{!! html()->label('Numéro','numero') !!} {!! html()->text('numero', null)->placeholder('Numéro')->attributes([($mode=="show"?'disabled':''),'class' => 'form-control']) !!}

{!! html()->label('sonum','Employeur') !!} {!! html()->text('sonum', null)->placeholder('')->attributes([($mode=="show"?'disabled':''),'class' => 'form-control']) !!}

{!! html()->label('Date d\'envoi','date_envoi') !!}

{!! html()->text('date_envoi', date('j/m/Y'))->placeholder('')->attributes([($mode=="show"?'disabled':''),'class' => 'form-control']) !!}

{!! html()->label('Motif','motif') !!} {!! html()->text('motif', isset($med)?$med->MotifLibelle:null)->placeholder('') ->attributes([($mode=="show"?'disabled':''),'class' => 'form-control']) !!}

{!! html()->label('Mois manquants','nbmois') !!} {!! html()->text('nbmois', null)->placeholder('')->attributes([($mode=="show"?'disabled':''),'class' => 'form-control']) !!}

Période

{!! html()->label('Début','periode_deb') !!}

{!! html()->text('periode_deb', null)->placeholder('')->attributes([($mode=="show"?'disabled':''),'class' => 'form-control']) !!}

{!! html()->label('Fin','periode_fin') !!}

{!! html()->text('periode_fin', null)->placeholder('')->attributes([($mode=="show"?'disabled':''),'class' => 'form-control']) !!}

{!! html()->label('Costisations','cotisations') !!} {!! html()->text('cotisations', null)->placeholder('')->attributes([($mode=="show"?'disabled':''),'class' => 'form-control']) !!}

{!! html()->label('Majorations','majorations') !!} {!! html()->text('majorations', null)->placeholder('')->attributes([($mode=="show"?'disabled':''),'class' => 'form-control']) !!}

{!! html()->label('Total de la dette','total') !!}

{!! html()->text('total', isset($med)?$med->majorations+$med->cotisations:null)->placeholder('')->attributes([($mode=="show"?'disabled':''),'class' => 'text-danger form-control']) !!}

{!! Form::label('sonum', 'Employeur') !!} {!! Form::select('sonum',array(""=>"")+$liste_employeur, $employeur->id, [ 'class' => 'selectpicker show-tick', 'id' => 'sonum', 'data-width' => "100%", ] ) !!}

{!! Form::label('date_envoi', 'Date d\'envoi') !!}

{!! Form::text('date_envoi', date('j/m/Y'), ['placeholder' => 'Date d\'envoi', 'class' => 'form-control']) !!}

{!! Form::label('motif', 'Motif') !!}
{!! Form::select( 'motif', [ ''=>' ', 'TAR' => 'Production tardive', 'ABS' => 'Absence ou insuffisance de versement', 'BOR' => 'Défaut de production du bordereau de déclaration nomminative', 'RET' => 'Retard dans le versement', 'RED' => 'Redressement suite au contrôle', ], '', [ 'class' => 'selectpicker','data-width' => "100%", ] ) !!}

{!! Form::label('nbmois', 'Mois manquants') !!} {!! Form::text('nbmois', $nbmois, ['id'=>'nbmois','placeholder' => 'Mois manquants', 'class' => 'form-control']) !!}

Période

{!! Form::label('periode_deb', 'Début') !!}

{!! Form::text('periode_deb', '01/01/'.(date('Y')-1), ['placeholder' => 'Début', 'class' => 'form-control']) !!}

{!! Form::label('periode_fin', 'Fin') !!}

{!! Form::text('periode_fin', '31/12/'.(date('Y')-1), ['placeholder' => 'Fin', 'class' => 'form-control']) !!}