{% extends 'base.html.twig' %}

{% block title %}createClaims{% endblock %}

{% block body %}

<script src="/app-assets/js/jquery-3.5.1.min.js"></script>

    <div style="width: calc(100% - 4vw); float: right">
        {% include '/include/interface.html.twig' %}
    </div>

    {% include '/include/menuCollapse.html.twig' %}

    <div class="w-100 Page" style="height: 100%; padding-top: 5vw; padding-left: 4vw">
        {% for message in app.flashes('success') %}
            <div class="alert alert-success position-absolute" style="width: 100% !important; z-index: 3000">
                {{ message }}
            </div>
        {% endfor %}
        {% for message in app.flashes('warning') %}
            <div class="alert alert-warning position-absolute" style="width: 100% !important; z-index: 3000">
                {{ message }}
            </div>
        {% endfor %}
        <div class="col-8 ml-auto mr-auto h-auto pt-3">
            <div class="text-left inscription_subTitle">
                <h3 class="w-100 text-center pt-5 pb-5 PageTitle">Creation d'une réclamation symbility</h3>
            </div>
            {{ form_start(form) }}
            <div class="my-custom-class-for-errors">
                {{ form_errors(form) }}
            </div>
            <h3 class="mb-3 mt-3">Information de la réclamation</h3>
            <div class="row">
                <div class="col-6">
                    <div class="form-group mb-2">
                        {{ form_row(form.claimNumber) }}
                    </div>
                    <div class="form-group mb-2">
                        {{ form_row(form.fileNumber) }}
                    </div>
                    <div class="form-group mb-2">
                        {{ form_row(form.policyNumber) }}
                    </div>
                    <div class="form-group mb-2">
                        {{ form_row(form.CATNumber) }}
                    </div>
                    <div class="form-group mb-2">
                        {{ form_row(form.insuranceCompanyName) }}
                    </div>
                </div>
                <div class="col-6">
                    <div class="form-group mb-2">
                        {{ form_row(form.lossType) }}
                    </div>
                    <div class="row">
                        <div class="form-group col-6 mb-2">
                            {{ form_row(form.lossDate) }}
                        </div>
                        <div class="form-group col-6 mb-2">
                            {{ form_row(form.lossTime) }}
                        </div>
                    </div>
                </div>
            </div>
            <h3 class="mb-3 mt-3">Information de l'assuré</h3>
            <div class="row">
                <div class="col-6">
                    <div class="form-group mb-2">
                        {{ form_row(form.insuredCompanyName) }}
                    </div>
                    <div class="form-group mb-2">
                        {{ form_row(form.insuredTitle) }}
                    </div>
                    <div class="form-group mb-2">
                        {{ form_row(form.insuredFirstName) }}
                    </div>
                    <div class="form-group mb-2">
                        {{ form_row(form.insuredLastName) }}
                    </div>
                </div>
                <div class="col-6">
                    <div class="form-group mb-2">
                        {{ form_row(form.insuredHomePhone) }}
                    </div>
                    <div class="form-group mb-2">
                        {{ form_row(form.insuredMobilePhone) }}
                    </div>
                    <div class="form-group mb-2">
                        {{ form_row(form.insuredEmail) }}
                    </div>
                </div>
            </div>
            <div class="row">
                <div class="col-6">
                    <div class="form-group mb-2">
                        {{ form_row(form.insuredAddressLine1) }}
                    </div>
                    <div class="form-group mb-2">
                        {{ form_row(form.insuredAddressLine2) }}
                    </div>
                </div>
                <div class="col-6">
                    <div class="row">
                        <div class="form-group col-6 mb-2">
                            {{ form_row(form.insuredAddressCity) }}
                        </div>
                        <div class="form-group col-6 mb-2">
                            {{ form_row(form.insuredAddressZipcode) }}
                        </div>
                    </div>
                    <div class="row">
                        <div class="form-group col-6 mb-2">
                            {{ form_row(form.insuredAddressState) }}
                        </div>
                        <div class="form-group col-6 mb-2">
                            {{ form_row(form.insuredAddressCountry) }}
                        </div>
                    </div>
                </div>
            </div>
            <div class="row">
                <div class="col-6">
                    <div class="form-group mb-2">
                        {{ form_row(form.builtYear) }}
                    </div>
                </div>
            </div>
            <h3 class="mb-3 mt-3">Information du dégat</h3>
            <div class="row">
                <div class="col-6">
                    <div class="form-group mb-2">
                        {{ form_row(form.contactName) }}
                    </div>
                </div>
                <div class="col-6">
                    <div class="form-group mb-2">
                        {{ form_row(form.contactPhone) }}
                    </div>
                </div>
            </div>
            <div class="form-group col-4 ml-auto mr-auto mb-3 mt-3">
                {{ form_row(form.save) }}
            </div>
            {{ form_end(form) }}
            <hr>
            <div class="text-center">
            </div>
        </div>
    </div>

{% endblock %}