@extends('admin.layouts.app')
@section('content')
    <div class="container-xl">
        <div class="card">
            <div class="card-header">
                <h3 class="card-title">Naksa</h3>
                <div class="card-actions">
                    <a href="{{ url()->previous() }}" class="btn btn-primary btn-3">


                        Back
                    </a>
                </div>
            </div>
            <div class="card-body">
                <form method="POST" action="{{ route('panel.naksa.store') }}">
                    @csrf
                    <div class="row">
                        <div class="form-group col-md-6 col-6 mb-3">
                            <label>चलानी नं</label>
                            <input type="text" class="form-control nepali-input" id="unique-input" name="chalani_no"
                                value="{{ old('chalani_no') }}" inputmode="numeric">
                            <div class="invalid-feedback">
                                कृपया चलानी नं भर्नुहोस्
                            </div>
                        </div>

                        <!-- Subject -->
                        <div class="form-group col-md-12 col-12 mb-3">
                            <label>विषय</label>
                            <input type="text" class="form-control" name="subject" value="मिशिल पेश सम्बन्धमा ।"
                                required="">
                            <div class="invalid-feedback">
                                कृपया विषय भर्नुहोस्
                            </div>
                        </div>
                         <div class="col-6 text-secondary mb-3">
                            <label>Office Name <span class="text-danger">*</span></label>
                            <input type="text" name="office_name" class="form-control nepali-input"
                                value="eQmk'/ gu/kflnsf" />
                            <x-input-error :messages="$errors->get('office_name')" class="mt-2" />
                        </div>
                         <div class="col-6 text-secondary mb-3">
                            <label>Office Address <span class="text-danger">*</span></label>
                            <input type="text" name="office_address" class="form-control nepali-input"
                                value="eQmk'/" />
                            <x-input-error :messages="$errors->get('office_address')" class="mt-2" />
                        </div>

                            <div class="col-6 text-secondary mb-3">
                            <label>Applicant Municipality <span class="text-danger">*</span></label>
                            <input type="text" name="applicant_municipality" class="form-control nepali-input"
                                value="{{ old('applicant_municipality') }}" />
                            <x-input-error :messages="$errors->get('applicant_municipality')" class="mt-2" />
                        </div>
                         <div class="col-6 text-secondary mb-3">
                            <label>Applicant Ward No <span class="text-danger">*</span></label>
                            <input type="text" name="applicant_ward_no" class="form-control nepali-input"
                                value="{{ old('applicant_ward_no') }}" />
                            <x-input-error :messages="$errors->get('applicant_ward_no')" class="mt-2" />
                        </div>

                        <div class="col-md-6 mb-3">
                            <label>Municipality <span class="text-danger">*</span></label>
                            <select name="municipality_id"
                                class="form-control @error('municipality_id') is-invalid @enderror" required>
                                <option value="">Select Municipality</option>
                                @foreach ($municipalities as $municipality)
                                    <option value="{{ $municipality->id }}"
                                        {{ old('municipality_id') == $municipality->id ? 'selected' : '' }}>
                                        {{ $municipality->name }}</option>
                                @endforeach
                            </select>
                            @error('municipality_id')
                                <span class="invalid-feedback">{{ $message }}</span>
                            @enderror
                        </div>

                        <div class="col-md-6 mb-3">
                            <label>Ward <span class="text-danger">*</span></label>
                            <select name="ward_id" class="form-control @error('ward_id') is-invalid @enderror" required>
                                <option value="">Select Ward</option>
                                @foreach ($wards as $ward)
                                    <option value="{{ $ward->id }}" {{ old('ward_id') == $ward->id ? 'selected' : '' }}>
                                        {{ $ward->name }}</option>
                                @endforeach
                            </select>
                            @error('ward_id')
                                <span class="invalid-feedback">{{ $message }}</span>
                            @enderror
                        </div>


                        <div class="col-6 text-secondary mb-3">
                            <label>Previous Ward No <span class="text-danger">*</span></label>
                            <input type="text" name="previous_ward_no" class="form-control nepali-input"
                                value="{{ old('previous_ward_no') }}" />
                            <x-input-error :messages="$errors->get('previous_ward_no')" class="mt-2" />
                        </div>
                        <div class="col-6 text-secondary mb-3">
                            <label>Applicant Name <span class="text-danger">*</span></label>
                            <input type="text" name="applicant_name" class="form-control nepali-input"
                                value="{{ old('applicant_name') }}" />
                            <x-input-error :messages="$errors->get('applicant_name')" class="mt-2" />
                        </div>
                        <div class="col-6 text-secondary -mb-3">
                            <label>Naksa Type <span class="text-danger">*</span></label>
                            <select name="naksa_type"
                                class="form-control @error('naksa_type') is-invalid @enderror nepali-input" required>
                                <option value=""></option>

                                <option value="3/">3/</option>
                                 <option value="6x/f">6x/f</option>
                                  <option value="kv{fn">kv{fn</option>

                            </select>
                            <x-input-error :messages="$errors->get('date')" class="mt-2" />
                        </div>
                        <div class="col-6 text-secondary mb-3">
                            <label>Myad Date <span class="text-danger">*</span></label>
                            <input type="text" name="myad_date" id="nepali-datepicker" class="form-control" value="{{ old('myad_date') }}" />
                            <x-input-error :messages="$errors->get('myad_date')" class="mt-2" />
                        </div>
                         <div class="col-6 text-secondary mb-3">
                            <label>Sarjamin Date <span class="text-danger">*</span></label>
                            <input type="text" name="sarjamin_date" id="nepalidate" class="form-control" value="{{ old('sarjamin_date') }}" />
                            <x-input-error :messages="$errors->get('sarjamin_date')" class="mt-2" />
                        </div>

                    </div>

                    <div class="row mb-3">
                        <div class="col-md-10"></div>
                        <div class="col-md-2 text-secondary ">
                            <button onclick="$('form').submit()" class="btn btn-primary px-4 float-right">Save
                                Changes</button>
                        </div>
                    </div>
                </form>
            </div>
        </div>

    </div>
@endsection