{{--

--}}

@csrf

Step 1

Insurance Type*

Fresh

Prospect

Renewal

Endorsement

Transaction Date*

Document Number*

Family Group*

This value is required.

Policy Holder Name*

This value is required.

Add

Select policy*

This value is required.

First Name

Middle Name

Last Name

Address Line1

Address Line2

City

Area

Mobile Number

Gender

Email Address

DOB

Relation With Head

Step 2

Select Division*

This value is required.

Select Segment*

This value is required.

Policy Type

Select Insurance Company*

This value is required.

{{--

--}}

Select Branch

This value is required.

Product Name

This value is required.

Optional Cover

This value is required.

{{--

--}}

Zone

Is Policy Received

Current Policy Number*

Previous Policy Number

@if ($data['is_renewable'] == 1) Policy Documents(JPG, PNG, JPEG or PDF)* {{--

--}} @else @if($data['can_edit'] == 0) Policy Documents(JPG, PNG, JPEG or PDF)* {{--

--}} @elseif ($data['is_renewable'] == 1) @if ($data['data']['image'] != "Found") Policy Documents(JPG, PNG, JPEG or PDF)* {{--

--}} @else Reset Policy Documents(JPG, PNG, JPEG or PDF)Download {{--

--}} @endif @else @if ($data['data']['image'] != "Found") Policy Documents(JPG, PNG, JPEG or PDF)* {{--

--}} @else Reset Policy Documents(JPG, PNG, JPEG or PDF)Download {{--

--}} @endif @endif @endif

Select Policy Mode*

This value is required.

{{--

--}}

Risk Start Date*

Risk End Date*

Select Tp Policy Mode*

This value is required.

{{--

--}}

TP Due Date*

Step 3

Sum Assured*

Basic Premium Amount*

Tax Amount

Total Premium Amount*

Commissionable Amount

@php $privileges = getPrivileges(); @endphp @if(Auth::user()->type == 1)

Commission Entry(%)

Commitment Amount

@else @if(!empty($privileges && array_key_exists(16,$privileges))) @if(array_key_exists(17,$privileges[16]))

Commission Entry(%)

Commitment Amount

@endif @endif @endif @if(Auth::user()->type == 1) @else @if(!empty($privileges && array_key_exists(16,$privileges))) @if(array_key_exists(17,$privileges[16])) @endif @endif @endif

Select Broker*

This value is required.

Select Agency Name*

This value is required.

Select Sub Agent Name

This value is required.

Nominee Name

Nominee Contact No.

Remarks

Paid By Client

Amount

Paid By Agent

Amount

Step 4

@if($data['can_edit'] == 0 || $data['is_renewable'] == 1)

Policy Document Type {{--

This value is required.

--}}

Policy Document Name {{--

This value is required.

--}}

Upload Document(JPG, PNG, JPEG or PDF)

Nos

@endif

{{ $data['title'] }}

Step 1

Step 2

Step 3

Step 4