58 lines
3.1 KiB
PHP
Executable File
58 lines
3.1 KiB
PHP
Executable File
<?php
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$this->titre = "INTER-SANTE - Modification Police Gestion Confiée";
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?>
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<script type="text/javascript">
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</script>
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<input class="sr-only" type="text" id="idPolice" name="idPolice" value="<?= $this->nettoyer($gc['idPolice']) ?>" >
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<INPUT class="sr-only" TYPE="text" id="codeGcAssureur" NAME="codeGcAssureur" value="<?=$this->nettoyer($gc['codeGcAssureur'])?>">
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<legend> <?= _("Modification Police") ?> </legend>
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<table class="table table-responsive table-condensed" style='font-size:10pt;'>
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<tbody>
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<tr>
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<td width="10%" > <?= _("Souscripteur") ?> </td>
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<td width="35%" ><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="souscripteur" NAME="souscripteur" value="<?=$this->nettoyer($gc['souscripteur'])?>" readonly></td>
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<td width="10%" align="center"> <?= _("Police") ?> </td>
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<td width="10%" ><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="numeroPolice" NAME="numeroPolice" value="<?=$this->nettoyer($gc['numeroPolice'])?>" readonly></td>
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<td width="10%" align="center"> <?= _("Assureur") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="libelle" NAME="libelle" value="<?=$this->nettoyer($gc['gcassureur'])?>" readonly></td>
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</tr>
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<tr>
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<td> <?= _("Tx Comm(%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="tauxFraisReel" NAME="tauxFraisReel" TYPE="text" value="<?= $this->nettoyer($gc['tauxFraisReel']) ?>" ></td>
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<td align="center"> <?= _("Tx Redr (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="tauxRedressement" NAME="tauxRedressement" TYPE="text" value="<?= $this->nettoyer($gc['tauxRedressement']) ?>" ></td>
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<td align="center"> <?= _("Tx Tva (%)") ?> </td>
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<td> <INPUT style='font-size:10pt;' class="form-control" id="tauxTva" NAME="tauxTva" TYPE="text" value="<?= $this->nettoyer($gc['tauxTva']) ?>" ></td>
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</tr>
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<tr>
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<td> <?= _("Nouv Carte") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="number" id="fraisCarteAfn" NAME="fraisCarteAfn" value="<?=$this->nettoyer($gc['fraisCarteAfn'])?>" ></td>
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<td align="center"> <?= _("Carte REN") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="number" id="fraisCarteRen" NAME="fraisCarteRen" value="<?=$this->nettoyer($gc['fraisCarteRen'])?>" ></td>
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<td align="center"> <?= _("Carte RE-IMPR") ?> </td>
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<td><INPUT style='font-size:10pt;' class="form-control" TYPE="number" id="fraisCarteImp" NAME="fraisCarteImp" value="<?=$this->nettoyer($gc['fraisCarteImp'])?>" ></td>
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</tr>
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<tr>
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<td> </td>
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<td colspan="3"> <input id="btn_enreg" name="btn_enreg" class = "form-control btn btn-primary" type="button" value="<?= _("Enregistrer") ?>" onClick="javascript:enregistrer_modif_gc_police();" style='font-size:10pt;' > </td>
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<td> </td>
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<td colspan="1"> <input class = "form-control btn btn-warning" type="button" value="<?= _("Annuler") ?>" onClick="javascript:retour_fiche_gc_police();" style='font-size:9pt;' > </td>
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</tr>
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</tbody>
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</table>
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