@include('common.header')

<link rel="stylesheet" href="//code.jquery.com/ui/1.12.1/themes/base/jquery-ui.css">

<section class="content">
    <div class="body_scroll">
        <div class="block-header">
            <div class="row">
                <div class="col-lg-7 col-md-6 col-sm-12">
                    <h2>Refund PET Application</h2>
                    <ul class="breadcrumb">
                        <li class="breadcrumb-item"><a href="{{ url('/admin/dashboard') }}"><i class="zmdi zmdi-home"></i> Home</a></li>
                        <!--<li class="breadcrumb-item"><a href="{{ url('/#') }}">PET Application</a></li>-->
                        <li class="breadcrumb-item active">Refund PET Application</li>
                    </ul>
                    <button class="btn btn-primary btn-icon mobile_menu" type="button"><i class="zmdi zmdi-sort-amount-desc"></i></button>
                </div>
                
                <div class="col-lg-5 col-md-6 col-sm-12">
                    <button class="btn btn-primary btn-icon float-right right_icon_toggle_btn" type="button"><i class="zmdi zmdi-arrow-right"></i></button>
                </div>
            </div>
        </div>

        <div class="container-fluid">
            <!-- Vertical Layout -->
            <div class="row clearfix">
                <div class="col-lg-12 col-md-12 col-sm-12">
                    <div class="body">
                            <form method="post" action="{{ url('/#') }}" class="form-horizontal" enctype="multipart/form-data">
                                @csrf
                                <h5 class="text-blue h5 mb-20" style="font-size: 17px;font-weight: bolder;">Basic Information  ( मुलभूत माहिती )  :- </h5>  
                                <div class="pd-20 card-box mb-30">
                                    <div class="form-group row">
                                                                                <label class="col-sm-2 col-form-label"><strong>अर्जाचा प्रकार  /<br> Category of Application : &nbsp; </strong></label>
                                        <div class="col-sm-4 pb-2">
                                            <input class="form-control " value="{{ $category_appli_id }}" readonly>
                                        </div>
                                        
                                        <label class="col-sm-2"><strong>प्रभाग / <br> Ward : </strong></label>
                                        <div class="col-sm-4 col-md-4 pb-2">
                                            <input class="form-control " value="{{ $pet_registration_view->ward_name }}" readonly>
                                        </div>
                                    </div>
                                    
                                    <div class="form-group row pb-2">
                                        <label class="col-sm-2"><strong>विभाग / <br> Department : </strong></label>
                                        <div class="col-sm-4 col-md-4">
                                            <input class="form-control " value="{{ $pet_registration_view->dept_name }}" readonly>
                                        </div>
                                    </div>
                                    
                                    
                                    <strong class="pb-1">अर्जदाराचे नाव /<br> Name of Applicant :  </strong>
                                    <div class="form-group row">
                                                                                <!--<label class="col-sm-1"><strong>Title : </strong></label>-->
                                        <div class="col-sm-3 col-md-3 p-2">
                                            <input class="form-control " value="{{ $applicant_title_id }}" readonly>
                                        </div>
                                        
                                        
                                        <!--<label class="col-sm-1"><strong>First Name : </strong></label>-->
                                        <div class="col-sm-3 col-md-3 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->applicant_fname }}" readonly>
                                        </div>
                                        
                                        <!--<label class="col-sm-1"><strong>Middle Name : </strong></label>-->
                                        <div class="col-sm-3 col-md-3 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->applicant_mname }}" readonly>
                                        </div>
                                        
                                        <!--<label class="col-sm-1"><strong>Last Name : </strong></label>-->
                                        <div class="col-sm-3 col-md-3 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->applicant_lname }}" readonly>
                                        </div>
                                    </div>
                                    
                                    <strong class="pb-1">मालकाचे नाव / <br> Name of Owner's :  </strong>
                                    <div class="form-group row">
                                                                                <!--<label class="col-sm-1"><strong>Title : </strong></label>-->
                                        <div class="col-sm-3 col-md-3 p-2">
                                            <input class="form-control " value="{{ $owner_title_id }}" readonly>
                                        </div>
                                        
                                        
                                        <!--<label class="col-sm-1"><strong>First Name : </strong></label>-->
                                        <div class="col-sm-3 col-md-3 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->owner_fname }}" readonly>
                                        </div>
                                        
                                        <!--<label class="col-sm-1"><strong>Middle Name : </strong></label>-->
                                        <div class="col-sm-3 col-md-3 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->owner_mname }}" readonly>
                                        </div>
                                        
                                        <!--<label class="col-sm-1"><strong>Last Name : </strong></label>-->
                                        <div class="col-sm-3 col-md-3 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->owner_lname }}" readonly>
                                        </div>
                                    </div>
                                    
                                    <strong class="pt-2 text-danger">
                                         मालकाचा निवासी पत्ता / Residential Address of Owner's
                                    </strong>
                                    <hr>
                                        
                                    <div class="form-group row">
 <label class="col-sm-2"><strong> घर/फ्लॅट क्रमांक / <br> House/Flat Number  :  </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->house_number }}" readonly>
                                        </div>
                                        
 <label class="col-sm-2"><strong>घर/इमारतीचे नाव / <br> House/Building Name  : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->house_name }}" readonly>
                                        </div>
                                    </div>
                                
                                    <div class="form-group row">
<label class="col-sm-2"><strong>ओळ १ / <br> Line 1 : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->street_1 }}" readonly>
                                        </div>
                                        
<label class="col-sm-2"><strong>ओळ २ / <br> Line 2 : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->street_2 }}" readonly>
                                        </div>
                                    </div>
                                
                                    <div class="form-group row">
                                        <label class="col-sm-2"><strong>क्षेत्र १ / <br> Area 1 : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->area_1 }}" readonly>
                                        </div>
                                        
                                        <label class="col-sm-2"><strong>क्षेत्र 2 / <br> Area 2  : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->area_2 }}" readonly>
                                        </div>
                                    </div>
                                
                                    <div class="form-group row">
                                                                                
                                        <label class="col-sm-2"><strong>देश / <br> Country : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $country_id }}" readonly>
                                        </div>
                                        
                                                                                <label class="col-sm-2"><strong>राज्य / <br> State : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $state_id }}" readonly>
                                        </div>
                                    </div>
                                    
                                    <div class="form-group row">
                                        <label class="col-sm-2"><strong>जिल्हा / <br> District : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->dist_name }}" readonly>
                                        </div>
                                        
                                        <label class="col-sm-2"><strong>तालुका / <br> Taluka  : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->taluka_name }}" readonly>
                                        </div>
                                    </div>
                                
                                
                                    <div class="form-group row">
                                        <label class="col-sm-2"><strong>मोबाईल नंबर / <br> Mobile Number : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->mobile_number }}" readonly>
                                        </div>
                                        
                                        <label class="col-sm-2"><strong>ई - मेल आयडी / Email Id  :  <br><span class="text-danger"> (Receipt and Certificate will be sent on this Email ID)</span>  </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->email }}" readonly>
                                        </div>
                                    </div>
                                
                                    <div class="form-group row">
                                        <label class="col-sm-2"><strong>आधार क्रमांक / <br> Aadhar Number : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->aadhar_number }}" readonly>
                                        </div>
                                        
                                        <label class="col-sm-2"><strong>पिनकोड / <br> Zip Code : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->zipcode }}" readonly>
                                        </div>
                                    </div>
                                    
                                    <!--<strong class="pt-2 text-danger text-justify">-->
                                    <!--    Note : <br>-->
                                    <!--    1. Please fill all the Dog details below, Since and Vaccination Date should be in mm/dd/yyyy format only Ex. 01/20/2018 .<br>-->
                                    <!--    2. Select Others in Breed and enter details if Dog Breed not found if drop down .<br>-->
                                    <!--    3. Vaccination Certificate of size upto 2 MB to be Uploaded as attachment .-->
                                    <!--</strong>-->
                                    <!--<hr>-->
                                    
                                    <!--<strong class="pt-2 text-danger text-justify">-->
                                    <!--    नोंद : <br>-->
                                    <!--    1. कृपया खाली सर्व कुत्र्याचे तपशील भरा, पासून आणि लसीकरणाची तारीख फक्त mm/dd/yyyy स्वरूपात असावी उदा. 01/20/2018 .<br>-->
                                    <!--    2. जातीतील इतर निवडा आणि ड्रॉप डाउन असल्यास डॉग ब्रीड आढळले नसल्यास तपशील प्रविष्ट करा.<br>-->
                                    <!--    3. संलग्नक म्हणून अपलोड करण्यासाठी 2 MB पर्यंत आकाराचे लसीकरण प्रमाणपत्र.-->
                                    <!--</strong>-->
                                    <hr>
                                     <h5 class="text-blue h5 mb-20" style="font-size: 17px;font-weight: bolder;">Dog Details :</h5>
                                    <div class="form-group row">
                                        <label class="col-sm-2"><strong>कुत्र्याचे नाव / <br> Dog Name : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->dog_name }}" readonly>
                                        </div>
                                        
                                                                                <label class="col-sm-2"><strong>लिंग / <br> Sex  :  </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $sex_id }}" readonly>
                                        </div>
                                    </div>
                                    
                                    <div class="form-group row">
                                        <label class="col-sm-2"><strong>ओळख चिन्ह / <br> Identification Mark : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->identification_mark }}" readonly>
                                        </div>
                                        
                                        <label class="col-sm-2"><strong>जाती / <br> Breed :  </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->breeds_name }}" readonly>
                                        </div>
                                    </div>
                                    
                                    <div class="form-group row">
                                        <label class="col-sm-2"><strong>इतर जाती / <br> Other Breed : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->other_breed }}" readonly>
                                        </div>
                                        
                                        <label class="col-sm-2"><strong>रंग /<br> Colour  : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->colour }}" readonly>
                                        </div>
                                    </div>
                                    
                                    <div class="form-group row">
                                        <label class="col-sm-2"><strong>पशुवैद्यकीय डॉक्टरांचे नाव / <br> Veterinary Doctor Name : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->veterinary_doctor_name }}" readonly>
                                        </div>
                                        
                                        <label class="col-sm-2"><strong>पशुवैद्यकीय डॉक्टरांचा MSVC/VCI नोंदणी क्रमांक / <br> Veterinary doctor’s MSVC/VCI registration number  : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->veterinary_doctor_msvc_no }}" readonly>
                                        </div>
                                    </div>
                                    
                                    <div class="form-group row">
                                        <label class="col-sm-2"><strong>महिना / <br> Month  : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->month }}" readonly>
                                        </div>
                                        
 <label class="col-sm-2"><strong>पाळीव प्राणी वय वर्षे/<br>Pet Age Years  : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->age }}" readonly>
                                        </div>
                                    </div>
                                    
                                    <div class="form-group row">
                                        <label class="col-sm-2"><strong>अँटी रेबीज लसीकरणाची तारीख (DD/MM/YYYY) / <br> Date of Anti Rabies Vaccination (DD/MM/YYYY) : </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <input class="form-control " value="{{ $pet_registration_view->date_of_rabies_vaccination }}" readonly>
                                        </div>
                                    </div>
                                    <hr>
                                     <h5 class="text-blue h5 mb-20" style="font-size: 17px;font-weight: bolder;">Documents :</h5>
                                    <div class="form-group row">
                                        <label class="col-sm-2"><strong>Upload Rabies Vaccination certificate / <br>( रेबीज लसीकरण प्रमाणपत्र अपलोड करा ) </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <a href="{{url('/')}}/PMC_PET_Registration/rabies_vaccination_certificate_doc/{{ $pet_registration_view->rabies_vaccination_certificate_doc }}" target="_blank">
                                                <div class="form-group">
                                                     <a href="#">Document Not Uploaded</a>                                                </div>
                                            </a>
                                        </div>
                                        
                                        <label class="col-sm-2"><strong>Upload Dog Photo / <br> ( कुत्र्याचा फोटो अपलोड करा ) :  </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <a href="{{url('/')}}/PMC_PET_Registration/dog_profile_photo/{{ $pet_registration_view->dog_profile_photo }}" target="_blank">
                                                <div class="form-group">
                                                     <a href="#">Document Not Uploaded</a>                                                </div>
                                            </a>
                                        </div>
                                    </div>
                                    
                                    <div class="form-group row">
                                        <label class="col-sm-2"><strong>Upload Address proof / <br>( पत्ता पुरावा अपलोड करा ) :  </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <a href="{{url('/')}}/PMC_PET_Registration/address_proof_doc/{{ $pet_registration_view->address_proof_doc }}" target="_blank">
                                                <div class="form-group">
                                                     <a href="#">Document Not Uploaded</a>                                                </div>
                                            </a>
                                        </div>
                                        
                                        <label class="col-sm-2"><strong>Upload Applicant Photo / <br>( अर्जदाराचा फोटो अपलोड करा ) :  </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <a href="{{url('/')}}/PMC_PET_Registration/applicant_image/{{ $pet_registration_view->applicant_image }}" target="_blank">
                                                <div class="form-group">
                                                     <a href="#">Document Not Uploaded</a>                                                </div>
                                            </a>
                                            <br>
                                            @error('applicant_image')
                                                <span class="invalid-feedback" role="alert">
                                                    <strong>{{ $message }}</strong>
                                                </span>
                                            @enderror
                                        </div>
                                    </div>
                                    
                                    <div class="form-group row">
                                        <label class="col-sm-2"><strong>Upload Applicant Signature / <br>( अर्जदाराची स्वाक्षरी अपलोड करा ) :  </strong></label>
                                        <div class="col-sm-4 col-md-4 p-2">
                                            <a href="{{url('/')}}/PMC_PET_Registration/applicant_signature/{{ $pet_registration_view->applicant_signature }}" target="_blank">
                                                <div class="form-group">
                                                     <a href="#">Document Not Uploaded</a>                                                </div>
                                            </a>
                                        </div>
                                    </div>
                                    
                                    
                                    <div class="form-group row mt-4">
                                        <label class="col-md-3"></label>
                                        <div class="col-md-9" style="display: flex; justify-content: flex-end;">
                                            <a href="{{ url('all_register_pet') }}"><button type="button"  class="btn btn-danger">Cancel</button></a>
                                        </div>
                                    </div>
                                    
                
                                </div>
                            </form>
                        </div>
                </div>
            </div>
        </div>
    </div>
</section>

@include('common.footer')