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<?php include('header.php'); ?> <!--! ================================================================ !--> <!--! ================================================================ !--> <!--! Header Content !--> <!--! ================================================================ !--> <!--! ================================================================ !--> <!--! ================================================================ !--> <!--! Header Content !--> <!--! ================================================================ !--> <!--! ================================================================ !--> <!--! ================================================================ !--> <!--! [Start] Main Content !--> <!--! ================================================================ !--> <main class="nxl-container"> <div class="nxl-content"> <!-- [ page-header ] start --> <div class="page-header"> <div class="page-header-left d-flex align-items-center"> <div class="page-header-title"> <h5 class="m-b-10"><a href="./">Dashboard</a></h5> </div> <ul class="breadcrumb"> <li class="breadcrumb-item"><a href="?dad=account&jc=profile">Profile</a></li> <li class="breadcrumb-item"><a href="?dad=account&jc=profile&hs=kin">Next of Kin</a></li> </ul> </div> <div class="page-header-right ms-auto"> <div class="page-header-right-items"> <div class="d-flex d-md-none"> <a href="javascript:void(0)" class="page-header-right-close-toggle"> <i class="feather-arrow-left me-2"></i> <span>Back</span> </a> </div> <div class="d-flex align-items-center gap-2 page-header-right-items-wrapper"> <div class="dropdown filter-dropdown"> <a href="investments.deposits.form.php" class="btn btn-md btn-primary"> <i class="feather-plus-circle me-2"></i> <span>Make A Deposit</span> </a> </div> </div> </div> <div class="d-md-none d-flex align-items-center"> <a href="javascript:void(0)" class="page-header-right-open-toggle"> <i class="feather-align-right fs-20"></i> </a> </div> </div> </div> <!-- [ page-header ] end --> <!--! ================================================================ !--> <!--! [Start] Main Content !--> <!--! ================================================================ !--> <!-- [ Main Content ] start --> <div class="main-content"> <div class="row"> <div class="col-lg-12"> <div class="card border-top-0"> <div class="card-header p-0"> <!-- Nav tabs --> <ul class="nav nav-tabs flex-wrap w-100 text-center customers-nav-tabs" id="myTab" role="tablist"> <li class="nav-item flex-fill border-top" role="presentation"> <a class="nav-link active">Add Next of Kin</a> </li> </ul> </div> <div class="tab-content"> <div class="tab-pane fade show active" id="billingTab" role="tabpanel"> <!--Alert Box Start--> <div class="alert alert-dismissible m-4 p-3 d-flex alert-soft-teal-message" role="alert"> <div class="me-4 d-none d-md-block"> <i class="feather feather-bell fs-20 text-primary"></i> </div> <div> <p class="fs-12 fw-medium text-primary">In Practice, you can set up an unlimited number of Next of Kins.</p> <button type="button" class="btn-close" data-bs-dismiss="alert" aria-label="Close"></button> </div> </div> <!--Alert Box End--> <div class="card-body pass-info"> <form action="" method="POST"> <input type="hidden" name="dad" value="account"> <input type="hidden" name="jc" value="profile"> <input type="hidden" name="hs" value="kin"> <input type="hidden" name="a" value="save"> <input type="hidden" name="id" value="{$smarty.request.id|default:'0'}"> <input type="hidden" name="status" value="on"> <input type="hidden" name="priority" value="1"> <div class="row mb-4 align-items-center"> <div class="col-lg-4"> <label for="zipCodeInput" class="fw-semibold">First Name * </label> </div> <div class="col-lg-8"> <div class="input-group"> <div class="input-group-text"><i class="feather-user text-primary"></i></div> <input type="text" name="fname" value="{$smarty.post.fname}" class="form-control" placeholder="Enter First Name" required> </div> </div> </div> <div class="row mb-4 align-items-center"> <div class="col-lg-4"> <label for="zipCodeInput" class="fw-semibold">Middle Name </label> </div> <div class="col-lg-8"> <div class="input-group"> <div class="input-group-text"><i class="feather-user text-primary"></i></div> <input type="text" name="mname" value="{$smarty.post.mname}" class="form-control" placeholder="Enter Middle Name"> </div> </div> </div> <div class="row mb-4 align-items-center"> <div class="col-lg-4"> <label for="zipCodeInput" class="fw-semibold">Last Name * </label> </div> <div class="col-lg-8"> <div class="input-group"> <div class="input-group-text"><i class="feather-user text-primary"></i></div> <input type="text" name="lname" value="{$smarty.post.lname}" class="form-control" placeholder="Enter Last Name" required> </div> </div> </div> <div class="row mb-4 align-items-center"> <div class="col-lg-4"> <label for="zipCodeInput" class="fw-semibold">Mobile Number * </label> </div> <div class="col-lg-8"> <div class="input-group"> <div class="input-group-text"><i class="fa fa-mobile text-primary"></i></div> <input type="number" name="phone" value="{$smarty.post.phone}" class="form-control" placeholder="Enter Mobile Number" required> </div> </div> </div> <div class="row mb-4 align-items-center"> <div class="col-lg-4"> <label for="zipCodeInput" class="fw-semibold">Email Address</label> </div> <div class="col-lg-8"> <div class="input-group"> <div class="input-group-text"><i class="feather-mail text-primary"></i></div> <input type="email" name="email" value="{$smarty.post.email}" class="form-control" placeholder="Enter Email Address"> </div> </div> </div> <div class="row mb-4 align-items-center"> <div class="col-lg-4"> <label for="zipCodeInput" class="fw-semibold">Company</label> </div> <div class="col-lg-8"> <div class="input-group"> <div class="input-group-text"><i class="fa fa-building text-primary"></i></div> <input type="text" name="company" value="{$smarty.post.company}" class="form-control" placeholder="Enter Company"> </div> </div> </div> <div class="row mb-4 align-items-center"> <div class="col-lg-4"> <label for="zipCodeInput" class="fw-semibold">Address #1</label> </div> <div class="col-lg-8"> <div class="input-group"> <div class="input-group-text"><i class="fa fa-map-marker text-primary"></i></div> <input type="text" name="add1" value="{$smarty.post.add1}" class="form-control" placeholder="Enter First Address"> </div> </div> </div> <div class="row mb-4 align-items-center"> <div class="col-lg-4"> <label for="zipCodeInput" class="fw-semibold">Address #2</label> </div> <div class="col-lg-8"> <div class="input-group"> <div class="input-group-text"><i class="fa fa-map-marker text-primary"></i></div> <input type="text" name="add2" value="{$smarty.post.add2}" class="form-control" placeholder="Enter Second Address"> </div> </div> </div> <div class="row mb-4 align-items-center"> <div class="col-lg-4"> <label for="zipCodeInput" class="fw-semibold">City/Town</label> </div> <div class="col-lg-8"> <div class="input-group"> <div class="input-group-text"><i class="fa fa-map-signs text-primary"></i></div> <input type="text" name="city" value="{$smarty.post.city}" class="form-control" placeholder="Enter City or Town"> </div> </div> </div> <div class="row mb-4 align-items-center"> <div class="col-lg-4"> <label for="zipCodeInput" class="fw-semibold">Postal/ZIP Code</label> </div> <div class="col-lg-8"> <div class="input-group"> <div class="input-group-text"><i class="fa fa-location-arrow text-primary"></i></div> <input type="text" name="zip" value="{$smarty.post.zip}" class="form-control" placeholder="Enter Postal or ZIP Code"> </div> </div> </div> <div class="row mb-4 align-items-center"> <div class="col-lg-4"> <label for="zipCodeInput" class="fw-semibold">Country</label> </div> <div class="col-lg-8"> <div class="input-group"> <div class="input-group-text"><i class="fa fa-flag text-primary"></i></div> <input type="text" name="country" value="{$smarty.post.country}" class="form-control" placeholder="Enter Country"> </div> </div> </div> <div class="row mb-4 align-items-center"> <div class="col-lg-12"> <button type="submit" class="btn btn-primary"><span class="me-2">Save Kin Details</span> <i class="feather-arrow-right"></i></button> </div> </div> </form> </div> </div> </div> </div> </div> </div> </div> <!-- [ Main Content ] end --> </div> <!-- Footer Content --> <?php include('footer.php'); ?> <!-- Footer Content -->
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