@isset($vars['claimData']->claimResponse)
<div class="box-header ">
    <h3 class="box-title text-green pull-right">{{$vars['claimData']->claimResponse->TiraStatusCode}} <i class="text-blue">{{$vars['claimData']->claimResponse->TiraStatusDesc}}</i> </h3>
</div>
@endisset
<form class="prevent-resubmit-form" id="create_claim_form" method="post" action="/claim_notifications" enctype="multipart/form-data">
    @csrf


        <input type="hidden" name="id"  @isset($vars['claimData'])value="{{$vars['claimData']->id}}"@endisset >
        <input type="hidden" name="officer_id"  value="{{auth()->user()->id}}" >
        <div class="row">
            <input type="hidden" name="cover_note_number">
            <div class="form-group col-md-3">
                <label for="exampleInputEmail1">CoverNote ReferenceNumber</label>
                <select class="form-control text-uppercase select2 cover_note_reference_select cover_note_reference_select_loader" id="cover_note_reference_select" name="policy_id" data-placeholder="Select CoverNote Reference Number" style="width: 100%" required>
                    <option  selected @isset($vars['claimData']->claim)value="{{$vars['claimData']->claim->policy_id}}"@endisset >@if(isset($vars['claimData']->claim)){{$vars['claimData']->claim->CoverNoteReferenceNumber}} @else Select Reference Number @endif</option>
                </select>
            </div>

            <div class="form-group col-md-3">
                <label for="exampleInputEmail1">Motor</label>
                <select class="form-control select2 search_by_motor_detail search_by_motor_detail_loader" id="search_by_motor_detail" name="motor_id" data-placeholder="Select Motor" style="width: 100%">
                    <option value="" selected > Select Motor </option>
                </select>
            </div>

            <div class="form-group col-md-3">
                <label for="license_plate">Claim Report Date</label>
                <input type="datetime-local" class="form-control text-uppercase  pull-right" @if(isset($vars['claimData'])) value="{{$vars['claimData']->claim_report_date}}" @else value="{{now()->format('Y-m-d\TH:i')}}" @endif name="claim_report_date" id="claim_report_date"  required >
            </div>
            <div class="form-group col-md-3">
                <label for="license_plate">Loss Discovery Date</label>
                <input type="datetime-local"  class="form-control text-uppercase pull-right " @if(isset($vars['claimData'])) value="{{$vars['claimData']->claim_report_date}}" @else value="{{now()->format('Y-m-d\TH:i')}}" @endif  name="loss_date" id="loss_date" placeholder="Loss Discovery Date"  required>

            </div> {{--chr(rand(65, 90)).--}}
        </div>
        <div class="row">
            <div class="form-group col-md-3">
                <label for="exampleInputEmail1">Claim Form Dully Filled</label>
                <select class="form-control text-uppercase select2 claim_form_dully_filled claim_form_dully_filled_loader" id="claim_form_dully_filled" name="claim_form_dully_filled" data-placeholder="Select Claim Form Dully Filled" style="width: 100%" required>
                    <option value="" selected disabled>Select Claim Form Dully Filled</option>
                    <option value="Y" @isset($vars['claimData']) {{$vars['claimData']->claim_form_dully_filled == 'Y' ? 'selected': ''  }} @endisset>Yes</option>
                    <option value="N" @isset($vars['claimData']) {{$vars['claimData']->claim_form_dully_filled == 'N' ? 'selected': ''  }} @endisset>No</option>
                </select>
            </div>

            <div class="form-group col-md-3">
                <label for="license_plate">Loss Nature</label>
                <input type="text"  class="form-control text-uppercase pull-right" @isset($vars['claimData'])value="{{$vars['claimData']->loss_nature}}"@endisset name="loss_nature" id="loss_nature" placeholder="Loss Nature"  required>
            </div>
            <div class="form-group col-md-3">
                <label for="license_plate">Loss Type</label>
                <input type="text"  class="form-control text-uppercase pull-right" @isset($vars['claimData'])value="{{$vars['claimData']->loss_type}}"@endisset name="loss_type" id="loss_type" placeholder="Loss Type"  required>
            </div>
            <div class="form-group col-md-2">
                <label for="license_plate">Loss Location</label>
                <input type="text"  class="form-control text-uppercase pull-right" @isset($vars['claimData'])value="{{$vars['claimData']->loss_location}}"@endisset name="loss_location" id="loss_location" placeholder="Loss Location"  required>
            </div>
            <div class="form-group col-md-1">
                @if(!isset($vars['claimData']) )
                    <button type="submit" class="btn btn-sm bg-orange" style="margin-top: 35px">  Submit</button>
                @endif
                @if(isset($vars['claimData']) && $vars['claimData']->status == 'Error')
                    <button type="submit" class="btn btn-sm bg-orange" style="margin-top: 35px">  Submit</button>
                @endif
            </div>
        </div>

</form>

{{--@include('claims._table._policy_detail_data')--}}