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@csrf

Step 1

Transaction Date*

Document Number*

Family Group*

This value is required.

Policy Holder Name*

This value is required.

Add

First Name

Middle Name

Last Name

Address Line1

Address Line2

City

Area

Mobile Number

Gender

Email Address

DOB

Relation With Head

Step 2

Select Insurance Company*

This value is required.

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Select Branch

Zone

Is Policy Received

Policy Number*

This value is required.

Insurance Plan Name*

This value is required.

Insurance Plan Type*

This value is required.

@if ($data['can_edit'] == 1) @if ($data['data']['image'] == "Found") Reset Policy Documents(Ex. jpg, png, jpeg, pdf)Download @else Policy Documents (JPG, PNG, JPEG or PDF)* @endif @else Policy Documents (JPG, PNG, JPEG or PDF)* @endif

Select Mode*

This value is required.

Risk Term*

This value is required.

Premium Paying Term*

This value is required.

Sum Assured*

This value is required.

Risk Start Date (Doc)*

Maturity Date

Last Premium Payment Date

Next Premium Due Date (FUP)

Basic Premium Amount*

Tax Amount

Total Premium Amount*

Commissionable Amount

Basic Premium Amount*

Tax Amount

Total Premium Amount*

Commissionable Amount

Riders

Sum Assured

Risk Term

Premium Paying Term

@foreach ($data['riders'] as $key => $value)

@endforeach

Step 3

Select Policy Status*

This value is required.

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Select Broker*

This value is required.

Select Agency Name*

This value is required.

Select Sub Agent Name

This value is required.

Nominee

Nominee Contact No.

Remarks

Paid By Client

Amount

Paid By Agent

Amount

{{$data['title']}}

Step 1

Step 2

Step 3

Step 4