184 lines
7.9 KiB
PHP
Executable File
184 lines
7.9 KiB
PHP
Executable File
<?php $this->titre = "INTER SANTE - Nouveau Garant"; ?>
|
|
|
|
|
|
|
|
<legend> <?= _("Nouveau Garant") ?> </legend>
|
|
|
|
|
|
<table class="table table-responsive table-condensed" style='font-size:10pt;'>
|
|
<tbody>
|
|
<tr>
|
|
<td width="19%" class="required"> <?= _("Nom") ?> </td>
|
|
<td width="32%"><INPUT style='font-size:10pt;' class="form-control majuscule" TYPE="text" id="libelle" NAME="libelle" required AUTOCOMPLETE="OFF"></td>
|
|
|
|
<td width="15%" align="center" class="required"><?= _("Type Garant") ?></td>
|
|
<td>
|
|
<select name="typeGarant" id="typeGarant" class="form-control selectpicker" data-live-search="true" required AUTOCOMPLETE="OFF">
|
|
<?= liste_options($gctypegarant,'',false) ?>
|
|
</select>
|
|
</td>
|
|
|
|
</tr>
|
|
|
|
<tr>
|
|
<td class=""> <?= _("Adresse Postale") ?> </td>
|
|
<td><INPUT style='font-size:10pt;' class="form-control majuscule" TYPE="text" id="adressePostale" NAME="adressePostale"></td>
|
|
|
|
|
|
<td align="center"><?= _("Représentant") ?></td>
|
|
<td><INPUT style='font-size:10pt;' class="form-control majuscule" TYPE="text" id="representant" NAME="representant" ></td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td ><?= _("Téléphone") ?></td>
|
|
<td><INPUT style='font-size:10pt;' class="form-control" TYPE="tel" id="telephoneGarant" NAME="telephoneGarant" ></td>
|
|
|
|
<td width="10%" align="center"><?= _("E-mail") ?></td>
|
|
<td><INPUT style='font-size:10pt;' class="form-control" TYPE="email" id="emailGcAssureur" NAME="emailGcAssureur" ></td>
|
|
|
|
</tr>
|
|
|
|
<tr>
|
|
<td > <?= _("Taux Commission Primes (%)") ?> </td>
|
|
<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxCommissionGerant" NAME="gcTauxCommissionGerant" TYPE="number" step="1" value="0" min="0" max="100"></td>
|
|
|
|
<td align="center"> <?= _("Taux Ristourne (%)") ?> </td>
|
|
<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxRistourne" NAME="gcTauxRistourne" TYPE="number" step="1" value="100" min="0" max="100"></td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td > <?= _("Taux Commission Sinistres (%)") ?> </td>
|
|
<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxFraisReel" NAME="gcTauxFraisReel" TYPE="number" step="1" value="0" min="0" max="100"></td>
|
|
|
|
<td align="center"> <?= _("Taux Redressement (%)") ?> </td>
|
|
<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxRedressement" NAME="gcTauxRedressement" TYPE="number" step="1" value="0" min="0" max="100"></td>
|
|
</tr>
|
|
|
|
<!--
|
|
<tr>
|
|
<td > <?= _("Taux Provision (%)") ?> </td>
|
|
<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxProvision" NAME="gcTauxProvision" TYPE="number" value="0" min="0" max="100"></td>
|
|
|
|
<td align="center"> <?= _("Forfait Provision") ?> </td>
|
|
<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="gcForfaitProvision" NAME="gcForfaitProvision" value="0" onkeyup="controle_numerique(this);" onblur="formatMonetaire(this);"></td>
|
|
</tr>
|
|
-->
|
|
<tr>
|
|
<td > <?= _("Taux Tva (%)") ?> </td>
|
|
<td> <INPUT style='font-size:10pt;' class="form-control" id="gcTauxTva" NAME="gcTauxTva" TYPE="number" step="1" value="<?= $tauxTva; ?>" min="0" max="100"></td>
|
|
|
|
<td align="center"> <?= _("Frais Nouvelle Carte") ?> </td>
|
|
<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="fraisCarteAfn" NAME="fraisCarteAfn" value="0" onkeyup="controle_numerique(this);" onblur="formatMonetaire(this);"></td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td > <?= _("Frais Renouvellement Carte") ?> </td>
|
|
<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="fraisCarteRen" NAME="fraisCarteRen" value="0" onkeyup="controle_numerique(this);" onblur="formatMonetaire(this);"></td>
|
|
|
|
<td align="center"> <?= _("Frais RE-IMPRESSION") ?> </td>
|
|
<td><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="fraisCarteImp" NAME="fraisCarteImp" value="0" onkeyup="controle_numerique(this);" onblur="formatMonetaire(this);"></td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td > <?= _("Taux Suspension (%)") ?> </td>
|
|
<td> <INPUT style='font-size:10pt;' class="form-control" id="gcLimiteConsommation" NAME="gcLimiteConsommation" TYPE="number" step="1" value="0" min="0" max="100"></td>
|
|
|
|
<td align="center"> <?= _("Seuil RD (%)") ?> </td>
|
|
<td ><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="seuilRdGarant" NAME="seuilRdGarant" TYPE="number" step="1" value="0" min="0" max="100"></td>
|
|
|
|
</tr>
|
|
|
|
<tr>
|
|
<td ><?= _("Téléphone du Représentant") ?></td>
|
|
<td ><INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="telephonerepresentant" NAME="telephonerepresentant" value=""></td>
|
|
|
|
<td align="center"><?= _("Sigle du Représentant") ?></td>
|
|
<td><INPUT style='font-size:10pt;' class="form-control majuscule" TYPE="text" id="siglerepresentant" NAME="siglerepresentant" value=""></td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td ><?= _("No Compte Comptable RD") ?></td>
|
|
<td><INPUT style='font-size:10pt;' class="form-control majuscule" TYPE="text" id="numerodeCompteComptableRD" NAME="numerodeCompteComptableRD" value=""></td>
|
|
|
|
|
|
<td align="center"><?= _("Adresse Géographique") ?></td>
|
|
<td >
|
|
<INPUT style='font-size:10pt;' class="form-control majuscule" TYPE="text" id="adresseGeographique" NAME="adresseGeographique" value=""></td>
|
|
</td>
|
|
</tr>
|
|
|
|
|
|
|
|
<tr>
|
|
<td ><?= _("No Compte Comptable TP") ?></td>
|
|
<td><INPUT style='font-size:10pt;' class="form-control majuscule" TYPE="text" id="numerodeCompteComptableTP" NAME="numerodeCompteComptableTP" value=""></td>
|
|
|
|
|
|
<td align="center"><?= _("No Compte Contribuable") ?></td>
|
|
<td >
|
|
<INPUT style='font-size:10pt;' class="form-control majuscule" TYPE="text" id="numeroCompteContribuable" NAME="numeroCompteContribuable" value="">
|
|
</td>
|
|
</tr>
|
|
|
|
|
|
<tr>
|
|
<td ><?= _("Service du Représentant") ?></td>
|
|
<td><INPUT style='font-size:10pt;' class="form-control majuscule" TYPE="text" id="servicerepresentant" NAME="servicerepresentant" value=""></td>
|
|
|
|
<td align="center"><?= _("Tarif Actes") ?></td>
|
|
<td >
|
|
<select name="codeTarifActe" id="codeTarifActe" class="form-control selectpicker" data-live-search="true">
|
|
<?= liste_options($tarifActe,"", false) ?>
|
|
</select>
|
|
</td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td > <?= _("Type Remboursement") ?> </td>
|
|
<td >
|
|
<SELECT style="font-size:10pt;" class="form-control selectpicker" data-live-search="true" id="codeTypeRemboursement" NAME="codeTypeRemboursement">
|
|
<?php liste_options($typeremboursement,"RDTP",true); ?>
|
|
</SELECT>
|
|
</td>
|
|
|
|
<td align="center" class="required"> <?= _("Mode Paiement") ?> </td>
|
|
<td>
|
|
<SELECT style="font-size:10pt;" class="form-control selectpicker" data-live-search="true" id="codeModePaiementDemande" NAME="codeModePaiementDemande" required AUTOCOMPLETE="OFF">
|
|
<?php liste_options($modepaiement, ""); ?>
|
|
</SELECT>
|
|
</td>
|
|
</tr>
|
|
|
|
<tr>
|
|
<td >
|
|
<?= _("Interdire prestation pour impayé ?") ?>
|
|
</td>
|
|
|
|
<td>
|
|
<select class="form-select" id="encaissementExige" NAME="encaissementExige" style='font-size:10pt;' >
|
|
<?php liste_options($encaissementExigeOuinon, "0", true); ?>
|
|
</SELECT>
|
|
</td>
|
|
|
|
<td align="center"></td>
|
|
<td >
|
|
<INPUT class="form-control" TYPE="text" value="" disabled>
|
|
</td>
|
|
</tr>
|
|
<!--
|
|
<tr>
|
|
<td colspan="4" style="height:30px; background-color:white;"></td>
|
|
</tr>
|
|
-->
|
|
<tr>
|
|
<td> </td>
|
|
<td > <input id="btn_enreg" name="btn_enreg" class = "form-control btn btn-primary" type="button" value="<?= _("Enregistrer") ?>" onClick="javascript:creer_gc_assureur();" style='font-size:10pt;' > </td>
|
|
|
|
<td> </td>
|
|
<td > <input class = "form-control btn btn-warning" type="button" value="<?= _("Annuler") ?>" onClick="javascript:retour_liste_gc_assureur();" style='font-size:9pt;' > </td>
|
|
</tr>
|
|
</tbody>
|
|
</table>
|
|
|
|
<div id="div_test_gc">
|
|
</div>
|