@extends('layouts.default') @section('content')
Two Wheeler 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
Male
Female
Others
Aadhaar No
Is Pan Card available ?
Select an Option
Yes
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
Vehicle No / Registration No
RTO Location
Year of Manufacture
Team Details
TEAM DETAILS
Employee
Partner
Caller
Select an Option
@foreach ($caller_list as $data)
{{ $data->firstname }} {{ $data->lastname }}-{{$data->employee_code }}
@endforeach
Team Leader
Assistant Manager
Manager
Center Head
Regional Head / AVP
Zonal Head
Vice President
SM / RM
Select an Option
@foreach ($leads->ResponseObject as $data)
{{ $data->firstname }} {{ $data->lastname }}-{{$data->employee_code }}
@endforeach
Branch - Center Location Name
Select an Option
@foreach ($branchlist->ResponseObject as $branch)
{{ $branch->branch_name }}
@endforeach
Partner Details
Choose an option
Manager Details
Relationship Manager
Choose an option
Payout Cycle
Location
Attachments
Add Attchment
Pan / Form 60
Select an Option
Pan / Form 60
File
Remarks
Aadhaar Front Side
Select an Option
Aadhaar Front Side
File
Remarks
Aadhaar Back Side
Select an Option
Aadhaar Back Side
File
Remarks
Recent Photo
Select an Option
Recent Photo
File
Remarks
Remarks
Add Remarks
Remarks
Remarks Filled by
Submit
@stop