@extends('layouts.default') @section('content')
Car Insurance Form
@csrf
Insurance Co. Details
Insurance Company Name
Select an Option
Plan Name
Select an Option
Sub Plan Name
Select an Option
Personal Details
Name
DOB
Gender
Select an Option
personal_gender=='male' ? 'selected': ''}}>Male
personal_gender=='female' ? 'selected': ''}}>Female
personal_gender=='others' ? 'selected': ''}}>Others
Aadhaar No
Is Pan Card available ?
Select an Option
pancard_available=='Yes' ? 'selected': ''}}>Yes
pancard_available=='No' ? 'selected': ''}}>No
PAN NO
Email
Mobile No
Alternate Mobile No
Permanent Address
Same as Permanent Address
Communication Address
Vehicle Details
Make / Model
Engine No
Chassis No
CC / HP
Seating Capacity Of Side Car (If Any) Including Driver
Have you registered your vehicle ?
Select an Option
Yes
No
Vehicle No / Registration No
RTO Location
Year of Manufacture
Package Category
Select an Option
private_car_package=='standlone_od' ? 'selected':''}}>Standlone OD
private_car_package=='standlone_tp' ? 'selected':''}}>Standlone TP
private_car_package=='bundled' ? 'selected':''}}>1 + 3 (Bundled)
private_car_package=='comprehensive_package' ? 'selected':''}}>1 + 1 (Comprehensive Package)
Car Fuel Type
Select an Option
pvt_car_fuel_type=='diesel' ? 'selected':''}}>Diesel
pvt_car_fuel_type=='non-diesel' ? 'selected':''}}>Non-Diesel
Attachments
Add Attchment
@if($checkattachfile == 0 || $checkattachfile == "0")
Document Type
Select an Option
Pan
Aadhaar Front Side
Aadhaar Back Side
Recent Photo
File
Remarks
@endif @foreach($policy_attachmentss as $key => $attchment)
Document Type
Select an Option
Pan
Aadhaar Front Side
Aadhaar Back Side
Recent Photo
File
@if($attchment['file_attach_type'] == "image")
x
@else
x
@endif
Remarks
{{$attchment['attachments_remarks']}}
@endforeach
Remarks
Add Remarks
@if($remarks =='')
Remarks
Remarks Filled by
@endif @foreach($remarks as $remark)
Remarks
{{$remark['pl_remarks']}}
Remarks Filled by
@endforeach
Submit
@stop