@extends('layouts.backend')

@section('content')
  <section>
    <div class="container">
        <div class="row justify-content-md-center">
            <div class="col-md-8 align-self-center mt-5">
                <div class="panel panel-alternative panel-alternative-register panel-alternative-blank">
                    <div class="panel-heading" style="height: auto;">
                        <h1 class="text-dark">Datos del cliente Persona Jurídica</h1>
                        <p>Los datos con * son requeridos</p>
                    </div>
                    <div class="panel-body">
                        <form id="kycJuridicForm">
                            <div class="row">
                                <div class="form-group col-md-6{{ $errors->has('corporate_name') ? ' has-error' : '' }}">
                                    <label for="corporate_name" class="control-label font-weight-bold">* Nombre de la compañia</label>
                                    <input id="corporate_name" type="input" class="form-control" name="corporate_name" value="{{ old('corporate_name') }}" required>
                                    @if ($errors->has('corporate_name'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('corporate_name') }}</strong>
                                    </span>
                                    @endif
                                </div>
                                <div class="form-group col-md-6{{ $errors->has('date_incorporation') ? ' has-error' : '' }}">
                                    <label for="date_incorporation" class="control-label font-weight-bold">* Fecha de Incorporación</label>
                                    <input id="date_incorporation" type="date" class="form-control" name="date_incorporation" value="{{ old('date_incorporation') }}" required>
                                    @if ($errors->has('date_incorporation'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('date_incorporation') }}</strong>
                                    </span>
                                    @endif
                                </div>
                            </div>
                            <div class="row">
                                <div class="form-group col-md-6{{ $errors->has('country') ? ' has-error' : '' }}">
                                    <label for="Country" class="control-label font-weight-bold">* País de Incorporación</label>
                                    <div class="countryinput">
                                        <select class="form-control custom-select" name="country" id="country" >
                                        </select>
                                    </div>
                                    @if ($errors->has('country'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('country') }}</strong>
                                    </span>
                                    @endif
                                </div>
                                <div class="form-group col-md-6{{ $errors->has('state') ? ' has-error' : '' }}">
                                    <label for="state" class="control-label font-weight-bold">* Estado de Incorporación</label>
                                    <div class="stateinput">
                                        <select class="form-control custom-select" name="state" id="state" >
                                        </select>
                                    </div>
                                    @if ($errors->has('state'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('state') }}</strong>
                                    </span>
                                    @endif
                                </div>
                            </div>
                            <div class="row">
                                <div class="form-group col-md-6{{ $errors->has('city') ? ' has-error' : '' }}">
                                    <label for="city" class="control-label font-weight-bold">* Ciudad de Incorporación</label>
                                    <div class="cityinput">
                                        <select class="form-control custom-select" name="city" id="city" >
                                        </select>
                                    </div>
                                    @if ($errors->has('state'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('state') }}</strong>
                                    </span>
                                    @endif
                                </div>
                                <div class="form-group col-md-6{{ $errors->has('place_incorporation') ? ' has-error' : '' }}">
                                    <label for="place_incorporation" class="control-label font-weight-bold">* Dirección exacta de la compañia</label>
                                    <input id="place_incorporation" type="text" class="form-control" name="place_incorporation" value="{{ old('place_incorporation') }}" required>
                                    @if ($errors->has('place_incorporation'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('place_incorporation') }}</strong>
                                    </span>
                                    @endif
                                </div>
                            </div>
                            <div class="row">
                                <div class="form-group col-md-6{{ $errors->has('postal') ? ' has-error' : '' }}">
                                    <label for="postal" class="control-label font-weight-bold">*{{__('messages.postal')}}</label>
                                    <input id="postal" type="text" class="form-control" name="postal" value="{{ old('postal') }}" required>
                                    @if ($errors->has('postal'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('postal') }}</strong>
                                    </span>
                                    @endif
                                </div>
                                <div class="form-group col-md-6{{ $errors->has('register_incoporation_office') ? ' has-error' : '' }}">
                                    <label for="register_incoporation_office" class="control-label font-weight-bold">* Registro de la oficina</label>
                                    <input id="register_incoporation_office" type="text" class="form-control" name="register_incoporation_office" value="{{ old('register_incoporation_office') }}" required>
                                    @if ($errors->has('register_incoporation_office'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('register_incoporation_office') }}</strong>
                                    </span>
                                    @endif
                                </div>                    
                            </div>
                            <div class="row">
                                <div class="form-group col-md-6{{ $errors->has('type_company') ? ' has-error' : '' }}">
                                    <label for="type_company" class="control-label font-weight-bold">* Tipo de Compañia</label>
                                    <input id="type_company" type="text" class="form-control" name="type_company" value="{{ old('type_company') }}" required>
                                    @if ($errors->has('type_company'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('type_company') }}</strong>
                                    </span>
                                    @endif
                                </div>
                                <div class="form-group col-md-6{{ $errors->has('shareholders') ? ' has-error' : '' }}">
                                    <label for="shareholders" class="control-label font-weight-bold">* Ingrese el número de socios</label>
                                    <input id="shareholders" type="number" class="form-control" name="shareholders" value="{{ old('shareholders') }}" required>
                                    @if ($errors->has('shareholders'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('shareholders') }}</strong>
                                    </span>
                                    @endif
                                </div>
                            </div>
                            <div class="row">
                                <div class="form-group col-md-6{{ $errors->has('fname_legal_representative') ? ' has-error' : '' }}">
                                    <label for="fname_legal_representative" class="control-label font-weight-bold">* Primer Nombre del representante legal</label>
                                    <input id="fname_legal_representative" type="text" class="form-control" name="fname_legal_representative" value="{{ old('fname_legal_representative') }}" required>
                                    @if ($errors->has('fname_legal_representative'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('fname_legal_representative') }}</strong>
                                    </span>
                                    @endif
                                </div>
                                <div class="form-group col-md-6{{ $errors->has('sname_legal_representative') ? ' has-error' : '' }}">
                                    <label for="sname_legal_representative" class="control-label font-weight-bold">* Segundo Nombre del representante legal</label>
                                    <input id="sname_legal_representative" type="text" class="form-control" name="sname_legal_representative" value="{{ old('sname_legal_representative') }}" required>
                                    @if ($errors->has('sname_legal_representative'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('sname_legal_representative') }}</strong>
                                    </span>
                                    @endif
                                </div>
                            </div>
                            <div class="row">
                                <div class="form-group col-md-6{{ $errors->has('flastname_legal_representative') ? ' has-error' : '' }}">
                                    <label for="flastname_legal_representative" class="control-label font-weight-bold">* Primer Apellido del representante legal</label>
                                    <input id="flastname_legal_representative" type="text" class="form-control" name="flastname_legal_representative" value="{{ old('flastname_legal_representative') }}" required>
                                    @if ($errors->has('flastname_legal_representative'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('flastname_legal_representative') }}</strong>
                                    </span>
                                    @endif
                                </div>
                                <div class="form-group col-md-6{{ $errors->has('slastname_legal_representative') ? ' has-error' : '' }}">
                                    <label for="slastname_legal_representative" class="control-label font-weight-bold">* Segundo Apellido del representante legal</label>
                                    <input id="slastname_legal_representative" type="text" class="form-control" name="slastname_legal_representative" value="{{ old('slastname_legal_representative') }}" required>
                                    @if ($errors->has('slastname_legal_representative'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('slastname_legal_representative') }}</strong>
                                    </span>
                                    @endif
                                </div>
                            </div>
                            <div class="row">
                                <div class="form-group col-md-6{{ $errors->has('id_legal_representative') ? ' has-error' : '' }}">
                                    <label for="id_legal_representative" class="control-label font-weight-bold">* Cédula o rif del representante legal</label>
                                    <input id="id_legal_representative" type="text" class="form-control" name="id_legal_representative" value="{{ old('id_legal_representative') }}" required>
                                    @if ($errors->has('id_legal_representative'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('id_legal_representative') }}</strong>
                                    </span>
                                    @endif
                                </div>
                                <div class="form-group col-md-6{{ $errors->has('position') ? ' has-error' : '' }}">
                                    <label for="position" class="control-label font-weight-bold">* Cargo del representante legal</label>
                                    <input id="position" type="text" class="form-control" name="position" value="{{ old('position') }}" required>
                                    @if ($errors->has('position'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('position') }}</strong>
                                    </span>
                                    @endif
                                </div>
                            </div>
                            <div class="row">
                                <div class="form-group col-md-6{{ $errors->has('email_address') ? ' has-error' : '' }}">
                                    <label for="email_address" class="control-label font-weight-bold">* Correo Electrónico de la empresa</label>
                                    <input id="email_address" type="text" class="form-control" name="email_address" value="{{ old('email_address') }}" required>
                                    @if ($errors->has('email_address'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('email_address') }}</strong>
                                    </span>
                                    @endif
                                </div>
                                <div class="form-group col-md-6{{ $errors->has('merchant_record') ? ' has-error' : '' }}">
                                    <label for="merchant_record" class="control-label font-weight-bold">* Registro Mercantil</label>
                                    <input id="merchant_record" type="text" class="form-control" name="merchant_record" value="{{ old('merchant_record') }}" required>
                                    @if ($errors->has('merchant_record'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('merchant_record') }}</strong>
                                    </span>
                                    @endif
                                </div>
                            </div>
                            <div class="row">
                                <div class="form-group col-md-6{{ $errors->has('issuing_state') ? ' has-error' : '' }}">
                                    <label for="issuing_state" class="control-label font-weight-bold">* Estado de emisión</label>
                                    <input id="issuing_state" type="text" class="form-control" name="issuing_state" value="{{ old('issuing_state') }}" required>
                                    @if ($errors->has('issuing_state'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('issuing_state') }}</strong>
                                    </span>
                                    @endif
                                </div>
                                <div class="form-group col-md-6{{ $errors->has('date_issue') ? ' has-error' : '' }}">
                                    <label for="date_issue" class="control-label font-weight-bold">* Fecha de Emisión</label>
                                    <input id="date_issue" type="date" class="form-control" name="date_issue" value="{{ old('date_issue') }}" required>
                                    @if ($errors->has('date_issue'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('date_issue') }}</strong>
                                    </span>
                                    @endif
                                </div>
                            </div>
                            <div class="row">
                                <div class="form-group col-md-6{{ $errors->has('date_expiry') ? ' has-error' : '' }}">
                                    <label for="date_expiry" class="control-label font-weight-bold">* Fecha de Expiración</label>
                                    <input id="date_expiry" type="date" class="form-control" name="date_expiry" value="{{ old('date_expiry') }}" required>
                                    @if ($errors->has('date_expiry'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('date_expiry') }}</strong>
                                    </span>
                                    @endif
                                </div>
                                <div class="form-group col-md-6{{ $errors->has('phone_number') ? ' has-error' : '' }}">
                                    <label for="phone_number" class="control-label font-weight-bold">* Nro. Teléfono</label>
                                    <input id="phone_number" type="text" class="form-control" name="phone_number" value="{{ old('phone_number') }}" required>
                                    @if ($errors->has('phone_number'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('phone_number') }}</strong>
                                    </span>
                                    @endif
                                </div>
                            </div>
                            <div class="row">
                                <div class="form-group col-md-6{{ $errors->has('website') ? ' has-error' : '' }}">
                                    <label for="website" class="control-label font-weight-bold">Web Site</label>
                                    <input id="website" type="text" class="form-control" name="website" value="{{ old('website') }}">
                                    @if ($errors->has('website'))
                                    <span class="help-block">
                                        <strong>{{ $errors->first('website') }}</strong>
                                    </span>
                                    @endif
                                </div>
                            </div>
                            <div class="text-center">
                                <a class="btn btn-alternative" href="{{ route('kyc-verification') }}">Regresar</a>
                                <button type="button" class="btn btn-alternative" id="continue" name="button">{{__('system.continue')}}</button>
                            </div>
                        </form>
                    </div>
                </div>
            </div>
        </div>
    </div>
</section>

@include('modals.confirmModal')

@endsection