@extends('dashboard.layout.master') @section('content')
@include('dashboard.layout.navbar')
GRM Edit Complaint Form
@if (count($errors) > 0)
Whoops! There were some problems with your input.

    @foreach ($errors->all() as $error)
  • {{ $error }}
  • @endforeach
@endif {!! Form::model($complaint, ['method' => 'PATCH', 'files'=>'true', 'route' => ['complaints.update', $complaint->id], 'class'=>'']) !!}
Complainant Information
{!! Form::select('source_channel', $source_channels, null, ['placeholder' => 'Source/Channel', 'class' => 'form-control select2', 'required']) !!}
{!! Form::select('piu', $pius, null, ['placeholder' => 'Select PIU', 'class' => 'form-control select2', 'required']) !!}
Personal Details
{!! Form::text('full_name', null, array('placeholder' => 'Full Name','class' => 'form-control', 'required')) !!}
{!! Form::text('father_name', null, array('placeholder' => 'Father Name','class' => 'form-control', 'required')) !!}
{!! Form::text('cnic', null, array('placeholder' => 'CNIC No','class' => 'form-control', 'id' => 'mask_cnic', 'required')) !!} 99999-9999999-9
{!! Form::text('hru_beneficiary_id', null, array('placeholder' => 'HRU Beneficiary ID','class' => 'form-control')) !!}
{!! Form::text('mobile', null, array('placeholder' => 'Mobile No','class' => 'form-control', 'maxlength' => '13', 'required')) !!}
{!! Form::email('email', null, array('placeholder' => 'Email ID (If Any)', 'class' => 'form-control')) !!}
{!! Form::select('district_id', $districts, null, array('placeholder' => 'Select District', 'class' => 'district form-control select2', 'required')) !!}
{!! Form::select('tehsil_id', $tehsil, null, ['placeholder' => 'Select Tehsil', 'class' => 'form-control select2', 'required']) !!}
{!! Form::select('uc_id', $uc, null, ['placeholder' => 'Select UC', 'class' => 'form-control select2', 'required']) !!}
{!! Form::textarea('postal_address', null, array('placeholder' => 'Postal Address', 'class' => 'form-control')) !!}
Grievance Registration
{!! Form::select('grievance_type', $grievance_types, null, ['placeholder' => 'Grievance Type', 'class' => 'form-control select2', 'disabled']) !!}
@if($complaint->grievance_type == 1)
@else
@endif
@push('ayiscss') @endpush @push('ayisscript') @endpush @if(session('error')) @endif @if(session('success')) @endif @endsection