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KONE SOREL 2026-01-05 14:52:10 +00:00
parent 79a1891d2b
commit 81988a5637
1 changed files with 4 additions and 4 deletions
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8
Vue/Rechercherassure/index.php
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@ -8,20 +8,20 @@
<form id="frmrecherche" name="frmrecherche" method="post" action="Rechercherassure/index/"> <form id="frmrecherche" name="frmrecherche" method="post" action="Rechercherassure/index/">
<div class="row g-3"> <div class="row g-3">
<div class="col-md-3"> <div class="col-md-3">
<label class="form-label small fw-bold text-muted"><?= _("Numéro Famille") ?></label> <label class="form-label small fw-bold text-uppercase"><?= _("Numéro Famille") ?></label>
<input class="form-control border-primary-subtle" type="text" id="numeroAdherent" name="numeroAdherent" autocomplete="off" placeholder="Ex: ADH-100..."> <input class="form-control border-primary-subtle" type="text" id="numeroAdherent" name="numeroAdherent" autocomplete="off" placeholder="Ex: ADH-100...">
</div> </div>
<div class="col-md-3"> <div class="col-md-3">
<label class="form-label small fw-bold text-muted"><?= _("Numéro Bénéficiaire") ?></label> <label class="form-label small fw-bold text-uppercase"><?= _("Numéro Bénéficiaire") ?></label>
<input class="form-control border-primary-subtle" type="text" id="numeroBeneficiaire" name="numeroBeneficiaire" autofocus autocomplete="off" placeholder="Ex: B-500..."> <input class="form-control border-primary-subtle" type="text" id="numeroBeneficiaire" name="numeroBeneficiaire" autofocus autocomplete="off" placeholder="Ex: B-500...">
</div> </div>
<div class="col-md-3"> <div class="col-md-3">
<label class="form-label small fw-bold text-muted"><?= _("Nom de l'assuré") ?></label> <label class="form-label small fw-bold text-uppercase"><?= _("Nom de l'assuré") ?></label>
<input class="form-control border-primary-subtle" type="text" id="nomBeneficiaire" name="nomBeneficiaire" autocomplete="off"> <input class="form-control border-primary-subtle" type="text" id="nomBeneficiaire" name="nomBeneficiaire" autocomplete="off">
</div> </div>
<div class="col-md-3"> <div class="col-md-3">
<label class="form-label small fw-bold text-muted"><?= _("Prénoms") ?></label> <label class="form-label small fw-bold text-uppercase"><?= _("Prénoms") ?></label>
<input class="form-control border-primary-subtle" type="text" id="prenomsBeneficiaire" name="prenomsBeneficiaire" autocomplete="off"> <input class="form-control border-primary-subtle" type="text" id="prenomsBeneficiaire" name="prenomsBeneficiaire" autocomplete="off">
</div> </div>