@if ($errors->any())
* Please Provide all data correctly. ×
@endif
{!! Form::open(['enctype' => 'multipart/form-data', 'role' => 'form', 'class' => 'form-horizontal form-groups']) !!} @if (count($data['existingReferences']) > 0) @foreach ($data['existingReferences'] as $key => $reference) @endforeach @else @endif
Company {!! Form::select('companies[]', ['' => 'Select'] + $data['companies'] + ['other' => 'Other'], $reference->referrer_company_id ?? 'other', [ 'class' => 'form-control company', ]) !!}
Company Name {!! Form::text('company_names[]', $reference->referrer_company_name, [ 'class' => 'form-control companyName', 'type' => 'text', 'placeholder' => 'Company Name', 'readonly' => 'readonly', ]) !!}
Name {!! Form::text('names[]', $reference->referrer_name, [ 'class' => 'form-control', 'type' => 'text', 'placeholder' => 'Name', ]) !!}
Occupation {!! Form::text('occupations[]', $reference->referrer_occupation, [ 'class' => 'form-control', 'id' => 'occupation', 'type' => 'text', 'placeholder' => $data['placeholder']['occupation'], ]) !!}
Designation {!! Form::text('designations[]', $reference->referrer_designation, [ 'class' => 'form-control', 'id' => 'designation', 'type' => 'text', 'placeholder' => $data['placeholder']['designation'], ]) !!}
Working Address {!! Form::text('working_addresses[]', $reference->referrer_working_address, [ 'class' => 'form-control', 'id' => 'working_address', 'type' => 'text', 'placeholder' => $data['placeholder']['working_address'], ]) !!}
NID No {!! Form::text('nid_nos[]', $reference->referrer_nid_no, [ 'class' => 'form-control', 'id' => 'nid_no', 'type' => 'text', 'placeholder' => $data['placeholder']['nid_no'], ]) !!}
Phone {!! Form::text('phones[]', $reference->referrer_phone, [ 'class' => 'form-control', 'id' => 'phone', 'type' => 'text', 'placeholder' => $data['placeholder']['phone'], ]) !!}
Relation {!! Form::text('relations[]', $reference->relation, [ 'class' => 'form-control', 'id' => 'relation', 'type' => 'text', 'placeholder' => $data['placeholder']['relation'], ]) !!}
Email {!! Form::text('emails[]', $reference->referrer_email, [ 'class' => 'form-control', 'id' => 'email', 'type' => 'text', 'placeholder' => $data['placeholder']['email'], ]) !!}
Mobile {!! Form::text('mobiles[]', $reference->referrer_mobile, [ 'class' => 'form-control', 'id' => 'mobile', 'type' => 'text', 'placeholder' => $data['placeholder']['mobile'], ]) !!}



@if ($key > 0) @endif
Company {!! Form::select('companies[]', ['' => 'Select'] + $data['companies'] + ['other' => 'Other'], null, [ 'class' => 'form-control company', ]) !!}
Company Name {!! Form::text('company_names[]', '', [ 'class' => 'form-control companyName', 'type' => 'text', 'placeholder' => 'Company Name', 'readonly' => 'readonly', ]) !!}
Name {!! Form::text('names[]', '', [ 'class' => 'form-control', 'type' => 'text', 'placeholder' => 'Name', ]) !!}
Occupation {!! Form::text('occupations[]', $data['model']->occupation, [ 'class' => 'form-control', 'id' => 'occupation', 'type' => 'text', 'placeholder' => $data['placeholder']['occupation'], ]) !!}
Designation {!! Form::text('designations[]', $data['model']->designation, [ 'class' => 'form-control', 'id' => 'designation', 'type' => 'text', 'placeholder' => $data['placeholder']['designation'], ]) !!}
Working Address {!! Form::text('working_addresses[]', $data['model']->working_address, [ 'class' => 'form-control', 'id' => 'working_address', 'type' => 'text', 'placeholder' => $data['placeholder']['working_address'], ]) !!}
NID No {!! Form::text('nid_nos[]', $data['model']->nid_no, [ 'class' => 'form-control', 'id' => 'nid_no', 'type' => 'text', 'placeholder' => $data['placeholder']['nid_no'], ]) !!}
Phone {!! Form::text('phones[]', $data['model']->phone, [ 'class' => 'form-control', 'id' => 'phone', 'type' => 'text', 'placeholder' => $data['placeholder']['phone'], ]) !!}
Relation {!! Form::text('relations[]', $data['model']->relation, [ 'class' => 'form-control', 'id' => 'relation', 'type' => 'text', 'placeholder' => $data['placeholder']['relation'], ]) !!}
Email {!! Form::text('emails[]', $data['model']->email, [ 'class' => 'form-control', 'id' => 'email', 'type' => 'text', 'placeholder' => $data['placeholder']['email'], ]) !!}
Mobile {!! Form::text('mobiles[]', $data['model']->mobile, [ 'class' => 'form-control', 'id' => 'mobile', 'type' => 'text', 'placeholder' => $data['placeholder']['mobile'], ]) !!}



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