@extends('member')
@section('title', 'Benevolent - Offline')

@section('content')
    <div class="container container_rule">
		<div class="directory-sec anual-subcription">
        <ul class="breadcrumb">
            <li><a href="/home">Dashboard</a></li>
            <li>Benevolent Fund </li>
            <li>Payment</li>
        </ul>
    </div>
        <div class="row">
            <div class="col-lg-8">
                <div class="Receipt-form">
                    <div class="Receipt_form">
                        <form action="{{ route('offline.subscription.submit') }}" method="POST" enctype="multipart/form-data">
                            @csrf <label class="quantity-text" for="fname">Cheque Number :</label>
                            <input class="name-text" type="text" placeholder="Enter Cheque Number" name="cheque_number"
                                required>
                    </div>
                    <div class="Receipt_form">
                        <label class="quantity-text" for="fname">Cheque Date :</label>
                        <input class="name-text" type="date" placeholder="Cheque Date" name="doc_date" required>
                    </div>

                </div>
                <div class="selection-box modal-trigger upload_btn">
                    <div class="box-content">
                        <div class="box-text">
                            <label for="offline_receipt_document" class="quantity-text">Upload Document :</label>
                            <input type="file" class="form-control quantity-text" id="offline_receipt_document"
                                name="receipt_document" accept="image/*,application/pdf" required>
                        </div>
                    </div>
                </div>
            </div>
            <div class="col-lg-4">
                <div class="shiping-sec">
                   <a href="#"> <img src="/loan_9202734.png" class="loan_img" alt="loan_icon"></a>
                    <h4>Benevolent Fund</h4>
                </div>
                <div class="subtotal-sec">

                    <div class="order-line">
                        <span class="sub-text">Amount</span>
                        <span class="price-text">₹ 20000.00</span>
                    </div>
                    <div class="order-line">
                        <span class="sub-text">Late Fees</span>
                        <span class="price-text">₹ 0.00</span>
                    </div>

                    <div class="order-line">
                        <span class="sub-text">Total</span>
                        <span class="price-text">₹ 20000.00</span>
                    </div>
                    <div class="order-line">
                        <button class="continue_btn" type="submit">Confirm</button>
                    </div>

                </div>
            </div>
        </div>
    </div>
    <input type="text" value="Benevolent Fund" name="type" hidden>
    <br>
    </form>
@endsection