| Current Path : /home1/savoy/public_html/savoyglobal.net/drafthr/system/application/views/Claims/ |
Linux gator3171.hostgator.com 4.19.286-203.ELK.el7.x86_64 #1 SMP Wed Jun 14 04:33:55 CDT 2023 x86_64 |
| Current File : /home1/savoy/public_html/savoyglobal.net/drafthr/system/application/views/Claims/addclaim.php |
<?php if ( ! defined('BASEPATH')) exit('No direct script access allowed');?>
<script type="text/javascript">
jQuery(document).ready(function ()
{
$('.one').datepick({dateFormat: 'dd-mm-yyyy'});
$('.two').datepick({dateFormat: 'dd-mm-yyyy'});
$('.three').datepick({dateFormat: 'dd-mm-yyyy'});
$('.four').datepick({dateFormat: 'dd-mm-yyyy'});
suggestpolicyno('policyno_search');
});
</script>
<div class="select-bar">
<label>
<img src="<?=base_url()?>/assets/images/backbutton.png" title="Back" class="clickimage" onclick="loadclaim('<?=$_SESSION['pagenum']?>','<?=$_SESSION['searchoption']?>','<?=$_SESSION['searchtxt']?>')" alt="Back" align = "center" width="25" height="25" />
</label>
</div>
<fieldset>
<legend>Add Claim</legend>
<?php
$attributes = array('id' => 'customForm');
echo form_open_multipart('claims/addclaim',$attributes);?>
<ul>
<li>
<label>Date</label>
<input class="three" name="date" id="date" value="<?php echo date("d-m-Y"); ?>" readonly="true" type="text" style="background-image: url(../../../../assets/images/datefocus.gif);">
</li>
<li>
<?php
$data = array(
'name' => 'policyno',
'id' => 'policyno',
);
?>
<label for="country">Policy No.</label>
<?php
echo form_input($data).form_error($data); ?>
<img id="inliexample1" src="<?=base_url()?>/assets/images/button-search.png" title="Search" class="clickimage" onclick="showpolidiv()" ><span id="policyidInfo" class="red_bold">*</span>
<input type="hidden" name="policyid" id="policyid">
</li>
<li >OR</li>
<li>
<label>Policy No.</label><input type="text" name="policyno_search" id="policyno_search" />
<img src="<?=base_url()?>/assets/images/use.png" class="clickimage" onclick="usepolicybynoforclaim($('input#policyno_search').val())" alt="" width="20" height="20" />
<input type="hidden" name="policyno_search_id" id="policyno_search_id">
</li>
<li>
<div id="enddet" >
</div>
<li>
<label>Date of Loss</label>
<input class="one" name="dateofloss" id="dateofloss" readonly="true" type="text" style="background-image: url(../../../../assets/images/datefocus.gif);">
<span id="dateoflossInfo" class="red_bold">*</span> </li>
<li>
<label>Claims Intimation Date</label>
<input class="two" name="intimationdate" id="intimationdate" readonly="true" type="text" style="background-image: url(../../../../assets/images/datefocus.gif);">
<span id="intimationdateInfo" class="red_bold">*</span>
</li>
<?php
$norecords++;
?>
<input type="hidden" name="claimref" value="<?php echo "CLAIM-10".$norecords; ?>">
<li>
<label for="country">Claims Policy No</label>
<?php
$data1 = array(
'name' => 'claimspolicyno',
'id' => 'claimspolicyno',
);
$options = array(
'Pending' => 'Pending',
'Settled' => 'Settled',
'Partial Payment' => 'Partial Payment',
'Denied' => 'Denied',
);
?>
<?php
echo form_input($data1).form_error($data1); ?>
</li>
<li>
<label>Currency</label><select name="currency" id="currency">
<option value="">Select</option>
<?php foreach($curlist as $cur)
{
echo '<option value="'.$cur['id'].'">'.$cur['currencyname'] .'</option>';
}
?>
</select><span id="currencyInfo" class="red_bold">*</span>
</li>
<li>
<?php
$data2 = array(
'name' => 'descofloss',
'id' => 'descofloss',
'rows' => '5',
'cols' => '5',
'style' => 'width:50%',
);
?>
<label for="date">Description of Loss</label>
<?php echo form_textarea($data2); ?>
</li>
<li>
<label for="country">Estimated Claim Amount</label>
<?php
$data3 = array(
'name' => 'estimatedamt',
'id' => 'estimatedamt',
);
?>
<?php
echo form_input($data3).form_error($data3); ?>
</li><li>
<label for="Name">Status</label>
<?php echo form_dropdown('status',$options);?>
</li>
<li></li> <fieldset>
<legend>Claim Description</legend>
<li> <input name="addRows" value="Add More" onclick="addRowToTableClaims();" title="Add more details." type="button">
<input name="deleteRows" value="Remove" onclick="removeRowFromTableClaims();" title="Delete the last detail." type="button">
</li>
<li></li>
<table class="sort" id="addrow" border="0" cellpadding="0" cellspacing="0" width="60%">
<tbody><tr class="red_bold" align="left" valign="top">
<th width="10%">Date</th>
<th width="18%">Description</th>
<th width="12%">Remarks</th>
</tr>
<tr class="bold_black" align="left" valign="top">
<td><input class="four" name="txt_conDate_1" id="txt_conDate_1" style="width: 100px;" type="text" style="background-image: url(../../../../assets/images/datefocus.gif);">
<input name="hid_conCnt" id="hid_conCnt" value="1" type="hidden"></td>
<td><input name="txt_conDesc_1" id="txt_conDesc_1" style="width: 150px;" type="text"></td>
<td><textarea name="txt_conRem_1" id="txt_conRem_1" style="width: 200px;"></textarea></td>
</tr>
</tbody></table>
</fieldset>
<li></li>
<li></li> <fieldset>
<legend>Claims Settlement Amount</legend>
<li> <input name="addRows" value="Add More" onclick="addRowToTableClaimsSet();" title="Add more details." type="button">
<input name="deleteRows" value="Remove" onclick="removeRowFromTableClaimsSet();" title="Delete the last detail." type="button">
</li>
<li></li>
<table class="sort" id="addsettl" border="0" cellpadding="0" cellspacing="0" width="60%">
<tbody><tr class="red_bold" align="left" valign="top">
<th width="18%">Description</th>
<th width="12%">Amount</th>
</tr>
<tr class="bold_black" align="left" valign="top">
<input name="hid_conCnt1" id="hid_conCnt1" value="1" type="hidden">
<td><textarea name="txt_conDescSet_1" id="txt_conDescSet_1" style="width: 250px;"></textarea></td>
<td><input name="txt_conAmt_1" id="txt_conAmt_1" style="width: 200px;" type="text"> <input name="hid_conCnt" id="hid_conCnt" value="1" type="hidden"></td>
</tr>
</tbody></table>
</fieldset>
<li><label for="submit"> </label>
<button type="submit" id="submit" class="clickimage" onclick="return doallthethree();">Save</button>
</li>
</ul>
<?php echo form_close();?>
</fieldset>