{mode === 'create' ? 'Tambah Asuransi Baru' : 'Edit Data Asuransi'}

{/* Informasi Dasar */}

Kode Asuransi* setData('code', e.target.value)} placeholder="BPJS, PRU, dll" />

Nama Asuransi* setData('name', e.target.value)} placeholder="Nama lengkap asuransi" />

{/* Kontak */}

Nomor Telepon setData('phone_number', e.target.value)} placeholder="02112345678" />

Email setData('email', e.target.value)} placeholder="contact@asuransi.com" />

Alamat

setData('address', e.target.value)}
                                    placeholder="Alamat kantor pusat"
                                />
                                <InputError message={errors.address} />
                            </div>

{/* Penanggung Jawab */}
                            <div className="space-y-2">
                                <Label htmlFor="contact_person">Nama Kontak</Label>
                                <Input
                                    id="contact_person"
                                    value={data.contact_person}
                                    onChange={(e) => setData('contact_person', e.target.value)}
                                    placeholder="Nama penanggung jawab"
                                />
                                <InputError message={errors.contact_person} />
                            </div>

<div className="space-y-2">
                                <Label htmlFor="contact_person_phone">No. HP Kontak</Label>
                                <Input
                                    id="contact_person_phone"
                                    value={data.contact_person_phone}
                                    onChange={(e) => setData('contact_person_phone', e.target.value)}
                                    placeholder="08123456789"
                                />
                                <InputError message={errors.contact_person_phone} />
                            </div>

{/* Cakupan */}
                            <div className="space-y-2">
                                <Label htmlFor="coverage_percentage">Persentase Cover (%)*</Label>
                                <Input
                                    id="coverage_percentage"
                                    type="number"
                                    min="0"
                                    max="100"
                                    step="0.01"
                                    value={data.coverage_percentage}
                                    onChange={(e) => setData('coverage_percentage', parseFloat(e.target.value))}
                                />
                                <InputError message={errors.coverage_percentage} />
                            </div>

<div className="space-y-2 col-span-full">
                                <Label htmlFor="coverage_description">Deskripsi Cakupan</Label>
                                <Textarea
                                    id="coverage_description"
                                    value={data.coverage_description}
                                    onChange={(e) => setData('coverage_description', e.target.value)}
                                    placeholder="Detail layanan yang dicover"
                                />
                                <InputError message={errors.coverage_description} />
                            </div>

{/* Perjanjian */}
                            <div className="space-y-2">
                                <Label htmlFor="agreement_start_date">Tanggal Mulai Perjanjian</Label>
                                <Popover>
                                    <PopoverTrigger asChild>
                                        <Button
                                            variant={"outline"}
                                            className={cn(
                                                "w-full justify-start text-left font-normal",
                                                !data.agreement_start_date && "text-muted-foreground"
                                            )}
                                        >
                                            <CalendarIcon className="mr-2 h-4 w-4" />
                                            {data.agreement_start_date ? (
                                                format(new Date(data.agreement_start_date), "dd/MM/yyyy")
                                            ) : (
                                                <span>Pilih tanggal</span>
                                            )}
                                        </Button>
                                    </PopoverTrigger>
                                    <PopoverContent className="w-auto p-0">
                                        <Calendar
                                            mode="single"
                                            selected={data.agreement_start_date ? new Date(data.agreement_start_date) : undefined}
                                            onSelect={(date) => date && setData('agreement_start_date', toLocalISOString(date))}
                                            initialFocus
                                        />
                                    </PopoverContent>
                                </Popover>
                                <InputError message={errors.agreement_start_date} />
                            </div>

<div className="space-y-2">
                                <Label htmlFor="agreement_end_date">Tanggal Berakhir Perjanjian</Label>
                                <Popover>
                                    <PopoverTrigger asChild>
                                        <Button
                                            variant={"outline"}
                                            className={cn(
                                                "w-full justify-start text-left font-normal",
                                                !data.agreement_end_date && "text-muted-foreground"
                                            )}
                                        >
                                            <CalendarIcon className="mr-2 h-4 w-4" />
                                            {data.agreement_end_date ? (
                                                format(new Date(data.agreement_end_date), "dd/MM/yyyy")
                                            ) : (
                                                <span>Pilih tanggal</span>
                                            )}
                                        </Button>
                                    </PopoverTrigger>
                                    <PopoverContent className="w-auto p-0">
                                        <Calendar
                                            mode="single"
                                            selected={data.agreement_end_date ? new Date(data.agreement_end_date) : undefined}
                                            onSelect={(date) => date && setData('agreement_end_date', toLocalISOString(date))}
                                            initialFocus
                                        />
                                    </PopoverContent>
                                </Popover>
                                <InputError message={errors.agreement_end_date} />
                            </div>

<div className="space-y-2 col-span-full">
                                <Label htmlFor="agreement_details">Detail Perjanjian</Label>
                                <Textarea
                                    id="agreement_details"
                                    value={data.agreement_details}
                                    onChange={(e) => setData('agreement_details', e.target.value)}
                                    placeholder="Ringkasan perjanjian kerjasama"
                                />
                                <InputError message={errors.agreement_details} />
                            </div>

{/* File & Status */}
                            <div className="space-y-2">
                                <Label htmlFor="agreement_file_path">File Perjanjian (Path)</Label>
                                <Input
                                    id="agreement_file_path"
                                    value={data.agreement_file_path}
                                    onChange={(e) => setData('agreement_file_path', e.target.value)}
                                    placeholder="/path/to/agreement.pdf"
                                />
                                <InputError message={errors.agreement_file_path} />
                            </div>

{mode === 'edit' && (
                                <div className="flex items-center space-x-2">
                                    <input
                                        type="checkbox"
                                        id="is_active"
                                        checked={data.is_active}
                                        onChange={(e) => setData('is_active', e.target.checked)}
                                        className="h-4 w-4 rounded border-gray-300 text-indigo-600 focus:ring-indigo-500"
                                    />
                                    <Label htmlFor="is_active">Asuransi Aktif</Label>
                                </div>
                            )}
                        </div>

<div className="flex justify-end gap-2">
                            <Button variant="outline" type="button" onClick={() => window.history.back()}>
                                Batal
                            </Button>
                            <Button type="submit" disabled={processing}>
                                {mode === 'create' ? 'Simpan' : 'Perbarui'} Asuransi
                            </Button>
                        </div>
                    </form>
                </div>
            </div>
        </AppLayout>
    );
}