 
<?php $__env->startSection('content'); ?>
<section class="forms">
    <div class="container-fluid">
        <div class="row">
            <div class="col-md-12">
                <div class="card">
                    <div class="card-header d-flex align-items-center">
                        <h4><?php echo e(trans('file.Add Excluded')); ?></h4>
                    </div>
                    <div class="card-body">
                        <p class="italic"><small><?php echo e(trans('file.The field labels marked with * are required input fields')); ?>.</small></p>
                        <?php echo Form::open(['route' => 'excluded.store', 'method' => 'post', 'files' => true]); ?>

                        <div class="row">
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label><?php echo e(trans('file.name')); ?> *</strong> </label>
                                    <input type="text" name="name" required class="form-control">
                                </div>
                            </div>
                            
                            <div class="col-md-6">
                                <div class="form-group">
                                    <label><?php echo e(trans('file.Email')); ?> *</label>
                                    <input type="email" name="email" placeholder="example@example.com" required class="form-control">
                                    <?php if($errors->has('email')): ?>
                                    <span>
                                        <strong><?php echo e($errors->first('email')); ?></strong>
                                    </span>
                                    <?php endif; ?>
                                </div>
                            </div>

                            <div class="col-md-4">
                                <div class="form-group">
                                    <label><?php echo e(trans('file.Dui')); ?></label>
                                    <input type="text" name="dui" class="form-control">
                                </div>
                            </div>

                            <div class="col-md-4">
                                <div class="form-group">
                                    <label><?php echo e(trans('file.Nit')); ?></label>
                                    <input type="text" name="nit" class="form-control">
                                </div>
                            </div>

                            <div class="col-md-4">
                                <div class="form-group">
                                    <label><?php echo e(trans('file.Phone Number')); ?> *</label>
                                    <input type="text" name="phone" required class="form-control">
                                </div>
                            </div>

                            <div class="col-md-6">
                                <div class="form-group">
                                    <label><?php echo e(trans('file.Address')); ?> *</label>
                                    <input type="text" name="address" required class="form-control">
                                </div>
                            </div>

                            <div id="unit" class="col-md-12">
                                <div class="row ">                                    
                                     <div class="col-md-6">
                                        <label><?php echo e(trans('file.Department')); ?> *</strong> </label>
                                        <div class="input-group">
                                            <select class="form-control selectpicker" data-live-search="true" data-live-search-style="begins" title="Select depto..." name="state_id">
                                                <?php $__currentLoopData = $lims_supplier_state; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $state): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                                    <option value="<?php echo e($state->id); ?>"><?php echo e($state->name); ?></option>
                                                <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                            </select>
                                        </div>
                                    </div>
                                    <div class="col-md-6">
                                        <label><?php echo e(trans('file.Municipality')); ?></strong> </label>                                        
                                        <div class="input-group">
                                            <select class="form-control selectpicker"  data-live-search="true" data-live-search-style="begins" name="municipality_id"> 
                                                <?php $__currentLoopData = $lims_supplier_municipalities; $__env->addLoop($__currentLoopData); foreach($__currentLoopData as $muni): $__env->incrementLoopIndices(); $loop = $__env->getLastLoop(); ?>
                                                    <option value="<?php echo e($muni->id); ?>"><?php echo e($muni->name); ?> | <?php echo e($muni->state->name); ?></option>
                                                <?php endforeach; $__env->popLoop(); $loop = $__env->getLastLoop(); ?>
                                            </select>
                                        </div>
                                    </div>                      
                                </div>                                
                            </div>

                            <div class="col-md-12">
                                <div class="form-group mt-4">
                                    <input type="submit" value="<?php echo e(trans('file.submit')); ?>" class="btn btn-primary">
                                </div>
                            </div>
                        </div>
                        <?php echo Form::close(); ?>

                    </div>
                </div>
            </div>
        </div>
    </div>
</section>

<script type="text/javascript">
    $("ul#people").siblings('a').attr('aria-expanded','true');
    $("ul#people").addClass("show");
    $("ul#people #biller-create-menu").addClass("active");
</script>
<?php $__env->stopSection(); ?>
<?php echo $__env->make('layout.main', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?><?php /**PATH /home/ltygkxsm/public_html/mrjbnew/resources/views/excluded/create.blade.php ENDPATH**/ ?>