62 lines
2.6 KiB
PHP
Executable File
62 lines
2.6 KiB
PHP
Executable File
<?php
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?>
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<input class="sr-only" type="text" id="idData" name="idData" value="<?= $beneficiaire['id'] ?>">
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<INPUT class="sr-only" TYPE="text" id="idAdherent" name="idAdherent" value="<?= $beneficiaire['idAdherent']; ?>">
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<table class="table table-responsive table-condensed" style='font-size:10pt;'>
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<tbody>
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<tr>
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<td class="required" width="13%"> <?= _("Bénéficiaire") ?> </td>
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<td width="50%"><INPUT class="form-control majuscule" TYPE="text" id="beneficiaireReglement" NAME="beneficiaireReglement" style='font-size:10pt;' value="<?=$beneficiaire['beneficiaireReglement'] ?>" required AUTOCOMPLETE="OFF"></td>
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<td align="center" class="required"> <?= _("Lien Parenté") ?> </td>
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<td>
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<select class="form-select" id="codeLienBeneficiaire" NAME="codeLienBeneficiaire" required AUTOCOMPLETE="OFF" style='font-size:10pt;'>
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<?php liste_options($lienbeneficiaire,$beneficiaire['codeLienBeneficiaire']); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td class="required"> <?= _("Mode Paiement") ?> </td>
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<td>
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<select class="form-select" id="codeModePaiement" NAME="codeModePaiement" required AUTOCOMPLETE="OFF" style='font-size:10pt;' >
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<?php liste_options($modepaiement,$beneficiaire['codeModePaiement']); ?>
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</SELECT>
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</td>
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<td align="center"> <?= _("En vigueur?") ?> </td>
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<td>
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<SELECT style='font-size:10pt;' class="form-select" id="enVigueur" NAME="enVigueur" required AUTOCOMPLETE="OFF">
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<?php liste_options($ouinonenvigueur, $beneficiaire['enVigueur'],true); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td > <?= _("Téléphone Portable") ?> </td>
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<td>
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<INPUT class="form-control" TYPE="text" id="telephoneMobile" NAME="telephoneMobile" style='font-size:10pt;' value="<?= $beneficiaire['telephoneMobile'] ?>">
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</td>
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<td align="center"> <?= _("RIB") ?> </td>
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<td>
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<INPUT class="form-control majuscule" TYPE="text" id="rib" NAME="rib" style='font-size:10pt;' value="<?= $beneficiaire['rib'] ?>">
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</td>
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</tr>
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<tr>
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<td colspan="2"> <input id="btn_enreg" name="btn_enreg" class = "form-control btn btn-primary" type="button" value="<?= _("Enregistrer") ?>" onClick="javascript:enregistrer_beneficiaire_remboursement();" style='font-size:10pt;' > </td>
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<td></td>
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<td > <input id="btn_init" name="btn_init" class = "form-control btn btn-info" type="button" value="<?= _("Reinitialiser") ?>" onClick="javascript:reinitialiser_beneficiaire_remboursement();" style='font-size:10pt;' > </td>
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</tr>
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</tbody>
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</table>
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