Add Reschedule

{!! Form::open(array('url' => '', 'role' => 'form', 'class' => 'form-horizontal form-groups')) !!}

{!! Form::label('loan id', 'Loan ID:', ['class' => 'col-sm-2 control-label']) !!}

{!! Form::text('loanId', $damageData['loanCode'], ['class' => 'form-control', 'id' => 'loanId', 'type' => 'text', 'readonly' => 'readonly']) !!}

{!! Form::label('member code', 'Member Code:', ['class' => 'col-sm-2 control-label']) !!}

{!! Form::text('memberCode', $damageData['memberCode'], ['class' => 'form-control', 'id' => 'memberCode', 'type' => 'text', 'readonly' => 'readonly']) !!}

{!! Form::label('installment number', 'Installment Number:', ['class' => 'col-sm-2 control-label']) !!}

{!! Form::text('installmentNumber', $damageData['installmentSl'], ['class' => 'form-control', 'id' => 'installmentNumber', 'type' => 'text', 'readonly' => 'readonly']) !!}

{!! Form::label('samity day', 'Samity Day:', ['class' => 'col-sm-2 control-label']) !!}

{!! Form::text('samityDay', $damageData['samityDay'], ['class' => 'form-control', 'id' => 'samityDay', 'type' => 'text', 'readonly' => 'readonly']) !!}

{!! Form::label('date from', 'Date From:', ['class' => 'col-sm-2 control-label']) !!}

{!! Form::text('dateFrom', $damageData['dateFrom'], ['class' => 'form-control', 'id' => 'dateFrom', 'type' => 'text', 'readonly' => 'readonly']) !!}

{!! Form::label('date to', 'Date To:*', ['class' => 'col-sm-2 control-label']) !!}

{!! Form::text('dateTo', $value = null, ['class' => 'form-control datepicker', 'id' => 'dateTo', 'type' => 'text']) !!}

{!! Form::submit('Submit', ['id' => 'submit', 'class' => 'btn btn-info']) !!} Close

{!! Form::close() !!}