@extends('layouts.app')
@section('css')
<style>
   .m-portlet__head-text{
   display: table-cell;
   vertical-align: middle;
   font-size: 1.3rem;
   font-weight: 500;
   font-family: Roboto;
   }
   .m-form .m-form__section.m-form__section--first, .m-form .m-form__section:first-child {
   margin-top: 40px!important;
   }
   .m-form.m-form--group-seperator-dashed .m-form__group {
   border-bottom: 0px!important;
   }
   .form-control{
   border: 1px solid #E6E7E8!important;
   overflow: hidden!important;
   border-radius: .40rem!important;
   font-family: sans-serif,Arial!important; 
   color: #575962!important;  
   font-size: 1rem!important;
   line-height: 1.25!important;
   background-color: #fff!important;
   }
   .m-form .m-form__heading .m-form__heading-title {
   color: #716aca;
   font-weight: 500;
   font-size: 1.3rem;
   }
   .form-control:focus,
   .form-control:active{
   border-color: #3273dc!important;;
   box-shadow: 0 0 0 0.125em rgba(50, 115, 220, 0.25)!important;
   }
   .noresize{
   resize: none;
   }
   .hidethis{
   display:none;
   }
   .placeitrighthandside{
   text-align: right;
   }
   .tablebutton{
   font-family:'Myriad Pro';
   font-weight: normal;   
   font-size: 15px;
   }
   .labelwarning{
   color: red!important;
   font-size: 13px!important;
   font-family:'Myriad Pro'!important;
   font-weight
   }
   .tablevisibility{
   border: 2px solid #BCBEC0; 
   border-collapse: collapse;  
   }
</style>
@endsection
@section('content')
<form class="m-form m-form--fit m-form--label-align-right m-form--group-seperator-dashed">
   <div class="m-content">
      <div class="row">
         <div class="col-lg-12">
            <div id="cardtabungwarisananakselangor" class="m-portlet">
               <div class="m-portlet__head" >
                  <div class="m-portlet__head-caption">
                     <div class="m-portlet__head-title">
                        <span class="m-portlet__head-icon m--hide">
                        <i class="la la-gear"></i>
                        </span>
                        <h3 id="tabungwarisananakselangor" class="m-portlet__head-text"  >
                           TABUNG WARISAN ANAK SELANGOR
                        </h3>
                     </div>
                  </div>
               </div>
               <div class="m-portlet__body">
                  <div class="m-form__section m-form__section--first maklumatpemohon">
                     <div class="m-form__heading">
                        <h3 id="maklumatanak" class="m-form__heading-title">
                           Maklumat Anak:
                        </h3>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>
                        Nama Penuh:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="namapenuh" name="namapenuh" placeholder="Sila masukan nama penuh">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Negeri Kelahiran:
                        </label>
                        <div class="col-lg-4">
                           <select class="form-control m-input" id="negerikelahiran" name="negerikelahiran">
                              <option hidden selected>Sila pilih negeri</option>
                              <option value="Johor">Johor</option>
                              <option value="Kedah">Kedah</option>
                              <option value="Kelantan">Kelantan</option>
                              <option value="Melaka">Melaka</option>
                              <option value="Negeri Sembilan">Negeri Sembilan</option>
                              <option value="Pahang">Pahang</option>
                              <option value="Penang">Penang</option>
                              <option value="Perak">Perak</option>
                              <option value="Perlis">Perlis</option>
                              <option value="Selangor">Selangor</option>
                              <option value="Terengganu">Terengganu</option>
                              <option value="Sabah">Sabah</option>
                              <option value="Sarawak">Sarawak</option>
                              <option value="W.P. Kuala Lumpur">W.P. Kuala Lumpur</option>
                              <option value="W.P. Labuan">W.P. Labuan</option>
                              <option value="W.P. Putrajaya">W.P. Putrajaya</option>
                           </select>
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>No.Kad Pengenalan / No.Polis / No.Tentera:
                        </label>
                        <div class="input-group m-input-group col-lg-4">
                           <select class="m-input" id="ic_type" name="ic_type" style="font-size: 13px; color: #575962; border-color: #ebedf2; background-color: #f4f5f8" onchange="getIc($(this).val())">
                              <option value="1">No. K/P</option>
                              <option value="2">No. Tentera</option>
                              <option value="3">No. Polis</option>
                           </select>
                           <input type="text" class="form-control m-input" id="nokadpengenalananak" name="nokadpengenalananak" placeholder="Sila masukan no kad pengenalan" value="" onblur="checkDuplicate($(this).val(),'ic')" data-inputmask-regex="([a-zA-Z0-9 ])+/g" maxlength="12">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>No.Sijil Kelahiran:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="nokadsijilkelahirananak" name="nosijilkelahirananak" placeholder="Sila masukan no sijil kelahiran" value="" onblur="checkDuplicate($(this).val(),'ic')" data-inputmask-regex="([a-zA-Z0-9 ])+/g" maxlength="12">
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Jantina:
                        </label>
                        <div class="col-lg-4">
                           <div class="m-radio-list">
                              <label class="m-radio m-radio--solid m-radio--brand">
                              <input type="radio" name="inputlelakiperempuan" id="lelaki" value="lelaki">
                              Lelaki
                              <span></span>
                              </label>
                              <label class="m-radio m-radio--solid m-radio--brand">
                              <input type="radio" name="inputlelakiperempuan" id="perempuan" value="perempuan">
                              Perempuan
                              <span></span>
                              </label>
                           </div>
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Penyakit Kronik:
                        </label>
                        <div class="col-lg-4">
                           <select class="form-control m-input" id="penyakitkronikanak" name="penyakitkronikanak" onchange="getPenyakitKronik($(this).val())">
                              <option value="" hidden selected>Sila pilih</option>
                              <option value="Ada">Ada</option>
                              <option value="Tiada">Tiada</option>
                           </select>
                           <br/>
                           <input type="text" class="form-control m-input hidethis" id="adapenyakitkronik" name="adapenyakitkronik" placeholder="Sila masukan penyakit kronik" >
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Tahap Kesihatan Anak:
                        </label>
                        <div class="col-lg-4">
                           <div class="m-radio-list">
                              <label class="m-radio m-radio--solid m-radio--brand">
                              <input type="radio" name="tahapkesihatananak" id="normal" value="normal">
                              Normal
                              <span></span>
                              </label>
                              <label class="m-radio m-radio--solid m-radio--brand">
                              <input type="radio" name="tahapkesihatananak" id="kurangupaya" value="kurangupaya">
                              Kurang Upaya
                              <span></span>
                              </label>
                           </div>
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Status Anak:
                        </label>
                        <div class="col-lg-4">
                           <div class="m-radio-list">
                              <label class="m-radio m-radio--solid m-radio--brand">
                              <input type="radio" name="statusanak" id="yatim" value="yatim">
                              Yatim
                              <span></span>
                              </label>
                              <label class="m-radio m-radio--solid m-radio--brand">
                              <input type="radio" name="statusanak" id="yatimpiatu" value="yatimpiatu">
                              Yatim Upaya
                              <span></span>
                              </label>
                           </div>
                        </div>
                     </div>
                  </div>
                  <div class="m-form__seperator m-form__seperator--dashed maklumatbapa"></div>
                  <div class="m-form__section m-form__section--middle maklumatbapa">
                     <div class="m-form__heading">
                        <h3 class="m-form__heading-title">
                           Maklumat Bapa Anak:
                        </h3>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>
                        Nama Penuh:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="namapenuhbapa" name="namapenuhbapa" placeholder="Sila masukan nama penuh">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Negeri Kelahiran:
                        </label>
                        <div class="col-lg-4">
                           <select class="form-control m-input" id="negerikelahiranbapa" name="negerikelahiranbapa">
                              <option hidden selected>Sila pilih negeri</option>
                              <option value="Johor">Johor</option>
                              <option value="Kedah">Kedah</option>
                              <option value="Kelantan">Kelantan</option>
                              <option value="Melaka">Melaka</option>
                              <option value="Negeri Sembilan">Negeri Sembilan</option>
                              <option value="Pahang">Pahang</option>
                              <option value="Penang">Penang</option>
                              <option value="Perak">Perak</option>
                              <option value="Perlis">Perlis</option>
                              <option value="Selangor">Selangor</option>
                              <option value="Terengganu">Terengganu</option>
                              <option value="Sabah">Sabah</option>
                              <option value="Sarawak">Sarawak</option>
                              <option value="W.P. Kuala Lumpur">W.P. Kuala Lumpur</option>
                              <option value="W.P. Labuan">W.P. Labuan</option>
                              <option value="W.P. Putrajaya">W.P. Putrajaya</option>
                           </select>
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>No.Kad Pengenalan / No.Polis / No.Tentera:
                        </label>
                        <div class="input-group m-input-group col-lg-4">
                           <select class="m-input" id="ic_type" name="ic_type" style="font-size: 13px; color: #575962; border-color: #ebedf2; background-color: #f4f5f8" onchange="getIc($(this).val())">
                              <option value="1">No. K/P</option>
                              <option value="2">No. Tentera</option>
                              <option value="3">No. Polis</option>
                           </select>
                           <input type="text" class="form-control m-input" id="nokadpengenalanbapa" name="nokadpengenalanbapa" placeholder="Sila masukan no kad pengenalan" value="" onblur="checkDuplicate($(this).val(),'ic')" data-inputmask-regex="([a-zA-Z0-9 ])+/g" maxlength="12">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>No Telefon Bimbit:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="notelefonbimbitbapa" name="notelefonbimbitbapa" placeholder="Sila masukan no telefon bimbit">
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>No Telefon Rumah:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="notelefonrumahbapa" name="notelefonrumahbapa" placeholder="Sila masukan no telefon rumah">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Emel:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="emelbapa" name="emelbapa" placeholder="Sila masukkan emel" onblur="checkEmail($(this))" >
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Bangsa:
                        </label>
                        <div class="col-lg-4">
                           <select class="form-control m-input" id="bangsabapa" name="bangsabapa" onchange="getBangsaBapa($(this).val())">
                              <option value="" hidden selected>Sila pilih bangsa</option>
                              <option value="Melayu">Melayu</option>
                              <option value="Cina">Cina</option>
                              <option value="India">India</option>
                              <option value="Lain-Lain">Lain-Lain</option>
                           </select>
                           <br/>
                           <input type="text" class="form-control m-input hidethis" id="bangsabapalainlain" name="bangsabapalainlain" placeholder="Sila masukan bangsa" >
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Agama:
                        </label>
                        <div class="col-lg-4">
                           <select id="agamabapa" name="agamabapa"  class="form-control m-input" onchange="getAgamaBapa($(this).val())" >
                              <option value="" hidden selected>Sila pilih agama</option>
                              <option value="Melayu">Melayu</option>
                              <option value="Cina">Cina</option>
                              <option value="India">India</option>
                              <option value="Lain-Lain">Lain-Lain</option>
                           </select>
                           <br/>
                           <input type="text" class="form-control m-input hidethis" id="agamabapalainlain" name="agamabapalainlain" placeholder="Sila masukan agama" >
                        </div>
                     </div>
                  </div>
                  <div class="m-form__seperator m-form__seperator--dashed maklumatibu"></div>
                  <div class="m-form__section m-form__section--middle maklumatibu">
                     <div class="m-form__heading">
                        <h3 class="m-form__heading-title">
                           Maklumat Ibu Anak:
                        </h3>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>
                        Nama Penuh:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="namapenuhibu" name="namapenuhibu" placeholder="Sila masukan nama penuh">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Negeri Kelahiran:
                        </label>
                        <div class="col-lg-4">
                           <select class="form-control m-input" id="negerikelahiranibu" name="negerikelahiranibu">
                              <option hidden selected>Sila pilih negeri</option>
                              <option value="Johor">Johor</option>
                              <option value="Kedah">Kedah</option>
                              <option value="Kelantan">Kelantan</option>
                              <option value="Melaka">Melaka</option>
                              <option value="Negeri Sembilan">Negeri Sembilan</option>
                              <option value="Pahang">Pahang</option>
                              <option value="Penang">Penang</option>
                              <option value="Perak">Perak</option>
                              <option value="Perlis">Perlis</option>
                              <option value="Selangor">Selangor</option>
                              <option value="Terengganu">Terengganu</option>
                              <option value="Sabah">Sabah</option>
                              <option value="Sarawak">Sarawak</option>
                              <option value="W.P. Kuala Lumpur">W.P. Kuala Lumpur</option>
                              <option value="W.P. Labuan">W.P. Labuan</option>
                              <option value="W.P. Putrajaya">W.P. Putrajaya</option>
                           </select>
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>No.Kad Pengenalan / No.Polis / No.Tentera:
                        </label>
                        <div class="input-group m-input-group col-lg-4">
                           <select class="m-input" id="ic_type" name="ic_type" style="font-size: 13px; color: #575962; border-color: #ebedf2; background-color: #f4f5f8" onchange="getIc($(this).val())">
                              <option value="1">No. K/P</option>
                              <option value="2">No. Tentera</option>
                              <option value="3">No. Polis</option>
                           </select>
                           <input type="text" class="form-control m-input" id="nokadpengenalanibu" name="nokadpengenalanibu" placeholder="Sila masukan no kad pengenalan" value="" onblur="checkDuplicate($(this).val(),'ic')" data-inputmask-regex="([a-zA-Z0-9 ])+/g" maxlength="12">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>No Telefon Bimbit:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="notelefonbimbitibu" name="notelefonbimbitibu" placeholder="Sila masukan no telefon bimbit">
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>No Telefon Rumah:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="notelefonrumahibu" name="notelefonrumahibu" placeholder="Sila masukan no telefon rumah">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Emel:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="emelibu" name="emelibu" placeholder="Sila masukkan emel" onblur="checkEmail($(this))" >
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Bangsa:
                        </label>
                        <div class="col-lg-4">
                           <select class="form-control m-input" id="bangsaibu" name="bangsaibu" onchange="getBangsaIbu($(this).val())">
                              <option value="" hidden selected>Sila pilih bangsa</option>
                              <option value="Melayu">Melayu</option>
                              <option value="Cina">Cina</option>
                              <option value="India">India</option>
                              <option value="Lain-Lain">Lain-Lain</option>
                           </select>
                           <br/>
                           <input type="text" class="form-control m-input hidethis" id="bangsaibulainlain" name="bangsaibulainlain" placeholder="Sila masukan bangsa" >
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Agama:
                        </label>
                        <div class="col-lg-4">
                           <select id="agamaibu" name="agamaibu" class="form-control m-input" onchange="getAgamaIbu($(this).val())" >
                              <option value="" hidden selected>Sila pilih agama</option>
                              <option value="Melayu">Melayu</option>
                              <option value="Cina">Cina</option>
                              <option value="India">India</option>
                              <option value="Lain-Lain">Lain-Lain</option>
                           </select>
                           <br/>
                           <input type="text" class="form-control m-input hidethis" id="agamaibulainlain" name="agamaibulainlain" placeholder="Sila masukan agama" >
                        </div>
                     </div>
                  </div>
                  <div class="m-form__seperator m-form__seperator--dashed maklumattempattinggal"></div>
                  <div class="m-form__section m-form__section--middle maklumattempattinggal">
                     <div class="m-form__heading">
                        <h3 id="maklumattempattinggal" class="m-form__heading-title">
                           Maklumat Tempat Tinggal:
                        </h3>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Alamat:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" name="alamat_1" placeholder="Sila masukan alamat">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Poskod:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="poskod" name="poskod" placeholder="Sila masukan poskod">
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" name="alamat_2" placeholder="Sila masukan alamat">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Bandar:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" name="bandar" placeholder="Sila masukan bandar">
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" name="alamat_3" placeholder="Sila masukan alamat">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>Negeri:
                        </label>
                        <div class="col-lg-4">
                           <select class="form-control m-input" id="negeri" name="negeri">
                              <option value="{{ old('') }}" hidden selected>Sila pilih negeri</option>
                              <option value="Johor">Johor</option>
                              <option value="Kedah">Kedah</option>
                              <option value="Kelantan">Kelantan</option>
                              <option value="Melaka">Melaka</option>
                              <option value="Negeri Sembilan">Negeri Sembilan</option>
                              <option value="Pahang">Pahang</option>
                              <option value="Penang">Penang</option>
                              <option value="Perak">Perak</option>
                              <option value="Perlis">Perlis</option>
                              <option value="Selangor">Selangor</option>
                              <option value="Terengganu">Terengganu</option>
                              <option value="Sabah">Sabah</option>
                              <option value="Sarawak">Sarawak</option>
                              <option value="W.P. Kuala Lumpur">W.P. Kuala Lumpur</option>
                              <option value="W.P. Labuan">W.P. Labuan</option>
                              <option value="W.P. Putrajaya">W.P. Putrajaya</option>
                           </select>
                        </div>
                     </div>
                  </div>

                  <div class="m-form__seperator m-form__seperator--dashed pengesahanpermohanan"></div>
                  <div class="m-form__section m-form__section--middle pengesahanpermohanan">
                     <div class="m-form__heading">
                        <h3 id="maklumattempattinggal" class="m-form__heading-title">
                           Pengesahan Permohanan:&ensp;<small><strong>(Diisi oleh Ibubapa/Penjaga)</strong></small>
                        </h3>
                     </div>
                     <div class="form-group m-form__group row">
                       <div class="col-lg-12">
                        Saya bersetuju bahawa pendaftaran ini akan terbatal sekiranya mana-mana penyataan yang telah saya buat di dalam permohanan ini adalah tidak benar atau palsu.<br/><br/>
                        ____________<br/>
                         &ensp; &ensp;Tarikh
                       <div>
                     </div>
                     <div class="form-group m-form__group row">
                      
                     </div>
                     <div class="form-group m-form__group row">
                      
                     </div>
                  </div>

                  <div class="m-form__seperator m-form__seperator--dashed pengesahanpermohanan"></div>
                  <div class="m-form__section m-form__section--middle pengesahanpermohanan">
                     <div class="m-form__heading">
                        <h3 id="maklumattempattinggal" class="m-form__heading-title">
                           Dokumentasi Pusat Pendftaran:&ensp;<small><strong>(Diisi oleh Petugas jika borang dihantar di PK DUN / PARLIMEN /PBT/ PTD)</strong></small>
                        </h3>
                     </div>
                     <div class="form-group m-form__group row">
                       <div class="col-lg-12">
                        Saya bersetuju bahawa pendaftaran ini telah diserahkan kepada Pusat Pendaftaran TAWAS di Pejabat YAWAS.
                       <div>
                     </div>
                     <div class="form-group m-form__group row">
                       <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>
                        Nama Parlimen:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="namaparlimen" name="namaparlimen" placeholder="Sila masukan nama parlimen">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>
                        Nama DUN:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="namaDUN" name="namaDUN" placeholder="Sila masukan nama DUN">
                        </div>
                     </div>
                     <div class="form-group m-form__group row">
                       <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>
                        Nama Petugas:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="namapetugas" name="namapetugas" placeholder="Sila masukan nama petugas">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>
                        No.MyKad Petugas:
                        </label>
                        <div class="col-lg-4">
                        <input type="text" class="form-control m-input" id="nokadpengenalanpetugas" name="nokadpengenalanpetugas" placeholder="Sila masukan no kad pengenalan" 1onblur="checkDuplicate($(this).val(),'ic')">
                        </div>
                     </div>
                  </div>

                  <div class="m-form__seperator m-form__seperator--dashed pengesahanpermohanan"></div>
                  <div class="m-form__section m-form__section--middle pengesahanpermohanan">
                     <div class="m-form__heading">
                        <h3 id="maklumattempattinggal" class="m-form__heading-title">
                           Pengesahan Taraf Mastautin:&ensp;<small><strong>(Ibubapa BUKAN kelahiran Selangor)</strong></small>
                        </h3>
                     </div>
                     <div class="form-group m-form__group row">
                       <div class="col-lg-12">
                        Saya mengesahkan bahawa ibubapa ini telah bermautautin secara sah sekurang-kurangnya 5 tahun wajib diisi jika menetap di Selangor
                       <div>
                     </div>
                     <div class="form-group m-form__group row">
                       <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>
                        Nama:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="nama" name="nama" placeholder="Sila masukan nama">
                        </div>
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>
                        No.MyKad:
                        </label>
                        <div class="col-lg-4">
                        <input type="text" class="form-control m-input" id="nokadpengenalan" name="nokadpengenalan" placeholder="Sila masukan no kad pengenalan" 1onblur="checkDuplicate($(this).val(),'ic')">
                        </div>
                     </div>

                     <div class="form-group m-form__group row">
                        <label class="col-lg-2 col-form-label">
                        <span style="color: red">* </span>No Telefon Bimbit:
                        </label>
                        <div class="col-lg-4">
                           <input type="text" class="form-control m-input" id="notelefonbimbit" name="notelefonbimbit" placeholder="Sila masukan no telefon bimbit">
                        </div>
                        <label class="col-lg-2 col-form-label">
                         <span style="color: red">* </span>Jawatan - tandakan (/) pada yang berkenaan
                        </label>
                        <div class="col-lg-4">
                        <table id="pengesahantarafmastautintable" class="table order table-responsive tablevisibility">
                           <tbody>
                              <tr>
                                 <td id="rowtickahliparlimensenator" class="col-lg-1 tablevisibility"><input type="text" class="form-control m-input" id="tickahliparlimensenator" name="tickahliparlimensenator"></td>
                                 <td class="col-lg-3 tablevisibility" id="ahliparlimensenator"><strong>Ahli Parlimen / Senator</strong></td>
                              </tr>
                              <tr>
                                 <td id="rowtickadunpengerusijkpenyelarasdun" class="col-lg-1 tablevisibility"><input type="text" class="form-control m-input" id="tickadunpengerusijkpenyelarasdun" name="tickadunpengerusijkpenyelarasdun"></td>
                                 <td class="col-lg-3 tablevisibility" id="adunpengerusijkpenyelarasdun"><strong>ADUN / Pengerusi JK Penyelaras DUN</strong></td>
                              </tr>
                              <tr>
                                 <td id="rowtickpenghuluketuakampung" class="col-lg-1 tablevisibility"><input type="text" class="form-control m-input" id="tickpenghuluketuakampung" name="tickpenghuluketuakampung"></td>
                                 <td class="col-lg-3 tablevisibility" id="penghuluketuakampung"><strong>Penghulu /Ketua Kampung</strong></td>
                              </tr>
                              <tr>
                                 <td id="rowtickahlimajlispihakberkuasatempatan" class="col-lg-1 tablevisibility"><input type="text" class="form-control m-input" id="tickahlimajlispihakberkuasatempatan" name="tickahlimajlispihakberkuasatempatan"></td>
                                 <td class="col-lg-3 tablevisibility" id="ahlimajlispihakberkuasatempatan"><strong>Ahli Majlis Pihak Berkuasa Tempatan</strong></td>
                              </tr>
                              <tr>
                                 <td id="rowtickpengerusitamanperumahan" class="col-lg-1 tablevisibility"><input type="text" class="form-control m-input" id="tickpengerusitamanperumahan" name="tickpengerusitamanperumahan"></td>
                                 <td class="col-lg-3 tablevisibility" id="pengerusitamanperumahan"><strong>Pengerusi Taman Perumahan</strong></td>
                              <tr>
                                 <td id="rowticknazirketuatokongkuilgereja" class="col-lg-1 tablevisibility"><input type="text" class="form-control m-input" id="ticknazirketuatokongkuilgereja" name="ticknazirketuatokongkuilgereja"></td>
                                 <td class="col-lg-3 tablevisibility" id="nazirketuatokongkuilgereja"><strong>Nazir / Ketua Tokong / kuil / Gereja</strong></td>
                              </tr>
                           </tbody>
                        </table>
                     </div>
                     </div>
                  </div>


               </div>
            </div>
         </div>
      </div>
   </div>
</form>
@endsection
@section('js')
<script src="../../../assets/vendors/base/vendors.bundle.js" type="text/javascript"></script>
<script src="../../../assets/demo/default/base/scripts.bundle.js" type="text/javascript"></script>
<script>
   $("#nokadpengenalanpemohon,#nokadpengenalansuamiisteri").inputmask({mask: "999999999999", placeholder: ""});
   
   $("#poskodpemohon,#poskodpenjaga,#poskodpenjagakedua").inputmask({mask: "99999", placeholder: ""});
   
   $('#notelefonbimbitpemohon,#notelefonbimbitsuamiisteri,#notelefonmajikansuamiisteri,#notelefonmajikanpemohon').inputmask('Regex', { regex: "^(01)[0-9]{8,9}$"}); 
   
   $("#pendapatanbulananpemohon,#pendapatanbulananpasangan").inputmask({mask: "9999999",placeholder: ""});
   
   $('#notelefonrumahpemohon,#notelefonrumahsuamiisteri').inputmask('Regex', { regex: "^(03)[0-9]{8}$"});
   
   $("#tempohtinggaldiselangorpasangan,#tempohtinggaldiselangorpemohon").inputmask({mask: "99",placeholder: ""});
   
   $("#pendapatansendiri, #pendapatananakanak, #pendapatanlainlain,#pendapatanpasangan, #jumlahpendapatan").inputmask({mask: "9999999",placeholder: ""});
   
   function checkEmail(x) {
       var email_format = /^(([^<>()\[\]\\.,;:\s@"]+(\.[^<>()\[\]\\.,;:\s@"]+)*)|(".+"))@((\[[0-9]{1,3}\.[0-9]{1,3}\.[0-9]{1,3}\.[0-9]{1,3}\])|(([a-zA-Z\-0-9]+\.)+[a-zA-Z]{2,}))$/;
   
           x.next().remove();
               
           if(x.val().match(email_format)) {
                   x.next().remove();
               } else if(x.val() == '') {
                   x.next().remove();
               } else {
                   x.after("<small style='color: #f4516c'>Sila masukkan format emel yang betul.</small>");
                   x.focus();
               }
           }
           
           $(document).ready(function(){
             $('#penyakitkronikanak').on('change', function() {
               if ( this.value == 'Ada')
               {
                 $("#adapenyakitkronik").show('slow');     
               }
               else
               {
                 $("#adapenyakitkronik").hide('slow');
                 $("#adapenyakitkronik").val('');
               }
             });
         });
   
         $(document).ready(function(){
             $('#agamaibu').on('change', function() {
               if ( this.value == 'Lain-Lain')
               {
                 $("#agamaibulainlain").show('slow');     
               }
               else
               {
                 $("#agamaibulainlain").hide('slow');
                 $("#agamaibulainlain").val('');
               }
             });
         });
         $(document).ready(function(){
             $('#bangsaibu').on('change', function() {
               if ( this.value == 'Lain-Lain')
               {
                 $("#bangsaibulainlain").show('slow');     
               }
               else
               {
                 $("#bangsaibulainlain").hide('slow');
                 $("#bangsaibulainlain").val('');
               }
             });
         });
         $(document).ready(function(){
             $('#agamabapa').on('change', function() {
               if ( this.value == 'Lain-Lain')
               {
                 $("#agamabapalainlain").show('slow');     
               }
               else
               {
                 $("#agamabapalainlain").hide('slow');
                 $("#agamabapalainlain").val('');
               }
             });
         });
         $(document).ready(function(){
             $('#bangsabapa').on('change', function() {
               if ( this.value == 'Lain-Lain')
               {
                 $("#bangsabapalainlain").show('slow');     
               }
               else
               {
                 $("#bangsabapalainlain").hide('slow');
                 $("#bangsabapalainlain").val('');
               }
             });
            });
</script>
@endsection