| Current File : /home/d/i/g/digitaw/Ycof/admin/devis_sante.php |
<?php
require 'configuration.php';
?>
<!-- ========== All CSS files linkup ========= -->
<link rel="stylesheet" href="css/bootstrap.min.css" />
<link rel="stylesheet" href="css/lineicons.css" />
<link rel="stylesheet" href="css/quill/bubble.css" />
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<link rel="stylesheet" href="css/datatable.css" />
<link rel="stylesheet" href="css/main.css" />
<link rel="stylesheet" href="css/voyag.css">
<link rel="stylesheet" href="../css/responsive.css">
<html>
<body>
<!-- ======== sidebar-nav start =========== -->
<aside class="sidebar-nav-wrapper">
<div class="navbar-logo">
<a href="index.php">
<img src="../img/ycof_bac.png" width="90px" alt="logo" />
</a>
</div>
<nav class="sidebar-nav">
<ul>
<li class="nav-item nav-item-has-children">
<a href="#0" data-bs-toggle="collapse" data-bs-target="#ddmenu_1" aria-controls="ddmenu_1"
aria-expanded="false" aria-label="Toggle navigation">
<span class="icon">
<svg width="22" height="22" viewBox="0 0 22 22">
<path
d="M17.4167 4.58333V6.41667H13.75V4.58333H17.4167ZM8.25 4.58333V10.0833H4.58333V4.58333H8.25ZM17.4167 11.9167V17.4167H13.75V11.9167H17.4167ZM8.25 15.5833V17.4167H4.58333V15.5833H8.25ZM19.25 2.75H11.9167V8.25H19.25V2.75ZM10.0833 2.75H2.75V11.9167H10.0833V2.75ZM19.25 10.0833H11.9167V19.25H19.25V10.0833ZM10.0833 13.75H2.75V19.25H10.0833V13.75Z" />
</svg>
</span>
<span class="text">Dashboard</span>
</a>
<ul id="ddmenu_1" class="collapse show dropdown-nav">
</a>
</li>
<li class="nav-item">
<a href="clients.php">
<span class="icon">
<svg width="22" height="22" viewBox="0 0 22 22" fill="none"
xmlns="http://www.w3.org/2000/svg">
<path
d="M11.0001 3.66675C11.9725 3.66675 12.9052 4.05306 13.5928 4.74069C14.2804 5.42832 14.6667 6.36095 14.6667 7.33341C14.6667 8.30587 14.2804 9.23851 13.5928 9.92614C12.9052 10.6138 11.9725 11.0001 11.0001 11.0001C10.0276 11.0001 9.09499 10.6138 8.40736 9.92614C7.71972 9.23851 7.33341 8.30587 7.33341 7.33341C7.33341 6.36095 7.71972 5.42832 8.40736 4.74069C9.09499 4.05306 10.0276 3.66675 11.0001 3.66675ZM11.0001 5.50008C10.5139 5.50008 10.0475 5.69324 9.70372 6.03705C9.3599 6.38087 9.16675 6.84718 9.16675 7.33341C9.16675 7.81964 9.3599 8.28596 9.70372 8.62978C10.0475 8.97359 10.5139 9.16675 11.0001 9.16675C11.4863 9.16675 11.9526 8.97359 12.2964 8.62978C12.6403 8.28596 12.8334 7.81964 12.8334 7.33341C12.8334 6.84718 12.6403 6.38087 12.2964 6.03705C11.9526 5.69324 11.4863 5.50008 11.0001 5.50008ZM11.0001 11.9167C13.4476 11.9167 18.3334 13.1359 18.3334 15.5834V18.3334H3.66675V15.5834C3.66675 13.1359 8.55258 11.9167 11.0001 11.9167ZM11.0001 13.6584C8.27758 13.6584 5.40841 14.9967 5.40841 15.5834V16.5917H16.5917V15.5834C16.5917 14.9967 13.7226 13.6584 11.0001 13.6584Z" />
</svg>
</span>
<span class="text">
Clients
</span>
</a>
</li>
<li class="nav-item">
<a href="voyage.php">
<span class="icon">
<svg xmlns="http://www.w3.org/2000/svg" width="25" height="25" fill="currentColor"
class="bi bi-airplane" viewBox="0 0 16 16">
<path
d="M6.428 1.151C6.708.591 7.213 0 8 0s1.292.592 1.572 1.151C9.861 1.73 10 2.431 10 3v3.691l5.17 2.585a1.5 1.5 0 0 1 .83 1.342V12a.5.5 0 0 1-.582.493l-5.507-.918-.375 2.253 1.318 1.318A.5.5 0 0 1 10.5 16h-5a.5.5 0 0 1-.354-.854l1.319-1.318-.376-2.253-5.507.918A.5.5 0 0 1 0 12v-1.382a1.5 1.5 0 0 1 .83-1.342L6 6.691V3c0-.568.14-1.271.428-1.849Zm.894.448C7.111 2.02 7 2.569 7 3v4a.5.5 0 0 1-.276.447l-5.448 2.724a.5.5 0 0 0-.276.447v.792l5.418-.903a.5.5 0 0 1 .575.41l.5 3a.5.5 0 0 1-.14.437L6.708 15h2.586l-.647-.646a.5.5 0 0 1-.14-.436l.5-3a.5.5 0 0 1 .576-.411L15 11.41v-.792a.5.5 0 0 0-.276-.447L9.276 7.447A.5.5 0 0 1 9 7V3c0-.432-.11-.979-.322-1.401C8.458 1.159 8.213 1 8 1c-.213 0-.458.158-.678.599Z" />
</svg>
</span>
<span class="text">Assurance Voyage</span>
</a>
</li>
<li class="nav-item">
<a href="auto.php">
<span class="icon">
<svg xmlns="http://www.w3.org/2000/svg" width="25" height="25" fill="currentColor"
class="bi bi-car-front" viewBox="0 0 16 16">
<path
d="M4 9a1 1 0 1 1-2 0 1 1 0 0 1 2 0Zm10 0a1 1 0 1 1-2 0 1 1 0 0 1 2 0ZM6 8a1 1 0 0 0 0 2h4a1 1 0 1 0 0-2H6ZM4.862 4.276 3.906 6.19a.51.51 0 0 0 .497.731c.91-.073 2.35-.17 3.597-.17 1.247 0 2.688.097 3.597.17a.51.51 0 0 0 .497-.731l-.956-1.913A.5.5 0 0 0 10.691 4H5.309a.5.5 0 0 0-.447.276Z" />
<path
d="M2.52 3.515A2.5 2.5 0 0 1 4.82 2h6.362c1 0 1.904.596 2.298 1.515l.792 1.848c.075.175.21.319.38.404.5.25.855.715.965 1.262l.335 1.679c.033.161.049.325.049.49v.413c0 .814-.39 1.543-1 1.997V13.5a.5.5 0 0 1-.5.5h-2a.5.5 0 0 1-.5-.5v-1.338c-1.292.048-2.745.088-4 .088s-2.708-.04-4-.088V13.5a.5.5 0 0 1-.5.5h-2a.5.5 0 0 1-.5-.5v-1.892c-.61-.454-1-1.183-1-1.997v-.413a2.5 2.5 0 0 1 .049-.49l.335-1.68c.11-.546.465-1.012.964-1.261a.807.807 0 0 0 .381-.404l.792-1.848ZM4.82 3a1.5 1.5 0 0 0-1.379.91l-.792 1.847a1.8 1.8 0 0 1-.853.904.807.807 0 0 0-.43.564L1.03 8.904a1.5 1.5 0 0 0-.03.294v.413c0 .796.62 1.448 1.408 1.484 1.555.07 3.786.155 5.592.155 1.806 0 4.037-.084 5.592-.155A1.479 1.479 0 0 0 15 9.611v-.413c0-.099-.01-.197-.03-.294l-.335-1.68a.807.807 0 0 0-.43-.563 1.807 1.807 0 0 1-.853-.904l-.792-1.848A1.5 1.5 0 0 0 11.18 3H4.82Z" />
</svg>
</span>
<span class="text">
Assurance Auto
</span>
</a>
</li>
<li class="nav-item">
<a href="habitat.php">
<svg xmlns="http://www.w3.org/2000/svg" width="25" height="25" fill="currentColor"
class="bi bi-house" viewBox="0 0 16 16">
<path
d="M8.707 1.5a1 1 0 0 0-1.414 0L.646 8.146a.5.5 0 0 0 .708.708L2 8.207V13.5A1.5 1.5 0 0 0 3.5 15h9a1.5 1.5 0 0 0 1.5-1.5V8.207l.646.647a.5.5 0 0 0 .708-.708L13 5.793V2.5a.5.5 0 0 0-.5-.5h-1a.5.5 0 0 0-.5.5v1.293L8.707 1.5ZM13 7.207V13.5a.5.5 0 0 1-.5.5h-9a.5.5 0 0 1-.5-.5V7.207l5-5 5 5Z" />
</svg>
<span class="text" style="margin-left: 8px;">
Assurance Habitation
</span>
</a>
</li>
<li class="nav-item active">
<a href="sante.php">
<span class="icon">
<svg xmlns="http://www.w3.org/2000/svg" width="25" height="25" fill="currentColor"
class="bi bi-lungs" viewBox="0 0 16 16">
<path
d="M8.5 1.5a.5.5 0 1 0-1 0v5.243L7 7.1V4.72C7 3.77 6.23 3 5.28 3c-.524 0-1.023.27-1.443.592-.431.332-.847.773-1.216 1.229-.736.908-1.347 1.946-1.58 2.48-.176.405-.393 1.16-.556 2.011-.165.857-.283 1.857-.241 2.759.04.867.233 1.79.838 2.33.67.6 1.622.556 2.741-.004l1.795-.897A2.5 2.5 0 0 0 7 11.264V10.5a.5.5 0 0 0-1 0v.764a1.5 1.5 0 0 1-.83 1.342l-1.794.897c-.978.489-1.415.343-1.628.152-.28-.25-.467-.801-.505-1.63-.037-.795.068-1.71.224-2.525.157-.82.357-1.491.491-1.8.19-.438.75-1.4 1.44-2.25.342-.422.703-.799 1.049-1.065.358-.276.639-.385.833-.385a.72.72 0 0 1 .72.72v3.094l-1.79 1.28a.5.5 0 0 0 .58.813L8 7.614l3.21 2.293a.5.5 0 1 0 .58-.814L10 7.814V4.72a.72.72 0 0 1 .72-.72c.194 0 .475.11.833.385.346.266.706.643 1.05 1.066.688.85 1.248 1.811 1.439 2.249.134.309.334.98.491 1.8.156.814.26 1.73.224 2.525-.038.829-.224 1.38-.505 1.63-.213.19-.65.337-1.628-.152l-1.795-.897A1.5 1.5 0 0 1 10 11.264V10.5a.5.5 0 0 0-1 0v.764a2.5 2.5 0 0 0 1.382 2.236l1.795.897c1.12.56 2.07.603 2.741.004.605-.54.798-1.463.838-2.33.042-.902-.076-1.902-.24-2.759-.164-.852-.38-1.606-.558-2.012-.232-.533-.843-1.571-1.579-2.479-.37-.456-.785-.897-1.216-1.229C11.743 3.27 11.244 3 10.72 3 9.77 3 9 3.77 9 4.72V7.1l-.5-.357V1.5Z" />
</svg>
</span>
<span class="text">
Assurance Santé
</span>
</a>
</li>
<li class="nav-item ">
<a style="cursor: pointer"> <span class="icon">
<svg xmlns="http://www.w3.org/2000/svg" width="25" height="25" fill="currentColor"
class="bi bi-person-lock" viewBox="0 0 16 16">
<path
d="M11 5a3 3 0 1 1-6 0 3 3 0 0 1 6 0ZM8 7a2 2 0 1 0 0-4 2 2 0 0 0 0 4Zm0 5.996V14H3s-1 0-1-1 1-4 6-4c.564 0 1.077.038 1.544.107a4.524 4.524 0 0 0-.803.918A10.46 10.46 0 0 0 8 10c-2.29 0-3.516.68-4.168 1.332-.678.678-.83 1.418-.832 1.664h5ZM9 13a1 1 0 0 1 1-1v-1a2 2 0 1 1 4 0v1a1 1 0 0 1 1 1v2a1 1 0 0 1-1 1h-4a1 1 0 0 1-1-1v-2Zm3-3a1 1 0 0 0-1 1v1h2v-1a1 1 0 0 0-1-1Z" />
</svg>
</span>
<span class="text" data-bs-toggle="modal" data-bs-target="#deconnexion"
data-bs-whatever="@mdo">Déconnexion</span>
</a>
</nav>
</aside>
<div class="overlay"></div>
<!-- ======== sidebar-nav end =========== -->
<!-- ======== main-wrapper start =========== -->
<main class="main-wrapper">
<!-- ========== header start ========== -->
<header class="header">
<div class="container-fluid">
<div class="row">
<div class="col-lg-5 col-md-5 col-6">
<div class="header-left d-flex align-items-center">
<div class="menu-toggle-btn mr-20">
<button id="menu-toggle" class="main-btn primary-btn btn-hover">
<i class="lni lni-chevron-left me-2"></i> Menu
</button>
</div>
<div class="header-search d-none d-md-flex">
<form action="#">
<input type="text" placeholder="Search..." />
<button><i class="lni lni-search-alt"></i></button>
</form>
</div>
</div>
</div>
<div class="col-lg-7 col-md-7 col-6">
<div class="header-right">
<!-- notification start -->
<div class="notification-box ml-15 d-none d-md-flex">
<button class="dropdown-toggle" type="button" id="notification"
data-bs-toggle="dropdown" aria-expanded="false">
<i class="lni lni-alarm"></i>
<span>2</span>
</button>
<ul class="dropdown-menu dropdown-menu-end" aria-labelledby="notification">
<li>
<a href="#0">
<div class="image">
<img src="/images/lead/lead-6.png" alt="" />
</div>
<div class="content">
<h6>
Arame Sy BA
<span class="text-regular">
comment on a product.
</span>
</h6>
<p>
Lorem ipsum dolor sit amet, consect etur adipiscing
elit Vivamus tortor.
</p>
<span>10 mins ago</span>
</div>
</a>
</li>
<li>
<a href="#0">
<div class="image">
<img src="/images/lead/lead-1.png" alt="" />
</div>
<div class="content">
<h6>
Jonathon
<span class="text-regular">
like on a product.
</span>
</h6>
<p>
Lorem ipsum dolor sit amet, consect etur adipiscing
elit Vivamus tortor.
</p>
<span>10 mins ago</span>
</div>
</a>
</li>
</ul>
</div>
<!-- notification end -->
<!-- message start -->
<div class="header-message-box ml-15 d-none d-md-flex">
<button class="dropdown-toggle" type="button" id="message" data-bs-toggle="dropdown"
aria-expanded="false">
<i class="lni lni-envelope"></i>
<span>3</span>
</button>
<ul class="dropdown-menu dropdown-menu-end" aria-labelledby="message">
<li>
<a href="#0">
<div class="image">
<img src="/images/lead/lead-5.png" alt="" />
</div>
<div class="content">
<h6>Jacob Jones</h6>
<p>Hey!I can across your profile and ...</p>
<span>10 mins ago</span>
</div>
</a>
</li>
<li>
<a href="#0">
<div class="image">
<img src="/images/lead/lead-3.png" alt="" />
</div>
<div class="content">
<h6>Arame Sy BA</h6>
<p>Développeuse Web</p>
<span>12 mins ago</span>
</div>
</a>
</li>
<li>
<a href="#0">
<div class="image">
<img src="/images/lead/lead-2.png" alt="" />
</div>
<div class="content">
<h6>Anee Lee</h6>
<p>Hey! are you available for freelance?</p>
<span>1h ago</span>
</div>
</a>
</li>
</ul>
</div>
<!-- message end -->
<!-- profile start -->
<div class="profile-box ml-15">
<button class="dropdown-toggle bg-transparent border-0" type="button" id="profile"
data-bs-toggle="dropdown" aria-expanded="false">
<div class="profile-info">
<div class="info">
<h6>
<?php echo $_SESSION['email']; ?>
</h6>
<div class="image">
<img src="/images/profile/profile-image.png" alt="" />
<span class="status"></span>
</div>
</div>
</div>
<i class="lni lni-chevron-down"></i>
</button>
<ul class="dropdown-menu dropdown-menu-end" aria-labelledby="profile">
<li>
<span class="icon ml-15">
<svg xmlns="http://www.w3.org/2000/svg" width="16" height="16"
fill="currentColor" class="bi bi-person" viewBox="0 0 16 16">
<path
d="M8 8a3 3 0 1 0 0-6 3 3 0 0 0 0 6Zm2-3a2 2 0 1 1-4 0 2 2 0 0 1 4 0Zm4 8c0 1-1 1-1 1H3s-1 0-1-1 1-4 6-4 6 3 6 4Zm-1-.004c-.001-.246-.154-.986-.832-1.664C11.516 10.68 10.289 10 8 10c-2.29 0-3.516.68-4.168 1.332-.678.678-.83 1.418-.832 1.664h10Z" />
</svg>
</span>
<span class="text ml-5" data-bs-toggle="modal" data-bs-target="#deconnexion1"
data-bs-whatever="@mdo" style="cursor: pointer;font-size: 13px;">Voir
profile</span>
</li>
<li>
<a href="#0"> <i class="lni lni-inbox"></i> Messages </a>
</li>
<li>
<span class="icon ml-15">
<svg xmlns="http://www.w3.org/2000/svg" width="16" height="16"
fill="currentColor" class="bi bi-person-lock" viewBox="0 0 16 16">
<path
d="M11 5a3 3 0 1 1-6 0 3 3 0 0 1 6 0ZM8 7a2 2 0 1 0 0-4 2 2 0 0 0 0 4Zm0 5.996V14H3s-1 0-1-1 1-4 6-4c.564 0 1.077.038 1.544.107a4.524 4.524 0 0 0-.803.918A10.46 10.46 0 0 0 8 10c-2.29 0-3.516.68-4.168 1.332-.678.678-.83 1.418-.832 1.664h5ZM9 13a1 1 0 0 1 1-1v-1a2 2 0 1 1 4 0v1a1 1 0 0 1 1 1v2a1 1 0 0 1-1 1h-4a1 1 0 0 1-1-1v-2Zm3-3a1 1 0 0 0-1 1v1h2v-1a1 1 0 0 0-1-1Z" />
</svg>
</span>
<span class="text ml-5" data-bs-toggle="modal" data-bs-target="#deconnexion"
data-bs-whatever="@mdo"
style="cursor: pointer;font-size: 13px;">Déconnexion</span>
</li>
</ul>
</div>
<!-- profile end -->
</div>
</div>
</div>
</div>
</header>
<div class="container-fluid bg-white mt-1">
<div class="title-wrapper p-3 ">
<div class="row align-items-center">
<div class="col-md-12 d-flex justify-content-between">
<a href="sante.php" class="btn btn-primary"> retourner</a>
<h2>Ajouter une assurance santé</h2>
</div>
</div>
</div>
</div>
<div class="wrapper shadow p-4">
<div class="header">
<ul>
<li class="active form_1_progessbar">
<div>
<p>1</p>
</div>
</li>
<li class="form_2_progessbar">
<div>
<p>2</p>
</div>
</li>
<li class="form_3_progessbar">
<div>
<p>3</p>
</div>
</li>
</ul>
</div>
<form id="sante">
<div class="form_wrap">
<div class="form_1 data_info">
<h3>Bénéficiaires</h3>
<select class="form-select" name="beneficiaire" aria-label="Default select example" id="benificiaire" onchange="validateBenificiaire()">
<option selected></option>
<option value="solo">Solo</option>
<option value="Famille">Famille</option>
<option value="Entreprise">Enteprise</option>
</select>
<p id="benificiaire-error"></p>
<div class="input_wrap">
<label for="company">Nom : </label>
<input type="text" name="nom" id="nom" class="form-control" oninput="validateNom()">
<p id="nom-error"></p>
</div>
<div class="input_wrap">
<label for="experience">Prénom : </label>
<input type="text" name="prenom" id="prenom" class="form-control" oninput="validatePrenom()">
<p id="prenom-error"></p>
</div>
<div class="input_wrap">
<label for="designation">Email : </label>
<input type="email" name="mail" id="email" class="form-control" oninput="validateEmail()">
<p id="email-error"></p>
</div>
<div class="input_wrap">
<label for="dat_retour">Telephone : </label>
<input type="tel" name="phone" id="telephone" class="form-control" oninput="validatePhone()">
<p id="telephone-error"></p>
</div>
</div>
<div class="form_2 data_info" style="display: none;">
<h3>Détail de l'assurance santé</h3>
<p>Veuillez remplir ce formulaire</p>
<div class="form_container">
<div class="input_wrap">
<label for="dest">Taux de couverture:</label>
<div class="form-check">
<input class="form-check-input" value="70%" type="radio" name="taux" id="flexRadioDefault1">
<label class="form-check-label" for="flexRadioDefault1">
Taux 70%
</label>
</div>
<div class="form-check">
<input class="form-check-input" value="80%" type="radio" name="taux" id="flexRadioDefault2" checked>
<label class="form-check-label" for="flexRadioDefault2">
Taux 80%
</label>
</div>
<div class="form-check">
<input class="form-check-input" value="90%" type="radio" name="taux" id="flexRadioDefault3" checked>
<label class="form-check-label" for="flexRadioDefault2">
Taux 90%
</label>
</div>
</div>
<div class="input_wrap">
<label for="nub_pass">Téritorialité:</label>
</div>
<div>
<select class="form-select" name="localite" aria-label="Default select example" id="localite" onchange="validateLocalite()">
<option >Choisir votre localité</option>
<option value="Senegal">Sénégal</option>
<option value="Afrique entière">Afrique entière</option>
<option value="Sénégal + Union Européenne">Sénégal + Union Européenne</option>
<option value="Monde entière">Monde entière </option>
</select>
<p id="localite-error"></p>
</div>
</div>
</div>
<div class="form_3 data_info" style="display: none;">
<h3>Récapitulatif Devis</h3>
<div class="form_container">
<div class="input_wrap">
<label for="company">Bénéficiaire : <b id="beneficiaire-recap"></b></label>
</div>
<div class="input_wrap">
<label for="experience">Taux : <b id="taux-recap""></b></label>
</div>
<div class=" input_wrap">
<label for="designation">Localité : <b id="localite-recap"></b></label>
</div>
</div>
</div>
</div>
<div class="btns_wrap">
<div class="common_btns form_1_btns">
<button type="button" class="btn_next">Next <span class="icon"><ion-icon name="arrow-forward-sharp"></ion-icon></span></button>
</div>
<div class="common_btns form_2_btns" style="display: none;">
<button type="button" class="btn_back"><span class="icon"><ion-icon name="arrow-back-sharp"></ion-icon></span>Back</button>
<button type="button" class="btn_next" onclick="loadData()">Next <span class="icon"><ion-icon name="arrow-forward-sharp"></ion-icon></span></button>
</div>
<div class="common_btns form_3_btns" style="display: none;">
<button type="button" class="btn_back"><span class="icon"><ion-icon name="arrow-back-sharp"></ion-icon></span>Back</button>
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