@extends('home')

@section('pagesection')

<div class="container">
    <div class="subheader">
        <h1 class="subheader-title">
            <i class='subheader-icon fal fa-table'></i> Create Insurance
        </h1>
    </div>
    <div class="row">
        <div class="col-xl-12">
            <div id="panel-1" class="panel">
                <div class="panel-hdr">
                    <h2>
                        Add <span class="fw-300"><i>Insurance</i></span>
                    </h2>
                    <div class="panel-toolbar">
                        <button class="btn btn-panel" data-action="panel-collapse" data-toggle="tooltip" data-offset="0,10" data-original-title="Collapse"></button>
                        <button class="btn btn-panel" data-action="panel-fullscreen" data-toggle="tooltip" data-offset="0,10" data-original-title="Fullscreen"></button>
                        <button class="btn btn-panel" data-action="panel-close" data-toggle="tooltip" data-offset="0,10" data-original-title="Close"></button>
                    </div>
                </div>
                <div class="panel-container show">
                    <div class="panel-content">
                        <div class="card-body">
                            <form method="POST" action="{{ route('insurance.store') }}">
                                @csrf

                                <div class="form-group row">
                                    <label for="c_name" class="col-md-4 col-form-label text-md-right">Company Name</label>

                                    <div class="col-md-6">
                                        <input id="c_name" type="text" class="form-control @error('name') is-invalid @enderror" name="c_name" value="{{ old('c_name') }}" required autocomplete="c_name" autofocus>
                                    </div>
                                </div>
                                <div class="form-group row">
                                    <label for="name" class="col-md-4 col-form-label text-md-right">Person Name</label>

                                    <div class="col-md-6">
                                        <input id="name" type="text" class="form-control @error('name') is-invalid @enderror" name="name" value="{{ old('name') }}" required autocomplete="name" autofocus>
                                    </div>
                                </div>
                                <div class="form-group row">
                                    <label for="email" class="col-md-4 col-form-label text-md-right">Email</label>

                                    <div class="col-md-6">
                                        <input id="email" type="email" class="form-control @error('name') is-invalid @enderror" name="email" value="{{ old('email') }}" required autocomplete="email" autofocus>
                                    </div>
                                </div>
                                <div class="form-group row">
                                    <label for="password" class="col-md-4 col-form-label text-md-right">Password</label>

                                    <div class="col-md-6">
                                        <input id="password" type="password" class="form-control @error('name') is-invalid @enderror" name="password" value="{{ old('password') }}" required autocomplete="password" autofocus>
                                    </div>
                                </div>

                                <div class="form-group row mb-0">
                                    <div class="col-md-6 offset-md-4">
                                        <button type="submit" class="btn btn-primary">
                                            Submit
                                        </button>
                                    </div>
                                </div>
                            </form>
                        </div>
                    </div>
                </div>
            </div>
        </div>
    </div>
</div>

@endsection