@extends('layouts.v2.frontend-user-backend')

@section('title', '| Last Will And Testament')

@section('content')
@include('frontend.forms.v2.Will-Testament.stepIndicator')

    <form action="{{route('willsAndTestFormcreate')}}" method="POST" id="signUpForm">
      @csrf
      <input type="hidden" id="stepInput" name="step" value="3-2">

      <div class="multiple-form dashboard-radio">
         <h4>Gifts</h4>
         <p>Do you want to leave any specific gifts in your Will?</p>

         <div class="form">
            <div class="row">
               <div class="col-12">
                  <div class="dashboard-radio-form">
                     <div class="form-check">
                        <input id="gifts32-y" class="form-check-input" name="gift" type="radio" value="yes" {{ $willsAndTest->specific_gifts == 'yes' && isset($willsAndTest->specific_gifts) ? 'checked' : '' }}>
                        <label for="gifts32-y"><p>Yes</p></label>
                     </div>
                     <div class="form-check">
                        <input id="gifts32-n" class="form-check-input" name="gift" type="radio" value="no" {{ $willsAndTest->specific_gifts == 'no' && isset($willsAndTest->specific_gifts) ? 'checked' : '' }}>
                        <label for="gifts32-n"><p>No</p></label>
                     </div>
                  </div>
               </div>
            </div>
            <div class="row">
               <div id="gifts32-container-card" class="child-card-holder">
                  <div class="sub-title mb-3">Who will receive gifts in the WILL?</div>
                  <div id="gifts32-container">
                  @php
                     $willsAndTestGiftArray = json_decode($willsAndTest->specific_gifts_details, true)
                  @endphp

                  @if(!empty($willsAndTest->specific_gifts_details) && count($willsAndTestGiftArray) > 0 )
                     @foreach($willsAndTestGiftArray as $index => $gift)
                        <div class="card list mb-3 beneficiary32-card" id="child">
                           <div class="card-header">
                              <div class="card-title">Gift recipient</div>
                              <a class="r-button" onclick="removetList(this)"><span class="fas fa-times"></span><span class="remove">Remove</span></a>
                           </div>
                           <div class="card-body">
                              <div class="long-btn-card">
                                 <div class="dashboard-radio-form">
                                    <div class="form-check">
                                       <input class="form-check-input beneficiary32-radio" data-form="gifts32_lbm" type="radio" id="gifts32_lb-{{$index}}" name="beneficiary_type[{{$index}}]" value="person" {{ $gift['type'] == 'person' && isset($gift['type']) ? 'checked' : '' }}>
                                       <label for="gifts32_lb-{{$index}}"><p>Person</p></label>
                                    </div>
                                    <div class="form-check">
                                       <input class="form-check-input beneficiary32-radio" data-form="gifts32_charity_lbm" type="radio" id="gifts32_charity_lb-{{$index}}" name="beneficiary_type[{{$index}}]" value="charity" {{ $gift['type'] == 'charity' && isset($gift['type']) ? 'checked' : '' }}>
                                       <label for="gifts32_charity_lb-{{$index}}"><p>Charity or Organization</p></label>
                                    </div>
                                 </div>
                              </div>

                              <div class="beneficiary-form-x" data-form-name="gifts32_lbm" id="individual_form_gifts32" @if($gift['type'] == 'person' && isset($gift['type'])) style="display: block;" @else style="display: none;" @endif>
                                 <div class="form-group mb-3">
                                    <label for="name">Name</label>
                                    <input  value="{{$gift['name'] ?? ''}}" type="text"  name="beneficiary31_name[]" id="beneficiary31_name_{{$index}}" aria-describedby="nameHelp" >
                                    <small id="nameHelp" class="form-text text-muted">e.g. William Timothy Smith</small>
                                 </div>
                                 <div class="form-group mb-3">
                                    <label for="city">City/Town</label>
                                    <input value="{{$gift['city'] ?? ''}}" type="text"  name="beneficiary31_city[]" id="beneficiary31_city_{{$index}}" aria-describedby="cityHelp">
                                    <small id="cityHelp" class="form-text text-muted d-none">city</small>
                                 </div>

                                 <div class="form-group mb-3">
                                    <label for="beneficiary31_country_{{ $index }}">Country</label>

                                    <input type="hidden"
                                       value="{{ $gift['country'] ?? '' }}"
                                       name="beneficiary31_country_value[]"
                                       id="beneficiary31_country_value_{{ $index }}" />

                                    <select id="beneficiary31_country_{{ $index }}"
                                       name="beneficiary31_country[]"
                                       class="form-control"
                                       data-country-dropdown
                                       data-country-value="beneficiary31_country_value_{{ $index }}"
                                       data-state-dropdown="beneficiary31_state_{{ $index }}"
                                       data-state-value="beneficiary31_state_value_{{ $index }}">
                                       <option value="">Select Country</option>
                                    </select>
                                 </div>

                                 <div class="form-group mb-3">
                                    <label for="beneficiary31_state_{{ $index }}">State</label>

                                    <input type="hidden"
                                       value="{{ $gift['state'] ?? '' }}"
                                       name="beneficiary31_state_value[]"
                                       id="beneficiary31_state_value_{{ $index }}" />

                                    <select id="beneficiary31_state_{{ $index }}"
                                       name="beneficiary31_state[]"
                                       class="form-control"
                                       data-state-dropdown>
                                       <option value="">Select State</option>
                                    </select>
                                 </div>
                                                                  <div class="form-group mb-3">
                                    <label for="leaving">What are you leaving to this person?</label>
                                    <input value="{{$gift['leaving'] ?? ''}} " type="text"  name="beneficiary31_leaving[]" id="beneficiary31_leaving_{{$index}}">
                                 </div>
                              </div>
                              <div class="beneficiary-form-x" data-form-name="gifts32_charity_lbm" id="charity_form_gifts32" @if($gift['type'] == 'charity' && isset($gift['type'])) style="display: block;" @else style="display: none;" @endif>
                                 <div class="form-group mb-3">
                                    <label for="name">Charity or Organization Name</label>
                                    <input value="{{$gift['charity_name'] ?? ''}}" type="text"  name="beneficiary31_charity_name[]" id="beneficiary31_recipient_name_{{$index}}" aria-describedby="nameHelp" >
                                    <small id="nameHelp" class="form-text text-muted">e.g. United Way Worldwide, Feeding America</small>
                                 </div>
                                 <div class="form-group mb-3">
                                    <label for="city">Employer Identification Number (EIN)</label>
                                    <input value="{{$gift['charity_registration'] ?? ''}}" type="text"  name="beneficiary31_charity_registration[]" id="beneficiary31_charity_registration_{{$index}}" aria-describedby="cityHelp">
                                    <small id="cityHelp" class="form-text text-muted">e.g. 200583415</small>
                                 </div>
                                 <div class="form-group mb-3">
                                    <label for="state">City</label>
                                    <input value="{{$gift['charity_city'] ?? ''}}" type="text"  name="beneficiary31_charity_city[]" id="beneficiary31_charity_City_{{$index}}">
                                 </div>
                                 <div class="form-group mb-3">
                                    <label for="state">State</label>
                                    <input value="{{$gift['charity_state'] ?? ''}}" type="text"  name="beneficiary31_charity_state[]" id="beneficiary31_charity_state_{{$index}}">
                                 </div>
                                 <div class="form-group mb-3">
                                    <label for="leaving">What are you leaving to this charity/organization?</label>
                                    <input value="{{$gift['charity_leaving'] ?? ''}}" type="text"  name="beneficiary31_charity_leaving[]" id="beneficiary31_charity_leaving_{{$index}}">
                                 </div>
                              </div>

                                 <div class="mb-3 custom_2">
                                   {{-- Hidden field to send "no" when checkbox is unchecked --}}
                                       <input type="hidden" name="alternate_recipient[{{ $index }}]" value="no">

                                       {{-- Actual checkbox (sends "yes" if checked) --}}
                                       <input 
                                       class="custom-checkbox alternate_recipient-checkbox" 
                                       data-index="{{ $index }}" 
                                       name="alternate_recipient[{{ $index }}]" 
                                       type="checkbox" 
                                       value="yes" 
                                       id="alternate_recipient_checked_{{ $index }}" 
                                       onclick="hideShowCheckBoxContainer(this,'alternate_recipient_holder_{{ $index }}')" 
                                       {{ $gift['alternate_name'] || $gift['alternate_city'] || $gift['alternate_state'] ? 'checked' : '' }}
                                       >

                                    
                                    <label>
                                       List an alternate recipient for this gift
                                       <a tabindex="0"
                                          class="info-icon"
                                          role="button"
                                          data-bs-toggle="popover"
                                          data-bs-html="true"
                                          data-bs-trigger="focus"
                                          title="What is an Alternate Recipient?"
                                          data-bs-content="<p>Your alternate recipient will receive the gift if your first choice declines it or passes away before you.</p>">?</a>
                                    </label>
   
                                       
                                    {{-- alternate gift holder --}}
                                    <div id="alternate_recipient_holder_{{$index}}" @if(empty($gift['alternate_name'])) style="display: none;" @endif>
                                       <div class="form-group mb-3">
                                          <label for="name">Name 
                                          <a tabindex="0" class="info-icon" role="button" data-bs-toggle="popover" data-bs-html="true" data-bs-trigger="focus" title="Gifting to a Minor" data-bs-content="<p>Your alternate recipient will receive the gift if your first choice declines it or passes away before you.</p>">?</a>

                                          </label>
                                          <input type="text" value="{{$gift['alternate_name'] ?? ""}}"  name="alternate_name[]" id="alternate_name_{{$index}}" aria-describedby="nameHelp" >
                                          <small id="nameHelp" class="form-text text-muted">e.g. William Timothy Smith</small>
                                       </div>
                                       <div class="form-group mb-3">
                                          <label for="city">City/Town</label>
                                          <input type="text" value="{{$gift['alternate_city'] ?? ""}}"  name="alternate_city[]" id="alternate_city_{{$index}}"  aria-describedby="cityHelp">
                                          <small id="cityHelp" class="form-text text-muted d-none">city</small>
                                       </div>
                                       <div class="form-group mb-3">
                                          <label for="state">Country</label>
                                          <input value="{{$gift['country'] ?? ""}}" type="hidden"  name="alternate_country_value_{{$index}}" id="alternate_country_value_{{ $index }}">
                                          <select id="alternate_country_{{ $index }}" name="alternate_country[]" class="form-control" data-country-dropdown data-country-value="alternate_country_value_{{ $index }}" data-state-dropdown="alternate_state_{{ $index }}" data-state-value="alternate_state_value_{{ $index }}">
                                             <option value="">Select Country</option>
                                          </select>
                                       </div>
                                       <div class="form-group mb-3">
                                          <label for="state">State</label>
                                          <input value="{{$gift['alternate_state'] ?? ""}}" type="hidden"  name="alternate_state_value_{{$index}}" id="alternate_state_value_{{ $index }}">
                                          <select id="alternate_state_{{$index}}" name="alternate_state[]" class="form-control" data-state-dropdown>
                                             <option value="">Select State</option>
                                          </select>

                                       </div>
                                    
                                    </div>
                                    {{-- alternate gift holder end--}}
                                 </div> 
                                

                           </div> 
                        </div>
                     @endforeach
                     @else
                     <div class="card list mb-3 beneficiary32-card" id="child">
                        <div class="card-header">
                           <div class="card-title">Gift recipient</div>
                           <a class="r-button" onclick="removetList(this)"><span class="fas fa-times"></span><span class="remove">Remove</span></a>
                        </div>
                        <div class="card-body">
                           <div class="long-btn-card">
                              <div class="dashboard-radio-form">
                                 <div class="form-check">
                                   <input  class="form-check-input beneficiary32-radio" data-form="gifts32_lbm" type="radio" id="gifts32_lb" name="beneficiary_type[]" value="person" checked>
                                   <label  for="gifts32_lb"><p>Person</p></label>
                                 </div>
                                 <div class="form-check">
                                   <input class="form-check-input beneficiary32-radio" data-form="gifts32_charity_lbm" type="radio" id="gifts32_charity_lb" name="beneficiary_type[]" value="charity">
                                   <label for="gifts32_charity_lb"><p>Charity or Organization</p></label>
                                 </div>
                               </div>
                           </div>

                           <div class="beneficiary-form-x" data-form-name="gifts32_lbm" id="individual_form_gifts32" style="display: block;">
                               <div class="form-group mb-3">
                                  <label for="name">Name</label>
                                  <input type="text"  name="beneficiary31_name[]" id="beneficiary31_name" aria-describedby="nameHelp" >
                                  <small id="nameHelp" class="form-text text-muted">e.g. William Timothy Smith</small>
                               </div>
                                 <div class="form-group mb-3">
                                    <label for="city">City/Town</label>
                                    <input type="text"  name="beneficiary31_city[]" id="beneficiary31_city" aria-describedby="cityHelp">
                                    <small id="cityHelp" class="form-text text-muted d-none">city</small>
                                 </div>
                               <div class="row">
                                 <div class="col-md-6">
                                 <div class="form-group mb-3">
                                       <label for="city">Country</label>
                                       <input type="hidden" name="beneficiary31_country_value" id="beneficiary31_country_value"/>
                                       <select id="beneficiary31_country" name="beneficiary31_country[]" class="form-control" data-country-dropdown data-country-value="beneficiary31_country_value" data-state-dropdown="beneficiary31_state" data-state-value="beneficiary31_state_value">
                                          <option value="">Select Country</option>
                                       </select>
                                       <small id="cityHelp" class="form-text text-muted d-none">country</small>
                                    </div>
                                 </div>
                                 <div class="col-md-6">
                                    <div class="form-group mb-3">
                                       <label for="state">State</label>
                                       <input type="hidden" name="beneficiary31_state_value" id="beneficiary31_state_value"/>
                                       <select id="beneficiary31_state" name="beneficiary31_state[]" class="form-control" data-state-dropdown>
                                          <option value="">Select State</option>
                                       </select>
                                    </div>
                                 </div>
                               </div>
                               <div class="form-group mb-3">
                                 <label for="leaving">What are you leaving to this person?</label>
                                 <input type="text"  name="beneficiary31_leaving[]" id="beneficiary31_leaving">
                              </div>
                           </div>
                           <div class="beneficiary-form-x" data-form-name="gifts32_charity_lbm" id="charity_form_gifts32" style="display: none;">

                              <div class="form-group mb-3">
                                  <label for="name">Charity or Organization Name</label>
                                  <input type="text"  name="beneficiary31_charity_name[]" id="beneficiary31_recipient_name" aria-describedby="nameHelp" >
                                  <small id="nameHelp" class="form-text text-muted">e.g. United Way Worldwide, Feeding America</small>
                               </div>

                               <div class="form-group mb-3">
                                 <label for="city">Employer Identification Number (EIN)</label>
                                  <input type="text"  name="beneficiary31_charity_registration[]" id="beneficiary31_charity_registration" aria-describedby="cityHelp">
                                  <small id="cityHelp" class="form-text text-muted">e.g. 200583415</small>
                               </div>

                               <div class="row">
                                 <div class="col-md-6">
                                    <div class="form-group mb-3">
                                       <label for="state">City</label>
                                       <input type="text"  name="beneficiary31_charity_city[]" id="beneficiary31_charity_city">
                                    </div>
                                 </div>
                                 <div class="col-md-6">
                                    <div class="form-group mb-3">
                                       <label for="state">State</label>
                                       <input type="text"  name="beneficiary31_charity_state[]" id="beneficiary31_charity_state">
                                    </div>
                                 </div>
                               </div>

                              <div class="form-group mb-3">
                                 <label for="leaving">What are you leaving to this charity/organization?</label>
                                 <input type="text"  name="beneficiary31_charity_leaving[]" id="beneficiary31_charity_leaving">
                              </div>                          
                           </div>

                           
                              <div class="mb-3 custom_2">
                               <!-- Hidden input to ensure unchecked checkbox sends "no" -->
                                 <input type="hidden" name="alternate_recipient[]" value="yes">

                                 <!-- Checkbox that overrides with "yes" when checked -->
                                 <input class="custom-checkbox alternate_recipient-checkbox" 
                                       name="alternate_recipient[]" 
                                       type="checkbox" 
                                       value="yes" 
                                       id="alternate_recipient_checked_0" 
                                       onclick="hideShowCheckBoxContainer(this,'alternate_recipient_holder_0')">

                                 <label>
                                    List an alternate recipient for this gift
                                    <a tabindex="0"
                                       class="info-icon"
                                       role="button"
                                       data-bs-toggle="popover"
                                       data-bs-html="true"
                                       data-bs-trigger="focus"
                                       title="What is an Alternate Recipient?"
                                       data-bs-content="<p>Your alternate recipient will receive the gift if your first choice declines it or passes away before you.</p>">?</a>
                                 </label>

                                 
                                 {{-- alternate gift holder --}}
                                 <div id="alternate_recipient_holder_0" style="display: none">
                                    <div class="form-group mb-3">
                                       <label for="name">Name 
                                       <a tabindex="0" class="info-icon" role="button" data-bs-toggle="popover" data-bs-html="true" data-bs-trigger="focus" title="Gifting to a Minor" data-bs-content="<p>Your alternate recipient will receive the gift if your first choice declines it or passes away before you.</p>">?</a>

                                       </label>
                                       <input type="text"  name="alternate_name[]" id="alternate_name_0" aria-describedby="nameHelp" >
                                       <small id="nameHelp" class="form-text text-muted">e.g. William Timothy Smith</small>
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="city">City/Town</label>
                                       <input type="text"  name="alternate_city[]" id="alternate_city_0"  aria-describedby="cityHelp" >
                                       <small id="cityHelp" class="form-text text-muted d-none">city</small>
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="state">Country</label>
                                       <input type="hidden"  name="alternate_country_value_0" id="alternate_country_value_0">
                                       <select id="alternate_country_0" name="alternate_country[]" class="form-control" data-country-dropdown data-country-value="alternate_country_value_0" data-state-dropdown="alternate_state_0" data-state-value="alternate_state_value_0">
                                          <option value="">Select Country</option>
                                       </select>
                                    </div>
                                    <div class="form-group mb-3">
                                       <label for="state">State</label>
                                       <input type="hidden"  name="alternate_state_value_0" id="alternate_state_value_0">
                                       <select id="alternate_state_0" name="alternate_state[]" class="form-control" data-state-dropdown>
                                          <option value="">Select State</option>
                                       </select>

                                    </div>
                                 
                                    
                                 </div>
                                 {{-- alternate gift holder end--}}

                              </div>
                        

                         
                        </div> 
                     </div>
                     @endif


                  </div>
                  <div class="add-child">
                        <a  onclick="custom_clone_b('gifts32-container')" class="add-another" >Add another recipient</a>
                  </div>
              </div> 
            </div>
         </div>
         <!-- start previous / next buttons -->
         <div id="buttonsection" class="submit-button-multiple">
            <button type="button" onclick="window.location.href = '{{ route('willsAndTest.create.step.three_1') }}'">Back</button>
            <button type="submit" class="submit-btn">Save and Continue</button>
            <button type="submit" class="d-none" name="preview_submit" value="preview">{{env('PREVIEW_BUTTON_TEXT')}}</button>
            <button type="button" class="skip-btn d-none">Skip Step</button>
         </div>
         <!-- end previous / next buttons -->
      </div>
    </form>
@endsection
@section('page-js')
<script>
   document.addEventListener("DOMContentLoaded", function () {
      setupFormToggle('gifts32-container', 'beneficiary32-radio','.beneficiary-form-x','.beneficiary32-card');
   });
</script>
<script src="{{ url('frontend/assets/js/forms/wills-And-Testament-step.js') }}?v={{ time() }}"></script>
<script src="{{ url('frontend/assets/js/forms/custom.js') }}?v={{ time() }}"></script>
<script src="{{ url('v2/js/form-validation.js') }}?v={{ time() }}"></script>
@endsection