30 lines
1.3 KiB
PHP
30 lines
1.3 KiB
PHP
<div class="modal fade" tabindex="-1" role="dialog" id="create_modal_asuransi">
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<div class="modal-dialog modal-dialog-centered" role="document">
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<div class="modal-content">
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<div class="modal-header">
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<h5 class="modal-title">Tambah Data</h5>
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<button type="button" class="close" data-dismiss="modal" aria-label="Close">
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<span aria-hidden="true">×</span>
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</button>
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</div>
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<form action="/asuransi" method="post" id="create_data_form">
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@csrf
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<div class="modal-body">
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<div id="insurance-wrapper">
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<div class="form-group">
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<label for="insuranceName">Nama Asuransi</label>
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<input type="text" class="form-control" name="name[]" placeholder="Enter name">
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</div>
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</div>
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<button type="button" id="addInsurance" class="btn btn-primary mt-2">Tambah Nama Asuransi</button>
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</div>
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<div class="modal-footer bg-whitesmoke br">
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<button type="button" class="btn btn-secondary" data-dismiss="modal">Close</button>
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<button type="submit" class="btn btn-primary">Save changes</button>
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</div>
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</form>
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</div>
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</div>
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</div>
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