@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"><strong>प्रभाग / 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>

                                    <label class="col-sm-2"><strong>विभाग / 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>

                                <hr>

                                <h5 class="text-blue h5 mb-20" style="font-size: 17px;font-weight: bolder;">Cat
                                    Details :</h5>
                                <div class="form-group row">
                                    <label class="col-sm-2"><strong>कुत्र्याचे नाव / <br> Cat 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>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>
                                    <label class="col-sm-2"><strong> Tentative Date of Birth (DD/MM/YYYY) / <br> अंदाजे जन्मतारीख (दि/महा/वर्ष) : </strong></label>
                                    <div class="col-sm-4 col-md-4 p-2">
                                        <input type="date" name="date_of_birth" id="date_of_birth"
                                            class="form-control @error('date_of_birth') is-invalid @enderror"
                                            value="{{ $pet_registration_view->date_of_birth }}"
                                            max="{{ date('Y-m-d') }}" placeholder="DD/MM/YYYY" 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" id="age" 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" id="month" value="{{ $pet_registration_view->age }}"
                                            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 Address proof of owner (Aadhar Card /
                                                Ration
                                                Card / Electricity Bill / Rent Agreement / Voter ID) / <br> मालकाचा
                                                पत्ता पुरावा अपलोड करा (आधार कार्ड / शिधा कार्ड / वीज बिल / भाडे
                                                करारनामा /
                                                मतदान ओळखपत्र
                                                अपलोड करा) : </strong></label>
                                    <div class="col-sm-4 col-md-4 p-2">
                                        <a href="{{ url('/') }}/TMC_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 Cat Photo / <br> ( मांजरीचा/मांजराचा  फोटो अपलोड करा
                                            ) : </strong></label>
                                    <div class="col-sm-4 col-md-4 p-2">
                                        <a href="{{ url('/') }}/TMC_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">
                                </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('/') }}/TMC_PET_Registration/applicant_signature/{{ $pet_registration_view->applicant_signature }}"
                                            target="_blank">
                                            <div class="form-group">
                                                 <a href="#">Document Not
                                                    Uploaded</a>
                                                                                            </div>
                                        </a>
                                    </div>


                                    <label class="col-sm-2">
                                        <strong>Upload latest Vaccination Card / <br>( नवीनतम
                                                लसीकरण कार्ड अपलोड करा ):</strong>
                                    </label>
                                    <div class="col-sm-4 col-md-4 p-2">
                                        <a href="{{ url('/') }}/TMC_PET_Registration/vaccination_card_doc/{{ $pet_registration_view->vaccination_card_doc }}"
                                            target="_blank">
                                            <div class="form-group">
                                                <a href="#">No Document
                                                    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')