@extends('main') @section('css') @endsection @section('content')

Risk Note #

Initiate Branch

Date:

Claim Currency:

Premium Amount:

Customer Balance Amount :

Insurer Balance Amount :

Insurer Name :

Email :

Period :

Period :

Insurance Type:

Insurance Class:

Insurance Description:

Cover Note :

Sticker Number :

Vehicle Number :

Policy Number :

Vehicle Make :

Vehicle Model :

Vehicle Type :

Client Name :

File # :

Insured Name :

@endsection @section('js') @endsection