@extends('layouts.app')

@section('content')

<form action="" class="col col-lg-9 pd-30" id="submitForm" method="POST">
    @csrf

    <div class="page-title divider-b pdb-10 flexbox align-between align-center-y mb-20">
        <h1 class="reset-block primary-color lineheight-130 fs-20">بيانات محو السابقه</h1>
        <button class="btn small primary">حفظ </button>
    </div>

    <div class="row">

        <x-prisoner-info type="not_be_modified" :$prisoner />

        <x-issue-info page="not_be_modified" :$issue />

        <div class="col-6">
            <div class="widget-block mb-30 white-bg radius-g pdb-5 form-ui gray-form">

                <h3 class="far widget-title fs-15 pdx-20 pdy-10 medium-weight mb-20 primary">
                    <label class="checkbox">
                        <input type="checkbox" name="erasing_previous" value="0">
                        <span>محو السابقه ورد الاعتبار</span>
                    </label>
                </h3>

                <div class="widget-content pdx-20">

                    <div class="row gpx-15">
                        <div class="col-12 col-md-12 widget-block ">


                            <div class="flexbox divider-b mb-20">
                                <div class="col-12">
                                    <label for="letter_number">جهة اصدار الخطاب</label>
                                    <input class="req" type="text" placeholder="جهة اصدار الخطاب" name="cancel_letter_direction" >

                                    <label for="letter_number">رقم الخطاب</label>
                                    <input class="req" type="text" placeholder="رقم الخطاب" name="cancel_letter_number" >

                                    <label for="arrested_letter_date">تاريخ الخطاب</label>
                                    <div class="pos-rel"><input type="text" name="cancel_letter_date"  class="req date-hijri"></div>

                                    <label for="arrested_notes"> ملاحظات </label>
                                    <textarea name="arrested_notes" id="" cols="30" rows="10">  </textarea>
                                </div>
                            </div>
                        </div>

                    </div>
                </div>
            </div>
        </div>
    </div>
</form>
@endsection