<?php $__env->startSection('content'); ?>
<div class="appHeader text-light ico1" style="display: none;">
            <div class="left">
                                    <a href="javascript:void()" onclick="history.back();" class="headerButton">
                        <ion-icon name="chevron-back-outline" role="img" class="icon md hydrated" aria-label="chevron back outline"></ion-icon>
                    </a>
                               
                
            </div>
            <div class="pageTitle">
                <img src="<?php echo e(siteLogo()); ?>" width="150" alt="">
            </div>
            <div class="right">
                <a href="<?php echo e(route('user.alerts')); ?>" class="headerButton">
                    <ion-icon class="icon md hydrated" name="notifications" role="img" aria-label="notifications"></ion-icon>
                </a>
            </div>
        </div>
        
        <div id="appCapsule" class="container">
            <form method="post" action="<?php echo e(route('user.kyc.submit')); ?>" enctype="multipart/form-data">
                            <?php echo csrf_field(); ?>

                <div id="ContentPlaceHolder1_UpdatePanel1">

                    <div class="row">
                        <div class="col-md-12 grid-margin stretch-card">
                            <div class="card pb-5">
                                
                                <div class="card-body">
                                    <p class="card-title mb-0">KYC</p>
                                    <br>
                                    <div class="container">
                                        <div class="row justify-content-md-center">
                                            <div class="rcx_prt col-xs-12 col-sm-12 col-md-10 col-lg-8">
                                                
                    <div id="ContentPlaceHolder1__Form" class="row">
                        <div id="ContentPlaceHolder1_Sect_1">
                            <div class="col-md-12 grid-margin stretch-card mb-3">
                                <div class="card mb-5">
                                    <div class="card-header">
                                        <h5 class="card-title">PART A: IDENTITY DETAILS</h5>
                                    </div>
                                    <div class="card-body">
                                        <div class="forms-sample">

                                            <div class="form-group basic">
                                                <label class="name">Full Name:</label>
                                                <input name="full_name" type="text" class="form-control form-control-lg" data-valid="text">
                                            </div>
                                            <div class="form-group basic">
                                                <label class="gender">Gender:</label>
                                                    
                                                <select name="gender" class="form-control form-control-lg">
                                                    <option value="">Select Gender</option>
                                                    <option value="male">Male</option>
                                                    <option value="female">Female</option>
                                           
                                                </select>
                                            </div>
                                            <div class="form-group basic">
                                                <label class="marital">Marital Status:</label>
                                                    
                                                <select name="marital_status" class="form-control form-control-lg">
                                                    <option value="">Select Marital Status</option>
                                                    <option value="single">Single</option>
                                                    <option value="divorced">Divorced</option>
                                                    <option value="married">Married</option>
                                                    <option value="widowed">Widowed</option>
                                                    <option value="seperated">Seperated</option>
                                           
                                                </select>
                                            </div>

                                            <div class="form-group basic">
                                                <label class="dob">Date of Birth</label>
                                                <input name="date_of_birth" type="date" class="form-control form-control-lg">
                                            </div>
                                            <div class="form-group basic">
                                                <label class="moi">Mode of Identification</label>
                                                <select name="mode_of_verification" class="form-control form-control-lg">
                                                    <option value="">Select Preferred Mode</option>
                                                    <option value="Passport">Passport</option>
                                                    <option value="Voter Registration Card">Voter Registration Card</option>
                                                    <option value="Valid Driver's License">Valid Driver's License</option>
                                                    <option value="National Identity Card">National Identity Card</option>
                                           
                                                </select>
                                                   </div>
                                            <div class="form-group basic row">
                                                <input class="col-lg-6 col-12" id="poi" name="id_card" type="file">
                                                
                                                <div class="col-lg-6 col-12 text-center mt-lg-0 mt-2">
                                                    <img src="/assets/img/placeholder.png" data-prev="/assets/img/placeholder.png" class="poi" width="100" alt="">
                                                </div>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                                <div class="card mb-5">
                                    <div class="card-header">
                                        <h5 class="card-title">PART B: ADDRESS DETAILS</h5>
                                    </div>
                                    <div class="card-body">
                                        <div class="forms-sample">

                                            <div class="form-group basic row">
                                                <div class="col-12">
                                                    <label class="address">Residential Address:</label>
                                                    <input name="address" type="text" class="form-control form-control-lg">
                                                </div>
                                            </div>
                                            <div class="form-group basic row">
                                                <div class="col-lg-6 col-12">
                                                    <label class="city">City:</label>
                                                    <input name="city" type="text" class="form-control form-control-lg">
                                                </div>
                                                <div class="col">
                                                    <label class="state">State:</label>
                                                    <input name="state" type="text" class="form-control form-control-lg">
                                                </div>
                                            </div>
                                            <div class="form-group basic row">
                                                <div class="col-lg-6 col-12">
                                                    <label class="country">Country:</label>
                                                    <input name="country" type="text" class="form-control form-control-lg">
                                                </div>
                                                <div class="col">
                                                    <label class="zip">Zip Code:</label>
                                                    <input name="zip_code" type="text" class="form-control form-control-lg">
                                                </div>
                                            </div>
                                            <div class="form-group basic row">
                                                <div class="col-12">
                                                <label class="moa">Proof of Address</label>
                                                <select name="proof_of_address" class="form-control form-control-lg">
                                                    <option value="">Select Preferred Mode</option>
                                                    <option value="Utility Bill">Utility Bill</option>
                                                    <option value="Insurance Card">Insurance Card</option>
                                                    <option value="Voter Registration Card">Bank Statement</option>
                                                    <option value="Lease Agreement">Lease Agreement</option>
                                                    <option value="Property Tax Receip">Property Tax Receipt</option>
                                           
                                                </select>
                                                </div>
                                            </div>
                                            <div class="form-group basic row">
                                                <input class="col-lg-6 col-12" id="poa" name="address_verification" type="file">
                                                
                                                <div class="col-lg-6 col-12 text-center mt-lg-0 mt-2">
                                                    <img src="/assets/img/placeholder.png" data-prev="/assets/img/placeholder.png" class="poa" width="100" alt="">
                                        </div>
                                    </div>
                                    <div class="card-footer text-end">
                                    <button type="submit" class="btn btn-primary m-1" style="border-radius:0" id="kyc_btn">
                                        Submit <ion-icon class="ms-1 md hydrated" name="checkbox-outline" role="img" aria-label="checkbox outline"></ion-icon>
                                    </button>
                                    
                                </div>
                                </div>
                            </div>
                        </div>
                    </div>
                                            
                                                                                            
                                            </div>
                                        </div>
                                    </div>
                                </div>
                            </div>
                        </div>
                    </div>
                </div>
                <script src="/static/js/kyc.js"></script>
            
        </div>

<script src="/static/js/lib/bootstrap.bundle.min.js"></script>
<script type="module" src="https://unpkg.com/ionicons%405.5.2/dist/ionicons/ionicons.js"></script>
<script src="/static/js/plugins/splide/splide.min.js"></script>

<script src="/static/js/base.js"></script>

<script src="/static/js/AppMain.js"></script>
<script src="/static/js/alertify/alertify.min.js"></script>
<script src="/static/js/panel.js"></script>
<script src="/static/js/base.js"></script>

<script src="/static/js/typo.js"></script>
<script src="/static/js/a_GenImage.js"></script>
<!-- Toastr JS -->

<script>
    $(document).ready(function () {
        var $u = window.location.pathname.replace(/\/$/, ""),
            pgName = $u.substring($u.lastIndexOf("/") + 1).toLowerCase();
        $(".sidebar-wrapper .menu .sidebar-item")
            .filter(function () {
                return (
                    $(this)
                        .find("a[href]")
                        .filter(function () {
                            return new RegExp(pgName, "i").test($(this).attr("href"));
                        }).length >= 1
                );
            })
            .last()
            .addClass("active");
    });
</script>

<script src="/panel/assets/js/toastr.min.js"></script>

</div></form></div>
<?php $__env->stopSection(); ?>
<?php echo $__env->make($activeTemplate.'layouts.master', \Illuminate\Support\Arr::except(get_defined_vars(), ['__data', '__path']))->render(); ?><?php /**PATH /home/syqhlpzd/web3worldchainsecurity.org/core/resources/views/templates/invester/user/kyc/form.blade.php ENDPATH**/ ?>