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<?php
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<?php
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$this->titre = "INTER-SANTE - Nouvelle Demande Frais Funéraires";
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$this->titre = "INTER-SANTE - Nouvelle Demande Frais Funéraires";
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?>
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?>
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<form id="frmderogation" name="frmderogation" method="post" >
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<div class="container-fluid py-2 animate__animated animate__fadeIn">
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<form id="frmderogation" name="frmderogation" method="post" class="needs-validation">
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<div class="card border-0 shadow-sm mb-4">
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<div class="card-header bg-dark text-white p-3 border-0 d-flex justify-content-between align-items-center" style="border-radius: 12px;">
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<h4 class="mb-0">
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<i class="fas fa-file-signature me-2 text-primary"></i>
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<?= _("Fiche de demande de Frais Funéraires") ?>
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</h4>
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<span class="badge bg-primary px-3 py-2"><?= _("NOUVELLE SAISIE") ?></span>
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</div>
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</div>
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<legend> <?= _("Fiche de demande de Frais Funéraires") ?> </legend>
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<input type="hidden" id="fraisReel" name="fraisReel" value="<?= $montant_fraisfuneraire ?>">
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<input class="sr-only" type="text" id="fraisReel" name="fraisReel" value="<?= $montant_fraisfuneraire ?>">
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<div class="card shadow-sm border-0" style="border-radius: 15px;">
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<div class="card-body p-4">
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<table class="table table-responsive table-condensed" style='font-size:10pt;'>
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<tbody>
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<h6 class="text-primary text-uppercase small fw-bold mb-4 border-bottom pb-2">
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<tr>
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<i class="fas fa-info-circle me-2"></i><?= _("Détails du sinistre") ?>
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<td width="10%" > <?= _("Demandeur") ?> </td>
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</h6>
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<td width="50%" ><INPUT class="form-control" TYPE="text" id="demandeur" NAME="demandeur" style='font-size:10pt;' required autofocus></td>
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<td width="10%" align="center"> <?= _("Lien Parenté") ?> </td>
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<div class="row g-3 mb-4">
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<td>
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<div class="col-md-6">
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<SELECT class="form-control" id="codeLienDemandeur" NAME="codeLienDemandeur" required style='font-size:10pt;'>
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<label class="form-label fw-bold small"><?= _("Demandeur (Nom & Prénoms)") ?> <span class="text-danger">*</span></label>
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<?php liste_options($liendemandeur,""); ?>
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<input class="form-control fw-bold border-primary" type="text" id="demandeur" name="demandeur" required autofocus>
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</SELECT>
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</div>
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</td>
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<div class="col-md-6">
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</tr>
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<label class="form-label fw-bold small"><?= _("Lien Parenté Demandeur") ?> <span class="text-danger">*</span></label>
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<select class="form-select fw-bold" id="codeLienDemandeur" name="codeLienDemandeur" required>
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<?php liste_options($liendemandeur,""); ?>
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</select>
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</div>
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<div class="col-md-8">
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<label class="form-label fw-bold small"><?= _("Cause du décès") ?> <span class="text-danger">*</span></label>
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<input class="form-control" type="text" id="causeDeces" name="causeDeces" required>
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</div>
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<div class="col-md-4">
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<label class="form-label fw-bold small"><?= _("Date du décès") ?> <span class="text-danger">*</span></label>
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<div class="input-group">
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<span class="input-group-text bg-white"><i class="fas fa-calendar-times text-danger"></i></span>
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<input class="form-control datepicker fw-bold" type="text" id="dateDeces" name="dateDeces" required>
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</div>
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</div>
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</div>
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<tr>
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<h6 class="text-primary text-uppercase small fw-bold mb-4 border-bottom pb-2">
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<td> <?= _("Cause décès") ?> </td>
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<i class="fas fa-user-check me-2"></i><?= _("Bénéficiaire du règlement") ?>
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<td ><INPUT class="form-control" TYPE="text" id="causeDeces" NAME="causeDeces" style='font-size:10pt;' required></td>
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</h6>
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<td align="center"> <?= _("Décédé le") ?> </td>
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<div class="row g-3 mb-4">
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<td><INPUT class="form-control datepicker" TYPE="text" id="dateDeces" NAME="dateDeces" Value="" style='font-size:10pt;' required ></td>
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<div class="col-md-6">
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</tr>
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<label class="form-label fw-bold small"><?= _("Nom du bénéficiaire au règlement") ?> <span class="text-danger">*</span></label>
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<input class="form-control fw-bold border-primary text-uppercase" type="text" id="beneficiaireReglement" name="beneficiaireReglement" required>
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<tr>
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</div>
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<td> <?= _("Bénéficiaire") ?> </td>
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<div class="col-md-6">
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<td ><INPUT class="form-control" TYPE="text" id="beneficiaireReglement" NAME="beneficiaireReglement" style='font-size:10pt;' required></td>
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<label class="form-label fw-bold small"><?= _("Lien Parenté Bénéficiaire") ?> <span class="text-danger">*</span></label>
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<select class="form-select fw-bold" id="codeLienBeneficiaire" name="codeLienBeneficiaire" required>
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<?php liste_options($lienbeneficiaire,""); ?>
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</select>
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</div>
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<div class="col-md-12">
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<label class="form-label fw-bold small"><?= _("Observations") ?></label>
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<textarea class="form-control" id="observations" name="observations" rows="2"></textarea>
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</div>
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</div>
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<td align="center"> <?= _("Lien Parenté") ?> </td>
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<div class="row g-3 mb-4 bg-light p-3 rounded-3 border">
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<td>
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<div class="col-md-6 text-center">
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<SELECT class="form-control" id="codeLienBeneficiaire" NAME="codeLienBeneficiaire" required style='font-size:10pt;'>
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<label class="form-label small text-muted text-uppercase fw-bold"><?= _("Frais prévus") ?></label>
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<?php liste_options($lienbeneficiaire,""); ?>
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<div class="h4 mb-0 text-secondary opacity-50"><?= format_N($montant_fraisfuneraire) ?></div>
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</SELECT>
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</div>
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</td>
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<div class="col-md-6 text-center border-start">
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</tr>
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<label class="form-label small text-muted text-uppercase fw-bold text-primary"><?= _("Montant Retenu") ?></label>
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<div class="h4 mb-0 text-primary fw-bold"><?= format_N($montant_fraisfuneraire) ?></div>
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<input type="hidden" id="montantApayer" name="montantApayer" value="<?= $montant_fraisfuneraire ?>">
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</div>
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</div>
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<tr>
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<h6 class="text-white text-uppercase small fw-bold mb-4 p-2 rounded bg-success d-flex align-items-center">
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<td> Observations </td>
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<i class="fas fa-university me-2 ms-2"></i><?= _("Informations sur le paiement") ?>
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<td colspan="3"><INPUT class="form-control" TYPE="text" id="observations" NAME="observations" style='font-size:10pt;' ></td>
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</h6>
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</tr>
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<tr>
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<div class="row g-3">
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<td> <?= _("Frais") ?> </td>
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<div class="col-md-4">
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<td> <input class="form-control" style="background-color: rgb(190,190,190);text-align: center; font-size:10pt;'" type="text" value="<?= format_N($montant_fraisfuneraire) ?>" disabled> </td>
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<label class="form-label fw-bold small"><?= _("Mode de Paiement") ?> <span class="text-danger">*</span></label>
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<select class="form-select border-success" id="codeModePaiementDemande" name="codeModePaiementDemande" required>
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<?php liste_options($modepaiement,""); ?>
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</select>
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</div>
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<div class="col-md-4">
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<label class="form-label fw-bold small"><?= _("Banque du Bénéficiaire") ?> <span class="text-danger">*</span></label>
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<select class="form-select border-success" id="codeBanqueBeneficiaire" name="codeBanqueBeneficiaire" required>
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<?php liste_options($banque, ""); ?>
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</select>
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</div>
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<div class="col-md-4">
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<label class="form-label fw-bold small"><?= _("N° Compte (RIB/IBAN)") ?> <span class="text-danger">*</span></label>
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<div class="input-group">
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<span class="input-group-text bg-success text-white"><i class="fas fa-credit-card"></i></span>
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<input class="form-control border-success fw-bold" type="text" id="numeroCompteBeneficiaire" name="numeroCompteBeneficiaire" required>
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</div>
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</div>
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</div>
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<td align="center" > <?= _("Retenu") ?> </td>
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<div class="row mt-5">
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<td> <INPUT class="form-control" style='font-size:10pt; text-align:center' TYPE="number" id="montantApayer" NAME="montantApayer" required value="<?= $montant_fraisfuneraire ?>" readonly > </td>
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<div class="col-12 text-end">
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</tr>
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<hr class="opacity-25">
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<button type="button" class="btn btn-primary btn-lg px-5 shadow-sm fw-bold" id="btn_enreg" onclick="enregistrerdemandefraisfuneraire();">
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<tr>
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<i class="fas fa-save me-2"></i><?= _("Enregistrer la demande") ?>
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<td colspan="4"> <input style='text-align:center; font-size:11pt; background-color:green;color:white;' class="form-control" type="text" value= "Informations sur le paiement proposées par le bénéficiaire" disabled > </td>
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</button>
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</tr>
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</div>
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</div>
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<tr>
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</div>
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<td > <?= _("Mode P") ?> </td>
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</div>
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<td>
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<SELECT class="form-control" id="codeModePaiementDemande" NAME="codeModePaiementDemande" required style='font-size:10pt;' >
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<?php liste_options($modepaiement,""); ?>
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</SELECT>
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</td>
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<td align="center"> <?= _("Banque Bénéf") ?> </td>
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<td>
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<SELECT style='font-size:10pt;' class="form-control" id="codeBanqueBeneficiaire" NAME="codeBanqueBeneficiaire" required>
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<?php liste_options($banque, ""); ?>
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</SELECT>
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</td>
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</tr>
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<tr>
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<td> <?= _("No Cpte Bénéf") ?> </td>
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<td > <INPUT style='font-size:10pt;' class="form-control" TYPE="text" id="numeroCompteBeneficiaire" NAME="numeroCompteBeneficiaire" required> </td>
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<td> </td>
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<?php if (isset($msgErreur)): ?>
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<td colspan="1"> <input id="btn_enreg" name="btn_enreg" class = "form-control btn btn-primary" type="button" value="<?= _("Enregistrer la demande") ?>" onClick="enregistrerdemandefraisfuneraire();" style='font-size:10pt;' > </td>
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<div id="msgErreur" class="alert alert-danger mt-3 shadow-sm border-0 animate__animated animate__shakeX">
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</tr>
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<i class="fas fa-exclamation-circle me-2"></i> <?= $msgErreur ?>
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</div>
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<?php endif; ?>
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</form>
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</div>
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<div id="div_test"></div>
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</tbody>
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</table>
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<?php if (isset($msgErreur)): ?>
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<style>
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<div id ="msgErreur" class="alert alert-danger" style="height:30px; padding:5px;" >
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.form-control:focus, .form-select:focus {
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<H4><?= $msgErreur ?></H4>
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border-color: #0d6efd;
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</div>
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box-shadow: 0 0 0 0.25rem rgba(13, 110, 253, 0.1);
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<?php endif; ?>
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}
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</form>
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textarea.form-control { min-height: 80px; }
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.bg-success { background-color: #28a745 !important; }
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<div id="div_test">
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</style>
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</div>
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