/typeahead.js') }}"></script>
<script src="{{ asset('js/bootstrap3-typeahead.min.js') }}"></script

<script src="{{ asset('js/autocomplete.js') }}"></script>-->
<link rel="stylesheet" href="{{ asset('css/jquery-ui.css')}}" />
<script src="{{ asset('js/jquery-ui.js') }}"></script>

<script src="{{ asset('js/hcrti/onlineapplication.js')}}"></script>
 <!--<script src="{{ asset('js/bootstrap-datetimepicker.fr.js') }}"></script>-->
 <meta name="csrf-token" content="{{ csrf_token() }}" />
 <link href="/assets/plugins/select2/dist/css/select2.min.css" rel="stylesheet" />
<!--<script src="https://ajax.googleapis.com/ajax/libs/jquery/1.9.1/jquery.js"></script>-->
<script src="/assets/plugins/select2/dist/js/select2.min.js" defer></script>
<link href="/assets/plugins/bootstrap-datepicker/dist/css/bootstrap-datepicker.css" rel="stylesheet" />
<script src="/assets/plugins/bootstrap-datepicker/dist/js/bootstrap-datepicker.js" defer></script>

<script src="/assets/plugins/sweetalert/dist/sweetalert.min.js"></script>


<meta http-equiv="Content-Type" content="text/html;charset=UTF-8"/>

 <script type="text/javascript">
 
 $(document).ready(function(){
    var ddlang=$('#ddlang').val();
    // alert(ddlang);
    getState_by_language(ddlang) ;
 });

  $(".dtp").datepicker({
  todayHighlight: true,
    autoclose: true,
	opens: "right",
    dateFormat: "dd-mm-yy"
  });

 
  $.ajaxSetup({
    headers: {
        'X-CSRF-TOKEN': $('meta[name="csrf-token"]').attr('content')
    }
});



 function getState_by_language(lang_code) 
 {
	//  alert(lang_code);
        $.ajax({
            type: "POST",
            url: "{{ url('hcrti/getState') }}",
            data: {'lang_code': lang_code},
            beforeSend: function (request) {
                return request.setRequestHeader('X-CSRF-Token', $("meta[name='csrf-token']").attr('content'));
            },
            success: function (data) {
                // alert(data);
                $("#state").empty();
                $("#state").append(data);
                getatitle(lang_code);
            },
            error: function (data) {
                $('.text-danger').text('');
                if (data.status === 401) {
                    $(location).prop('/', 'login');
                } else if (data.status === 422) {
                    $.each(data.responseJSON.errors, function (field_name, error) {
                        $(document).find('[name=' + field_name + ']').after('<span class="text-danger">' + error + '</span>')
                    })

                }
            }
        });
    }

   function getatitle(id)
        {  
            //    var id=$(this).val();  
            // var id=$(this).val();  
               var dataString = 'id='+ id; 
			   //alert(dataString);
               $.ajax  
               ({  
                type: "POST",  
                url: "{{ url('hcrti/getatitle') }}",  
                data: dataString,  
                cache: false,  
                success: function(html)  
                {  
				//alert(html);
                 //$("#atitle").html(html); 
		 $("#atitle").html('<option value="-1">Select</option>'+html); 
                }  
               });  
      
            }  


 function getState_t(state_code) 
 {
	 
        $.ajax({
            type: "POST",
            url: "{{ url('hcrti/getDistrict') }}",
            data: {'state_code': state_code,'lang_code':$('#ddlang').val()},
			//alert(data);
            beforeSend: function (request) {
                return request.setRequestHeader('X-CSRF-Token', $("meta[name='csrf-token']").attr('content'));
            },
            success: function (data) {
                $("#district_t").empty();
                $("#district_t").append(data);
            },
            error: function (data) {
                $('.text-danger').text('');
                if (data.status === 401) {
                    $(location).prop('/', 'login');
                } else if (data.status === 422) {
                    $.each(data.responseJSON.errors, function (field_name, error) {
                        $(document).find('[name=' + field_name + ']').after('<span class="text-danger">' + error + '</span>')
                    })

                }
            }
        });
    }
	
 function getTaluka_t(dist_code) 
 {
	 //alert("sdfsdf");
        $.ajax({
            type: "POST",
            url: "{{ url('hcrti/getTaluka') }}",
            data: {'dist_code': dist_code,'lang_code':$('#ddlang').val()},
            beforeSend: function (request) {
                return request.setRequestHeader('X-CSRF-Token', $("meta[name='csrf-token']").attr('content'));
            },
            success: function (data) {
                $("#taluka_t").empty();
                $("#taluka_t").append(data);
            },
            error: function (data) {
                $('.text-danger').text('');
                if (data.status === 401) {
                    $(location).prop('/', 'login');
                } else if (data.status === 422) {
                    $.each(data.responseJSON.errors, function (field_name, error) {
                        $(document).find('[name=' + field_name + ']').after('<span class="text-danger">' + error + '</span>')
                    })

                }
            }
        });
    }
	</script>
@endpush

@push('head')

<!--<link href="../assets/plugins/select2/dist/css/select2.min.css" rel="stylesheet" />
<script src="https://ajax.googleapis.com/ajax/libs/jquery/1.9.1/jquery.js"></script>
<script src="../assets/plugins/select2/dist/js/select2.min.js" defer></script>
<link href="../assets/plugins/bootstrap-datepicker/dist/css/bootstrap-datepicker.css" rel="stylesheet" />
<script src="../assets/plugins/bootstrap-datepicker/dist/js/bootstrap-datepicker.js" defer></script>
<script src="../assets/plugins/sweetalert/dist/sweetalert.min.js"></script>-->



@endpush

@section('content') 

<div class="container">
    @if (session('status'))

    <div class="alert alert-success alert-dismissible" >
        <button type="button" class="btn-close" data-bs-dismiss="alert"></button>
        {!! session('status') !!}
    </div>
    @elseif(session('failed'))
    <div class="alert alert-danger alert-dismissible" >
        <button type="button" class="btn-close" ddata-bs-dismiss="alert"></button>
        <strong>{{ session('failed') }}	</strong>
    </div>
    @endif
  


<script>
@if (Session::has('success'))

        swal("{{Session::get('success')}}").then(function() {
//window.location = "/project/" + loc;
});
@endif


</script>


    <form method='post' action='' name='f1' id="f1" enctype="multipart/form-data">
	  @csrf
	  @if( !empty($results->id)) <input type="hidden" name="id" value="{{ $results->id ?? '' }}"> @endif
	    <div class="card mb-3" id="google_translate_element">
            <div class="card-header bg-dark ">Registration [Form-A]</div>
            <div class="card-body">
                <div class="row mb-3">
 



                  
@php 
$sn_language='-1';
$sn_language=session()->get('sn_language');
@endphp

<div class="col-sm-4 mb-3"> <label class="control-label" for="ddlang"><b>Language:</b></label>
<select class="form-select select2bs4" name='ddlang' id='ddlang' onchange="getState_by_language(this.value)" value="{{ $results->lang ?? old('ddlang') }}">
<option value="-1">Select</option>
<option value="0" @if($sn_language==0) selected @endif>English</option>
<option value="1" @if($sn_language==1) selected @endif> हिंदी </option>
</select>
</div>

<!-- <div class="col-sm-4 mb-3"><label class="control-label" for="txtaddress"><b>Establishment:</b></label>
<select id="establishment" name="establishment"  class="form-select select2bs4" value="{{ $results->est_name ?? old('est_name')}}">
<option   value="-1">-Select Establishment-</option>
   
            @foreach($getEstDetailsFromId as $val)
          <option value="{{ $val->id }}">{{$val->est_name}}</option>
          @endforeach

</select>
</div>-->
                    
<div class="col-sm-4 mb-3"> <label class="control-label" for="atitle"><b>Title:</b></label>
<select class="form-select select2bs4" name='atitle' id='atitle' value="{{ $results->title_id ?? old('atitle') }}"  	>
</select>
</div>

<div class="col-sm-4 mb-3"> <label class="control-label" for="txtname"><b>Name of the Applicant:</b></label>
<input class="form-control" type='text' name='txtname' id='txtname' autocomplete="on" value="{{ $results->name ?? old('txtname')}}"/>
</div>

<div class="col-sm-4 mb-3"> <label class="control-label" for="txtfname"><b>Father's Name:</b></label>
   <input class="form-control" type='text' name='txtfname' id='txtfname'   autocomplete="on" value="{{ $results->f_name ?? old('txtfname')}}"/>
</div>
<tr>
<div class="col-sm-4 mb-3"> <label class="control-label" for="txtage"><b>Age:</b></label>
<input class="form-control" type='text' name='txtage' id='txtage' autocomplete="off" value="{{ $results->age ?? old('txtage')}}"/>
</div>

<div class="col-sm-4 mb-3"> <label class="control-label" for="txtoccupation"><b>Occupation:</b></label>
<input class="form-control" type='text' name='txtoccupation' id='txtoccupation'  autocomplete="on" value="{{ $results->occupation ?? old('txtoccupation')}}"/>
</div>


<div class="col-sm-4 mb-3"><label class="control-label" for="txtaddress"><b>Address:</b></label>
<input type="text" class="form-control" name='txtaddress' id='txtaddress'  autocomplete="on"  	value="{{ $results->address ?? old('txtaddress')}}" 	/>
</div>

<div class="col-sm-4 mb-3"><label class="control-label" for="txtaddress"><b>State:</b></label>
<select id="state" name="state"  class="form-select select2bs4" onchange="getState_t(this.value)" value="{{ $results->state_name ?? old('state')}}">
<option   value="-1">-Select State-</option>


</select>
</div>

<div class="col-sm-4 mb-3"><label class="control-label" for="district_t"><b>District</b></label>  
<select onchange="getTaluka_t(this.value)" id="district_t" name="district_t"  class="form-select select2bs4">
<option value="-1">Select District</option>


</select>

</div>                      
                                   
<div class="col-sm-4 mb-3"><label class="control-label" for="taluka_t"><b>Select Tehsil</b></label>  
<select id="taluka_t" name="taluka_t"  class="form-select select2bs4">
<option value="-1">Tehsil</option>
</select>
<span class="help-block"></span>
</div> 

<div class="col-sm-4 mb-3"> <label class="control-label" for="pincode"><b>Pincode:</b></label>
    <input class="form-control" type='text' name='pincode' id='pincode' maxlength="6" autocomplete="on" value="{{ $results->pincode ?? old('pincode')}}"/>
</div>
 	 	
<div class="col-sm-4 mb-3"> <label class="control-label" for="txtinfoperiod"><b><label class="control-label">Application Date:</b></label>
<td><input class="form-control dtp" type='text' name='txtappdate' id='txtappdate' maxlength='10' autocomplete="on" value="{{ !empty($results->app_date) ? \Carbon\Carbon::parse($results->app_date)->format('d-m-Y'):old('txtappdate') }}" />
<!--<img src="icons/b_calendar.png" onclick="displayDatePicker('txtappdate', false, 'dmy', '.');" style="width:16px;height:16px;cursor:pointer;"/>-->
</div>


<div class="col-sm-12 mb-3"><label class="control-label" for="txtinforeq1"><b>Details of Information Required:</b></label>
<textarea  type='text' name='txtinforeq1' id='txtinforeq1' maxlength='800' autocomplete="on" class="form-control">{{ $results->info_req1 ?? old('txtinforeq1')}}</textarea>
</div>




<div class="col-sm-4 mb-3"> <label class="control-label" for="txtinfoperiod"><b>Period for which information asked for:</b></label>

<input class="form-control" type='text' name='txtinfoperiod' id='txtinfoperiod'  autocomplete="on" value="{{ $results->info_period ?? old('txtinfoperiod')}}" />
</div>

<div class="col-sm-4 mb-3"> <label class="control-label" for="txtinfoperiod"><b>Other Details:</b></label>
<input class="form-control" type='text' name='txtother' id='txtother' maxlength='60' autocomplete="on" value="{{ $results->other_detail ?? old('txtother')}}" />
</div>

<div class="col-sm-4 mb-3"> <label class="control-label" for="txtinfoperiod"><b>General Information / Tender Documents etc:</b></label>
<select class="form-select" name='ddgenTend' id='ddgenTend'>
        <option value="0">General Information</option>
        <option value="1">Tender/Business Information</option>
</select>
</div>

<div class="col-sm-4 mb-3"> <label class="control-label" for="txtinfoperiod"><b>Is Below Poverty Line (BPL):</b></label>
<input type="radio" name='bpl' class="bpl" value="1" id='bplYes'> Yes
<input type="radio" name='bpl' class="bpl" value="2" id='bplNo' checked> No
</div>


<div id="bpldetail" class="col-sm-4 mb-3"> <label class="control-label" for="txtbpldetail"><b>Details of BPL Certificate:</b></label>
<input class="form-control" type='text' name='txtbpldetail' id='txtbpldetail' maxlength='100' autocomplete="on" value="{{ $results->info_period ?? old('txtinfoperiod')}}" />      
</div>
  


<div id="feedetail"  class="col-sm-4 mb-3 tbl"> <label class="control-label" for="ddpmtType"><b>Mode of Fee:</b></label>
<select class="form-select"  name='ddpmtType' id='ddpmtType'>
        <option value="0">Non-Judicial Stamp</option>
        <option value="1">Treasury Challan</option>
</select>
</div>  
      


<div class="col-sm-4 mb-3 feeRecvDt" > <label class="control-label" ><b>Fee Received Date:</b></label>


<input class='form-control dtp' type='text' name='feeRecvDt' id='feeRecvDt' value="" maxlength='10' autocomplete="on" value="{{ $results->fee_rec_date ?? old('feeRecvDt')}}"/>
<!--<img src="icons/b_calendar.png" onclick="displayDatePicker('feeRecvDt', false, 'dmy', '.');" style="width:16px;height:16px;cursor:pointer;"/>-->
</div>



<div class="col-sm-4 mb-3 txtfee1"> <label class="control-label" for="txtinfoperiod"><b><label class="control-label" >Fees:</b></label><input class='form-control' type='text' name='txtfee1' id='txtfee1' maxlength='10' autocomplete="on" value="{{ $results->info_period ?? old('txtinfoperiod')}}"/></div>
<div class="col-sm-4 mb-3 txtpmtTypeNo1"> <label class="control-label" for="txtinfoperiod"><b><label class="control-label" >Non-Judicial Stamp/Treasury Challan No.:</b></label><input class='form-control' type='text' name='txtpmtTypeNo1' id='txtpmtTypeNo1' maxlength='60' autocomplete="on" value="{{ $results->info_period ?? old('txtinfoperiod')}}"/></div>
<div class="col-sm-4 mb-3 txtpmtTypeDate1"> <label class="control-label" for="txtinfoperiod"><b><label class="control-label" >Non-Judicial Stamp/Treasury Challan Date:</b></label><input class='form-control dtp' type='text' name='txtpmtTypeDate1' id='txtpmtTypeDate1' maxlength='10' autocomplete="on" value="{{ $results->info_period ?? old('txtinfoperiod')}}"/></div>




   


<div class="col-sm-4 mb-3"> <label class="control-label" for="txtinfoperiod"><b><label class="control-label">Application Received On:</b></label>
<input class="form-control dtp" type='text' name='txtapprecdate' id='txtapprecdate' maxlength='10' autocomplete="on" value="{{ !empty($results->app_ent_date) ? \Carbon\Carbon::parse($results->app_ent_date)->format('d-m-Y'):old('txtapprecdate') }}"/>
<!--<img src="icons/b_calendar.png" onclick="displayDatePicker('txtapprecdate', false, 'dmy', '.');" style="width:16px;height:16px;cursor:pointer;"/>-->
</div>

<div class="col-sm-4 mb-3"> <label class="control-label" for="txtinfoperiod"><b><label class="control-label">E-mail:</b></label>
<input class="form-control" type='text' name='txtemail' id='txtemail'  maxlength='60' autocomplete="on" value="{{ $results->email ?? old('txtemail')}}"/>
</div>
<div class="col-sm-4 mb-3"> <label class="control-label" for="txtinfoperiod"><b><label class="control-label">Landline No.:</b></label>
<input class="form-control" type='text' name='txttoffice' id='txttoffice'  maxlength='60' autocomplete="on" value="{{ $results->phone_residence ?? old('txttoffice')}}"/></div>



<div class="col-sm-4 mb-3"> <label class="control-label" for="txtinfoperiod"><b><label class="control-label">Mobile No.:</b></label>
<input class="form-control" type='text' name='txtmobile' id='txtmobile'  maxlength='10' autocomplete="on" value="{{ $results->mobile ?? old('txtmobile')}}"/></div>

<div class="col-sm-4 mb-3"> <label class="control-label" for="txtinfoperiod"><b><label class="control-label"></b></label>
<select class="form-select" name='ddrecFrom' id='ddrecFrom'>
        <!--<option value="-1">--Select--</option>-->
        <option value="0">Personally From Applicant</option>
<!--		<option value="1">Receipt Section</option><option value="2">Post</option>
        <option value="3">Other Section of this High Court</option><option value="4">Other Department (U/s 6(3))</option>        
        <option value="5">By Other Person</option>-->
    </select></div>
	
<div class="col-sm-4 mb-3"> <label class="control-label" for="txtinfoperiod"><b><label class="control-label">Mode of Delivery:</b></label>

<select class="form-select"  maxlength='100' autocomplete="off" name="mode_of_delivery" id="mode_of_delivery">
<!--<option value="-1">Select</option>-->
<option value="by_email">By Email</option>
<!--<option value="by_post">By Post</option>-->
</select>
</div>	
	
<div class="col-sm-4 mb-3"> <label class="control-label" for="txtinfoperiod"><b><label class="control-label">Photo Upload.:</b></label>
<input class="form-control" type='file' name='profile_image' id='profile_image' maxlength='100' autocomplete="off"/></div>

<div class="col-sm-4 mb-3"> <label class="control-label" for="txtinfoperiod"><b><label class="control-label">Sign Upload:</b></label>
<input class="form-control" type='file' name='sign' id='sign' maxlength='100' autocomplete="off"/>
</div>

<div class="col-sm-4 mb-3" id="bpl_upload"> <label class="control-label" for="txtinfoperiod"><b><label class="control-label">BPL Upload:</b></label>
<input class="form-control" type='file' name='bpl_doc' id='bpl_doc' maxlength='100' autocomplete="off"/>
</div>

<div>information will provided on your email.</div>


 <div class="col-sm-12 mb-3">
<center> <input type="button"  id="bsubmit" style="width:80px;" class="btn-primary form-control" value="Payment" ></center>
</div>






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






@endsection