@extends('layouts.master') @section('title') Nouveau beneficiaire @stop @section('content')
@if ($errors) @foreach ($errors->all() as $error)
{!! $error !!}
@endforeach @endif

Nouveau bénéficiaire

{!! Form::open(['beneficiaire' => 'form', 'url' => '/tiers/beneficiaires', 'class' => 'form-horizontal']) !!} {!! Form::hidden('type_liste',$type_liste); !!}
{!! Form::label('nom', 'Nom') !!} {!! Form::text('nom', null, ['placeholder' => 'Nom', 'class' => 'form-control text-uppercase']) !!}
{!! Form::label('prenom', 'Prénom') !!} {!! Form::text('prenom', null, ['placeholder' => 'Prénom', 'class' => 'form-control']) !!}
{!! Form::label('civilite', 'Civilité') !!}
{!! Form::select('civilite',[''=>'A définir','Mr'=>'Monsieur','Mme' => 'Madame', 'Mll' => 'Mademoiselle'],'',['class' => 'selectpicker',] ) !!}
{!! Form::label('datenaiss', 'Date de naissance') !!}
{!! Form::text('datenaiss', '', ['placeholder' => 'Date de naissance', 'class' => 'form-control']) !!}
{!! Form::label('lieunaiss', 'Lieu de naissance') !!} {!! Form::text('lieunaiss', null, ['placeholder' => 'Lieu de naissance', 'class' => 'form-control text-uppercase']) !!}
{!! Form::label('statut', 'Statut') !!}
{!! Form::select('statut',$liste_benefstatut,'-' ,['class' => 'selectpicker','data-width' => "100%",'id'=>'statut']) !!}
{!! Form::label('n_all', 'Certificat de vie') !!} {!! Form::text('n_all', null, ['placeholder' => 'Certificat de vie', 'class' => 'form-control']) !!}
{!! Form::label('date_pi', 'Date 1ère immatriculation') !!}
{!! Form::text('date_pi', '', ['placeholder' => 'Date de première immatriculation', 'class' => 'form-control']) !!}
{!! Form::label('verrou', 'Verrou') !!} {!! Form::checkbox('verrou', false, ['class' => 'form-control']) !!}
{!! Form::label('obs', 'Observations') !!} {!! Form::textarea('obs', null, ['placeholder' => 'Observations', 'class' => 'form-control', 'rows'=>'3']) !!}
{!! Form::label('adresse', 'Adresse') !!} {!! Form::textarea('adresse', null, ['placeholder' => 'ADRESSE', 'class' => 'form-control', 'rows'=>'2']) !!}
{!! Form::label('code_postal', 'Code postal') !!} {!!Form::text('code_postal', null, ['placeholder' => 'CODE POSTAL', 'class' => 'form-control']) !!}
{!! Form::label('district', 'District - Zone') !!}
{!! Form::select( 'district', App\Models\MyApp::DISTRICTS2, '', [ 'class' => 'selectpicker','data-width' => "100%", ] ) !!}
{!! Form::label('ile', 'Ile') !!}
{!! Form::select( 'ile', App\Models\MyApp::ILES2, '', [ 'class' => 'selectpicker','data-width' => "100%", ] ) !!}
{!! Form::label('email', 'Email') !!} {!! Form::email('email', null, ['placeholder' => 'EMAIL', 'class' => 'form-control'] )!!}
{!! Form::label('tel', 'Téléphone') !!} {!! Form::text('tel', null, ['placeholder' => 'TELEPHONE', 'class' => 'form-control']) !!}
{!! Form::label('fax', 'Fax') !!} {!! Form::text('fax', null, ['placeholder' => 'FAX', 'class' => 'form-control']) !!}
{!! Form::label('nom_conjoint', 'Conjoint') !!} {!! Form::hidden('conjoint', null, ['id' => 'conjoint']) !!}
{!! Form::label('nb_enf', "Nombre d'enfants") !!} {!! Form::text('nb_enf', null, ['placeholder' => "Nombre d'enfants", 'class' => 'form-control']) !!}
{!! Form::label('nb_enf_tot', "Nombre d'enfants total") !!} {!! Form::text('nb_enf_tot', null, ['placeholder' => "Nombre d'enfants total", 'class' => 'form-control']) !!}
{!! Form::label('employeur', 'Employeur :' ) !!} {!! Form::hidden('sonum', null, ['id' => 'sonum']) !!}
{!! Form::label('banque_id', 'Banque') !!}
{!! Form::select( 'banque_id', array(""=>"")+DB::table('banques')->where('active','=','1')->orderby(db::raw("nom"))->pluck(db::raw("CONCAT(nom,' - ',ville)"), 'id')->toArray(), '',['class' => 'selectpicker','data-width' => "100%",]) !!}
{!! Form::label('IBAN', 'IBAN') !!}
{!! Form::label('IBAN_pays', 'Pays') !!} {!! Form::text('IBAN_pays', null, ['placeholder' => '', 'class' => 'form-control'])!!}
{!! Form::label('IBAN', 'Clé IBAN') !!} {!! Form::text('IBAN_cle', null, ['placeholder' => '', 'class' => 'form-control'])!!}
{!! Form::label('IBAN_banque', 'Banque') !!} {!! Form::text('IBAN_banque', null, ['placeholder' => '', 'class' => 'form-control'])!!}
{!! Form::label('IBAN_guichet', 'Guichet') !!} {!! Form::text('IBAN_guichet', null, ['placeholder' => '', 'class' => 'form-control'])!!}
{!! Form::label('IBAN_compte', 'Numéro de compte') !!} {!! Form::text('IBAN_compte', null, ['placeholder' => '', 'class' => 'form-control'])!!}
{!! Form::label('IBAN_clerib', 'Clé RIb') !!} {!! Form::text('IBAN_clerib', null, ['placeholder' => '', 'class' => 'form-control'])!!}
{!! Form::label('nb_enf', 'Nb enfants') !!} {!! Form::text('nb_enf', null, ['placeholder' => 'Nombre d\'enfants', 'class' => 'form-control'])!!}

{!! Form::label('montants_allocations', 'Montants') !!}
Montant allocation
{!! Form::text('mt_allloc', null, ['placeholder' => 'Montant', 'class' => 'text-right form-control'])!!}
CFP
Montant calculé
{!! Form::text('mt_calc', null, ['placeholder' => 'Montant calculé', 'class' => 'text-right form-control'])!!}
CFP
Montant rappel
{!! Form::text('rappel', null, ['placeholder' => 'Montant rappel', 'class' => 'text-right form-control'])!!}
CFP

{!! Form::label('obs_vers', 'Observations') !!} {!! Form::textarea('obs_vers', null, ['placeholder' => 'Observations', 'class' => 'form-control', 'rows'=>'3']) !!}
{!! Form::label('ret_numdec', 'Numéro de décision') !!} {!! Form::text('ret_numdec', null, ['placeholder' => 'Numéro de décision', 'class' => 'form-control'])!!}
{!! Form::label('ret_dateed', 'Date de décision') !!}
{!! Form::text('ret_dateed', '', ['placeholder' => 'Date de décision', 'class' => 'form-control']) !!}
{!! Form::label('ret_type', 'Type de retraite') !!}
{!! Form::select( 'ret_type', ['' => 'A définir' , 'PRE' =>'PRE' , 'PRV' => 'PRV', 'PAV' => 'PAV', 'PRA' => 'PRA', 'AUT' => 'Autre'], '', [ 'class' => 'selectpicker', ] ) !!}

{!! Form::label('montants_retraite', 'Montants') !!}
Montant retraite
{!! Form::text('ret_montant', null, ['placeholder' => 'Montant rappel', 'class' => 'text-right form-control'])!!}
CFP
Montant rappel
{!! Form::text('ret_rappel', null, ['placeholder' => 'Montant rappel', 'class' => 'text-right form-control'])!!}
CFP

{!! Form::label('montants_csr', 'Montants CSR') !!}
Montant CSR
{!! Form::text('csr_montant', null, ['placeholder' => 'Montant CSR', 'class' => 'text-right form-control'])!!}
CFP
Montant rappel CSR
{!! Form::text('csr_rappel', null, ['placeholder' => 'Montant rappel CSR', 'class' => 'text-right form-control'])!!}
CFP
{!! Form::submit('Enregistrer', ['class' => 'btn btn-primary']) !!}
{!! Form::close() !!}
@stop