plac-micro-common 1.3.12 → 1.3.14

This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
Files changed (6) hide show
  1. package/dist/libs/pdf-form/img/logo.img.d.ts +1 -0
  2. package/dist/libs/pdf-form/img/logo.img.js +4 -0
  3. package/dist/libs/pdf-form/pdf-form.lib.js +2 -0
  4. package/dist/libs/pdf-form/templates/sio-form-kh.template.d.ts +1 -1
  5. package/dist/libs/pdf-form/templates/sio-form-kh.template.js +680 -527
  6. package/package.json +1 -1
package/dist/libs/pdf-form/img/logo.img.d.ts ADDED
@@ -0,0 +1 @@
1
+ export declare const LOGO_BASE64 = "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package/dist/libs/pdf-form/img/logo.img.js ADDED
@@ -0,0 +1,4 @@
1
+ "use strict";
2
+ Object.defineProperty(exports, "__esModule", { value: true });
3
+ exports.LOGO_BASE64 = void 0;
4
+ exports.LOGO_BASE64 = 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package/dist/libs/pdf-form/pdf-form.lib.js CHANGED
@@ -35,6 +35,7 @@ var __importStar = (this && this.__importStar) || (function () {
35
35
  Object.defineProperty(exports, "__esModule", { value: true });
36
36
  exports.generateFormSIO = generateFormSIO;
37
37
  const khmer_os_font_1 = require("./fonts/khmer-os.font");
38
+ const logo_img_1 = require("./img/logo.img");
38
39
  const sio_form_en_template_1 = require("./templates/sio-form-en.template");
39
40
  const sio_form_kh_template_1 = require("./templates/sio-form-kh.template");
40
41
  const ejs = __importStar(require("ejs"));
@@ -43,5 +44,6 @@ async function generateFormSIO(data, lang) {
43
44
  return ejs.render(template, {
44
45
  ...data,
45
46
  font_base64: khmer_os_font_1.KHMER_OS_FONT_BASE64,
47
+ logo_base64: logo_img_1.LOGO_BASE64,
46
48
  });
47
49
  }
package/dist/libs/pdf-form/templates/sio-form-kh.template.d.ts CHANGED
@@ -1 +1 @@
1
- export declare const SIO_FORM_KH_TEMPLATE = "\n<!DOCTYPE html>\n<html lang=\"km\">\n<head>\n <meta charset=\"UTF-8\" />\n <meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\" />\n <title>\u1796\u17B6\u1780\u17D2\u1799\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17A2\u17B6\u1799\u17BB\u1787\u17B8\u179C\u17B7\u178F</title>\n <style>\n @font-face {\n font-family: 'Khmer OS';\n src: url('data:font/truetype;base64,<%= font_base64 %>') format('truetype');\n font-weight: normal;\n font-style: normal;\n }\n\n *, *::before, *::after { box-sizing: border-box; margin: 0; padding: 0; }\n\n body {\n font-family: 'Khmer OS', sans-serif;\n font-size: 9pt;\n color: #1a1a1a;\n background: #fff;\n padding: 14mm 12mm;\n line-height: 1.5;\n -webkit-print-color-adjust: exact;\n print-color-adjust: exact;\n }\n\n .logo {\n color: #005bac;\n font-size: 13pt;\n font-weight: bold;\n letter-spacing: 0.5px;\n margin-bottom: 4px;\n }\n\n .form-title {\n text-align: center;\n font-size: 11pt;\n font-weight: bold;\n margin-bottom: 10px;\n line-height: 1.6;\n }\n\n .meta-grid {\n display: grid;\n grid-template-columns: 1fr 1fr;\n gap: 4px 16px;\n margin-bottom: 8px;\n }\n\n .meta-row {\n display: flex;\n align-items: center;\n gap: 4px;\n border-bottom: 1px solid #333;\n padding-bottom: 2px;\n font-size: 8.5pt;\n }\n\n .meta-row span.label { white-space: nowrap; }\n .meta-row span.value { flex: 1; min-width: 0; }\n\n .section-header {\n background-color: #005bac;\n color: #fff;\n text-align: center;\n font-weight: bold;\n font-size: 9pt;\n padding: 4px 8px;\n margin: 8px 0 6px;\n }\n\n .field-row {\n display: flex;\n align-items: center;\n flex-wrap: wrap;\n gap: 4px 10px;\n margin-bottom: 5px;\n font-size: 8.5pt;\n }\n\n .field-row .label { white-space: nowrap; }\n\n .underline {\n border-bottom: 1px solid #333;\n min-width: 60px;\n display: inline-block;\n padding-bottom: 1px;\n }\n\n .underline.lg { min-width: 140px; }\n .underline.md { min-width: 90px; }\n .underline.sm { min-width: 50px; }\n .underline.xs { min-width: 30px; }\n .underline.full { flex: 1; min-width: 120px; }\n\n .cb-group { display: flex; align-items: center; gap: 12px; flex-wrap: wrap; }\n\n .cb-item {\n display: flex;\n align-items: center;\n gap: 4px;\n white-space: nowrap;\n }\n\n .cb-box {\n width: 11px;\n height: 11px;\n border: 1.2px solid #333;\n display: inline-flex;\n align-items: center;\n justify-content: center;\n font-size: 8pt;\n flex-shrink: 0;\n }\n\n .cb-box.checked::after { content: '\u2714'; color: #005bac; }\n\n table {\n width: 100%;\n border-collapse: collapse;\n font-size: 8.5pt;\n margin-bottom: 6px;\n }\n\n th {\n background-color: #dce9f7;\n border: 1px solid #aac4e0;\n padding: 4px 6px;\n text-align: center;\n font-weight: bold;\n }\n\n td {\n border: 1px solid #aac4e0;\n padding: 4px 6px;\n text-align: center;\n min-height: 20px;\n }\n\n .td-empty { height: 20px; }\n\n .note {\n font-size: 8pt;\n display: flex;\n justify-content: space-between;\n align-items: center;\n margin-top: 2px;\n }\n\n .health-q {\n font-size: 8.5pt;\n margin-bottom: 6px;\n line-height: 1.6;\n }\n\n .health-q .q-text { display: inline; }\n\n .detail-line {\n border-bottom: 1px solid #333;\n min-height: 14px;\n margin-top: 3px;\n width: 100%;\n }\n\n .declaration {\n font-size: 8pt;\n line-height: 1.6;\n margin-bottom: 6px;\n }\n\n .declaration p { margin-bottom: 5px; }\n\n .sig-row {\n display: grid;\n grid-template-columns: 1fr 1fr;\n gap: 16px;\n margin-top: 10px;\n font-size: 8.5pt;\n }\n\n .sig-block { display: flex; flex-direction: column; gap: 6px; }\n\n .sig-line {\n border-bottom: 1px solid #333;\n min-height: 36px;\n margin-bottom: 4px;\n }\n\n .page-num {\n text-align: right;\n font-size: 7.5pt;\n color: #555;\n margin-bottom: 4px;\n }\n\n .page-break { page-break-before: always; }\n </style>\n</head>\n<body>\n <div class=\"page-num\">\u1791\u17C6\u1796\u17D0\u179A 1 \u1793\u17C3 2</div>\n\n <div class=\"logo\">PhillipLife</div>\n\n <div class=\"form-title\">\n \u1796\u17B6\u1780\u17D2\u1799\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17A2\u17B6\u1799\u17BB\u1787\u17B8\u179C\u17B7\u178F<br/>\n \u179F\u1798\u17D2\u179A\u17B6\u1794\u17CB\u1791\u1798\u17D2\u179A\u1784\u17CB\u179F\u17B6\u1798\u1789\u17D2\u1789\u179F\u1798\u17D2\u179A\u17B6\u1794\u17CB\u17A2\u178F\u17B7\u1790\u17B7\u1787\u1793\u1787\u17C4\u1782\u1787\u17D0\u1799\u17A0\u17D2\u179C\u17B6\u1799\u1793\u17C2\u1793 (SIO)\n </div>\n\n <div class=\"meta-grid\">\n <div class=\"meta-row\">\n <span class=\"label\">\u1788\u17D2\u1798\u17C4\u17C7\u1793\u17B7\u1784\u179B\u17C1\u1781\u1780\u17BC\u178A\u179F\u17B6\u1781\u17B6</span>\n <span class=\"value underline full\">\n <%= branch_staff_app_info?.branch_name ?? '' %> / <%= branch_staff_app_info?.branch_code ?? '' %>\n </span>\n </div>\n <div class=\"meta-row\">\n <span class=\"label\">\u1788\u17D2\u1798\u17C4\u17C7\u1793\u17B7\u1784\u179B\u17C1\u1781\u1780\u17BC\u178A\u1794\u17BB\u1782\u17D2\u1782\u179B\u17B7\u1780\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17CB</span>\n <span class=\"value underline full\">\n <%= branch_staff_app_info?.advisor_name ?? '' %> / <%= branch_staff_app_info?.advisor_code ?? '' %>\n </span>\n </div>\n <div class=\"meta-row\">\n <span class=\"label\">\u1788\u17D2\u1798\u17C4\u17C7\u1793\u17B7\u1784\u179B\u17C1\u1781\u1780\u17BC\u178A\u1794\u17BB\u1782\u17D2\u1782\u179B\u17B7\u1780\u1792\u1793\u17B6\u1782\u17B6\u179A</span>\n <span class=\"value underline full\">\n <%= branch_staff_app_info?.bank_staff_name ?? '' %> / <%= branch_staff_app_info?.bank_staff_code ?? '' %>\n </span>\n </div>\n <div class=\"meta-row\">\n <span class=\"label\">\u179B\u17C1\u1781\u1796\u17B6\u1780\u17D2\u1799\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6</span>\n <span class=\"value underline full\"><%= branch_staff_app_info?.application_no ?? '' %></span>\n </div>\n </div>\n\n <div class=\"section-header\">\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u17A2\u17C6\u1796\u17B8\u17A2\u17D2\u1793\u1780\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1796\u178E\u17D2\u178E\u179F\u1793\u17D2\u1799\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17CB</div>\n\n <div class=\"field-row\">\n <span class=\"label\">\u1788\u17D2\u1798\u17C4\u17C7\u1796\u17C1\u1789\u178A\u17BC\u1785\u1794\u1784\u17D2\u17A0\u17B6\u1789\u1793\u17C5\u1780\u17D2\u1793\u17BB\u1784\u17AF\u1780\u179F\u17B6\u179A\u17A2\u178F\u17D2\u178F\u179F\u1789\u17D2\u1789\u17B6\u178E \u1787\u17B6\u1797\u17B6\u179F\u17B6\u1781\u17D2\u1798\u17C2\u179A:</span>\n <span class=\"underline lg\"><%= applicant_info?.full_name_kh ?? '' %></span>\n <span class=\"label\">\u1787\u17B6\u1797\u17B6\u179F\u17B6\u17A2\u1784\u17CB\u1782\u17D2\u179B\u17C1\u179F</span>\n <span class=\"underline lg\"><%= applicant_info?.full_name ?? '' %></span>\n <span class=\"label\">\u1797\u17C1\u1791:</span>\n <div class=\"cb-group\">\n <div class=\"cb-item\">\n <div class=\"cb-box <%= applicant_info?.gender === 'M' ? 'checked' : '' %>\"></div>\n <span>\u1794\u17D2\u179A\u17BB\u179F</span>\n </div>\n <div class=\"cb-item\">\n <div class=\"cb-box <%= applicant_info?.gender === 'F' ? 'checked' : '' %>\"></div>\n <span>\u179F\u17D2\u179A\u17B8</span>\n </div>\n </div>\n </div>\n\n <div class=\"field-row\">\n <span class=\"label\">\u179F\u17D2\u1790\u17B6\u1793\u1797\u17B6\u1796\u1782\u17D2\u179A\u17BD\u179F\u17B6\u179A:</span>\n <div class=\"cb-group\">\n <div class=\"cb-item\">\n <div class=\"cb-box <%= applicant_info?.marital_status === 'single' ? 'checked' : '' %>\"></div>\n <span>\u1793\u17C5\u179B\u17B8\u179C</span>\n </div>\n <div class=\"cb-item\">\n <div class=\"cb-box <%= applicant_info?.marital_status === 'married' ? 'checked' : '' %>\"></div>\n <span>\u179A\u17C0\u1794\u1780\u17B6\u179A</span>\n </div>\n <div class=\"cb-item\">\n <div class=\"cb-box <%= applicant_info?.marital_status === 'divorced' ? 'checked' : '' %>\"></div>\n <span>\u179B\u17C2\u1784\u179B\u17C7</span>\n </div>\n <div class=\"cb-item\">\n <div class=\"cb-box <%= applicant_info?.marital_status === 'widowed' ? 'checked' : '' %>\"></div>\n <span>\u1798\u17C1\u1798\u17C9\u17B6\u1799/\u1796\u17C4\u17C7\u1798\u17C9\u17B6\u1799</span>\n </div>\n </div>\n <span class=\"label\">\u178F\u17BD\u1793\u17B6\u1791\u17B8\u1793\u17B7\u1784\u1794\u17D2\u179A\u1797\u17C1\u1791\u1780\u17B6\u179A\u1784\u17B6\u179A:</span>\n <span class=\"underline md\"><%= applicant_info?.occupation ?? '' %></span>\n </div>\n\n <div class=\"field-row\">\n <span class=\"label\">\u17AF\u1780\u179F\u17B6\u179A\u1794\u1789\u17D2\u1785\u17B6\u1780\u17CB\u17A2\u178F\u17D2\u178F\u179F\u1789\u17D2\u1789\u17B6\u178E:</span>\n <div class=\"cb-group\">\n <div class=\"cb-item\">\n <div class=\"cb-box <%= applicant_info?.identity_type === 'nid' ? 'checked' : '' %>\"></div>\n <span>\u17A2\u178F\u17D2\u178F\u179F\u1789\u17D2\u1789\u17B6\u178E\u1794\u178E\u17D2\u178E</span>\n </div>\n <div class=\"cb-item\">\n <div class=\"cb-box <%= applicant_info?.identity_type === 'passport' ? 'checked' : '' %>\"></div>\n <span>\u179B\u17B7\u1781\u17B7\u178F\u1786\u17D2\u179B\u1784\u178A\u17C2\u1793</span>\n </div>\n <div class=\"cb-item\">\n <div class=\"cb-box <%= applicant_info?.identity_type === 'birth' ? 'checked' : '' %>\"></div>\n <span>\u179F\u17C6\u1794\u17BB\u178F\u17D2\u179A\u1780\u17C6\u178E\u17BE\u178F</span>\n </div>\n <div class=\"cb-item\">\n <div class=\"cb-box <%= applicant_info?.identity_type === 'other' ? 'checked' : '' %>\"></div>\n <span>\u1795\u17D2\u179F\u17C1\u1784\u1791\u17C0\u178F</span>\n </div>\n </div>\n </div>\n\n <div class=\"field-row\">\n <span class=\"label\">\u1795\u17D2\u179F\u17C1\u1784\u1791\u17C0\u178F:</span>\n <span class=\"underline sm\"><%= applicant_info?.identity_type === 'other' ? (applicant_info?.identity_other_description ?? '') : '' %></span>\n <span class=\"label\">\u179B\u17C1\u1781\u17A2\u178F\u17D2\u178F\u179F\u1789\u17D2\u1789\u17B6\u178E:</span>\n <span class=\"underline md\"><%= applicant_info?.identity_no ?? '' %></span>\n <span class=\"label\">\u1790\u17D2\u1784\u17C3\u1781\u17C2\u1786\u17D2\u1793\u17B6\u17C6\u1780\u17C6\u178E\u17BE\u178F:</span>\n <span class=\"underline md\"><%= applicant_info?.date_of_birth ?? '' %></span>\n <span class=\"label\">\u17A2\u17B6\u1799\u17BB:</span>\n <span class=\"underline xs\"><%= applicant_info?.age ?? '' %></span>\n <span class=\"label\">\u179F\u1789\u17D2\u1787\u17B6\u178F\u17B7:</span>\n <span class=\"underline sm\"><%= applicant_info?.nationality ?? '' %></span>\n <span class=\"label\">\u179B\u17C1\u1781\u1791\u17BC\u179A\u179F\u17D0\u1796\u17D2\u1791:</span>\n <span class=\"underline md\"><%= applicant_info?.phone_number ?? '' %></span>\n </div>\n\n <div class=\"field-row\">\n <span class=\"label\">\u17A2\u17B6\u179F\u1799\u178A\u17D2\u178B\u17B6\u1793\u1794\u1785\u17D2\u1785\u17BB\u1794\u17D2\u1794\u1793\u17D2\u1793:</span>\n <span class=\"underline full\"><%= applicant_info?.current_address ?? '' %></span>\n </div>\n\n <div class=\"section-header\" style=\"background:#e8f0fb; color:#005bac; border:1px solid #aac4e0; font-size:8.5pt;\">\n \u179F\u17C1\u1785\u1780\u17D2\u178A\u17B8\u1794\u17D2\u179A\u1780\u17B6\u179F\u179F\u1798\u17D2\u179A\u17B6\u1794\u17CB\u1780\u17B6\u179A\u17A2\u1793\u17BB\u179C\u178F\u17D2\u178A FATCA\n </div>\n\n <div class=\"field-row\">\n \u17A2\u17D2\u1793\u1780\u179F\u17D2\u1793\u17BE\u179A\u179F\u17BB\u17C6\u1794\u178E\u17D2\u178E\u179F\u1793\u17D2\u1799\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17CB\u1798\u17B7\u1793\u1798\u17C2\u1793\u1787\u17B6\u1796\u179B\u179A\u178A\u17D2\u178B\u17A2\u17B6\u1798\u17C1\u179A\u17B7\u1780 \u17AC \u1787\u17B6\u1794\u17CB\u1796\u1793\u17D2\u1792\u179F\u17D2\u1793\u17B6\u1780\u17CB\u1793\u17C5\u17A2\u17B6\u1798\u17C1\u179A\u17B7\u1780 \u17AC \u1798\u17B6\u1793\u179F\u17B7\u1791\u17D2\u1792\u17B7\u1780\u17B6\u1793\u17CB Green Card \u1793\u17C4\u17C7\u1791\u17C1\u17D4\n </div>\n\n <div class=\"field-row\">\n <div class=\"cb-group\">\n <div class=\"cb-item\">\n <div class=\"cb-box <%= fatca_info?.is_fatca === false ? 'checked' : '' %>\"></div>\n <span>\u1798\u17B7\u1793\u1798\u17C2\u1793</span>\n </div>\n <div class=\"cb-item\">\n <div class=\"cb-box <%= fatca_info?.is_fatca === true ? 'checked' : '' %>\"></div>\n <span>\u1798\u17C2\u1793</span>\n </div>\n </div>\n <span class=\"label\">US TIN:</span>\n <span class=\"underline md\"><%= fatca_info?.us_tin_no ?? '' %></span>\n <span class=\"label\">\u179B\u17C1\u1781\u1780\u17BC\u178A\u179B\u17BE\u1780\u179B\u17C2\u1784 FATCA (\u1794\u17D2\u179A\u179F\u17B7\u1793\u1798\u17B6\u1793):</span>\n <span class=\"underline md\"><%= fatca_info?.fatca_exempt_code ?? '' %></span>\n </div>\n\n <div class=\"health-q\" style=\"font-size:7.8pt; color:#333;\">\n \u1794\u17D2\u179A\u179F\u17B7\u1793\u1794\u17BE\u1780\u17B6\u179A\u1794\u1789\u17D2\u1785\u17B6\u1780\u17CB\u17A2\u17C7\u17A2\u17B6\u1784\u178E\u17B6\u1798\u17BD\u1799\u1798\u17B7\u1793\u178F\u17D2\u179A\u17B9\u1798\u178F\u17D2\u179A\u17BC\u179C \u1781\u17D2\u1789\u17BB\u17C6\u1793\u17B9\u1784\u1794\u17D2\u179A\u1782\u179B\u17CB\u1787\u17BC\u1793\u1793\u17BC\u179C\u17AF\u1780\u179F\u17B6\u179A\u1790\u17D2\u1798\u17B8\u1780\u17D2\u1793\u17BB\u1784\u179A\u1799\u17C7\u1796\u17C1\u179B \u17E3\u17E0\u1790\u17D2\u1784\u17C3\u17A0\u17BE\u1799\u17A2\u17C7\u17A2\u17B6\u1784\u1790\u17B6\u1781\u17D2\u1789\u17BB\u17C6\u1798\u17B7\u1793\u1787\u17B6\u1794\u17CB\u1796\u1793\u17D2\u1792\u1780\u17B6\u178F\u17CB\u1791\u17BB\u1780\u179A\u1794\u179F\u17CB\u179F\u17A0\u179A\u178A\u17D2\u178B\u17A2\u17B6\u1798\u17C1\u179A\u17B7\u1780\u1791\u17C1\u17D4\n </div>\n\n <div class=\"section-header\">\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u17A2\u17C6\u1796\u17B8\u1795\u179B\u17B7\u178F\u1795\u179B</div>\n\n <table>\n <thead>\n <tr>\n <th>\u1788\u17D2\u1798\u17C4\u17C7\u1795\u179B\u17B7\u178F\u1795\u179B \u1793\u17B7\u1784\u179A\u1799\u17C7\u1796\u17C1\u179B\u1792\u17B6\u1793\u17B6</th>\n <th>\u1791\u17B9\u1780\u1794\u17D2\u179A\u17B6\u1780\u17CB\u178F\u17D2\u179A\u17BC\u179C\u1792\u17B6\u1793\u17B6<br/>(\u178A\u17BB\u179B\u17D2\u179B\u17B6\u179A\u17A2\u17B6\u1798\u17C1\u179A\u17B7\u1780)</th>\n <th>\u179A\u1794\u17C0\u1794\u1794\u1784\u17CB\u1794\u17BB\u1796\u17D2\u179C\u179B\u17B6\u1797</th>\n <th>\u1794\u17BB\u1796\u17D2\u179C\u179B\u17B6\u1797\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17CB<br/>(\u178A\u17BB\u179B\u17D2\u179B\u17B6\u179A\u17A2\u17B6\u1798\u17C1\u179A\u17B7\u1780)</th>\n </tr>\n </thead>\n <tbody>\n <% if (product_payment_info?.products && product_payment_info.products.length > 0) { %>\n <% product_payment_info.products.forEach((p) => { %>\n <tr>\n <td><%= p.name ?? '' %> <%= p.term ? '(' + p.term + ')' : '' %></td>\n <td><%= p.sum_assured ?? '' %></td>\n <td><%= p.payment_mode ?? '' %></td>\n <td><%= p.premium ?? '' %></td>\n </tr>\n <% }) %>\n <% } else { %>\n <tr>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n </tr>\n <tr>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n </tr>\n <% } %>\n </tbody>\n </table>\n\n <div class=\"field-row\">\n <span class=\"label\">\u179C\u17B7\u1792\u17B8\u179F\u17B6\u179F\u17D2\u179A\u17D2\u178A\u1794\u1784\u17CB\u1794\u17BB\u1796\u17D2\u179C\u179B\u17B6\u1797\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17CB:</span>\n <div class=\"cb-group\">\n <div class=\"cb-item\">\n <div class=\"cb-box <%= product_payment_info?.payment_method === 'transfer' ? 'checked' : '' %>\"></div>\n <span>\u1780\u17B6\u179A\u1795\u17D2\u1791\u17C1\u179A\u1794\u17D2\u179A\u17B6\u1780\u17CB</span>\n </div>\n <div class=\"cb-item\">\n <div class=\"cb-box <%= product_payment_info?.payment_method === 'cash' ? 'checked' : '' %>\"></div>\n <span>\u179F\u17B6\u1785\u17CB\u1794\u17D2\u179A\u17B6\u1780\u17CB</span>\n </div>\n </div>\n </div>\n\n <div class=\"section-header\">\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u17A2\u17C6\u1796\u17B8\u17A2\u17D2\u1793\u1780\u1791\u1791\u17BD\u179B\u1795\u179B</div>\n\n <table>\n <thead>\n <tr>\n <th>\u1788\u17D2\u1798\u17C4\u17C7\u1796\u17C1\u1789\u179A\u1794\u179F\u17CB\u17A2\u17D2\u1793\u1780\u1791\u1791\u17BD\u179B\u1795\u179B</th>\n <th>\u17A2\u17B6\u1799\u17BB</th>\n <th>\u1791\u17C6\u1793\u17B6\u1780\u17CB\u1791\u17C6\u1793\u1784</th>\n <th>\u179B\u17C1\u1781\u17A2\u178F\u17B7\u1790\u17B7\u1787\u1793/\u17AF\u1780\u179F\u17B6\u179A</th>\n <th>% \u1793\u17C3\u1780\u17B6\u179A\u1794\u17C2\u1784\u1785\u17C2\u1780</th>\n </tr>\n </thead>\n <tbody>\n <% if (beneficiary_info && beneficiary_info.length > 0) { %>\n <% beneficiary_info.forEach((b) => { %>\n <tr>\n <td><%= b.full_name ?? '' %></td>\n <td><%= b.age ?? '' %></td>\n <td><%= b.relationship ?? '' %></td>\n <td><%= b.id_number ?? '' %></td>\n <td><%= b.percentage ?? '' %></td>\n </tr>\n <% }) %>\n <% } else { %>\n <tr>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n </tr>\n <tr>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n </tr>\n <tr>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n <td class=\"td-empty\"></td>\n </tr>\n <% } %>\n </tbody>\n </table>\n\n <div class=\"note\">\n <span>\u1780\u178E\u178F\u17CB\u179F\u1798\u17D2\u1782\u17B6\u179B\u17CB\u17D6 \u1794\u17D2\u179A\u179F\u17B7\u1793\u1794\u17BE\u1797\u17B6\u1782\u179A\u1799\u1798\u17B7\u1793\u178F\u17D2\u179A\u17BC\u179C\u1794\u17B6\u1793\u1794\u1789\u17D2\u1787\u17B6\u1780\u17CB\u1785\u17C6\u1793\u17BD\u1793\u1791\u17B9\u1780\u1794\u17D2\u179A\u17B6\u1780\u17CB\u1793\u17B9\u1784\u178F\u17D2\u179A\u17BC\u179C\u1794\u17C2\u1784\u1785\u17C2\u1780\u179F\u17D2\u1798\u17BE\u17D7\u1782\u17D2\u1793\u17B6</span>\n <span>% \u179F\u179A\u17BB\u1794\u179F\u17D2\u1798\u17BE\u179A \u17E1\u17E0\u17E0%</span>\n </div>\n\n <div class=\"section-header\">\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u1796\u17B6\u1780\u17CB\u1796\u17D0\u1793\u17D2\u1791\u1793\u17B9\u1784\u179F\u17BB\u1781\u1797\u17B6\u1796\u179A\u1794\u179F\u17CB \u17A2\u17D2\u1793\u1780\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1794\u178E\u17D2\u178E\u179F\u1793\u17D2\u1799\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17CB</div>\n\n <div class=\"health-q\">\n <span class=\"q-text\">1) \u1780\u1798\u17D2\u1796\u179F\u17CB:</span>\n <span class=\"underline xs\"><%= health_info?.height ?? '' %></span> \u179F.\u1798\n <span class=\"q-text\" style=\"margin-left:8px;\">\u1791\u1798\u17D2\u1784\u1793\u17CB:</span>\n <span class=\"underline xs\"><%= health_info?.weight ?? '' %></span> \u1782.\u1780\n <span class=\"q-text\" style=\"margin-left:8px;\">\u178F\u17BE\u179B\u17C4\u1780\u17A2\u17D2\u1793\u1780\u1796\u17B7\u179F\u17B6\u179A\u1794\u17B6\u179A\u17B8\u178A\u17C2\u179A\u17AC\u1791\u17C1?:</span>\n <div class=\"cb-group\" style=\"display:inline-flex; margin-left:4px;\">\n <div class=\"cb-item\">\n <div class=\"cb-box <%= health_info?.is_smoke === false ? 'checked' : '' %>\"></div>\n <span>\u1798\u17B7\u1793\u1798\u17B6\u1793</span>\n </div>\n <div class=\"cb-item\">\n <div class=\"cb-box <%= health_info?.is_smoke === true ? 'checked' : '' %>\"></div>\n <span>\u1798\u17B6\u1793</span>\n </div>\n </div>\n <span class=\"underline xs\"><%= health_info?.smoke_detail ?? '' %></span> \u1780\u17D2\u1793\u17BB\u1784\u1798\u17BD\u1799\u179F\u1794\u17D2\u178A\u17B6\u17A0\u17CD\n </div>\n\n <div class=\"health-q\">\n <span class=\"q-text\">2) \u178F\u17BE\u179B\u17C4\u1780\u17A2\u17D2\u1793\u1780\u1796\u17B7\u179F\u17B6\u179A\u1782\u17D2\u179A\u17BF\u1784\u179F\u17D2\u179A\u179C\u17B9\u1784\u178A\u17C2\u179A\u17AC\u1791\u17C1?:</span>\n <div class=\"cb-group\" style=\"display:inline-flex; margin-left:4px;\">\n <div class=\"cb-item\">\n <div class=\"cb-box <%= health_info?.is_drink_alcohol === false ? 'checked' : '' %>\"></div>\n <span>\u1798\u17B7\u1793\u1798\u17B6\u1793</span>\n </div>\n <div class=\"cb-item\">\n <div class=\"cb-box <%= health_info?.is_drink_alcohol === true ? 'checked' : '' %>\"></div>\n <span>\u1798\u17B6\u1793</span>\n </div>\n </div>\n <span class=\"underline xs\"><%= health_info?.drink_alcohol_detail ?? '' %></span> \u1780\u17D2\u1793\u17BB\u1784\u1798\u17BD\u1799\u179F\u1794\u17D2\u178A\u17B6\u17A0\u17CD\n </div>\n\n <div class=\"health-q\">\n <span class=\"q-text\">3) \u1780\u17D2\u1793\u17BB\u1784\u179A\u1799\u17C8\u1796\u17C1\u179B\u17E0\u17E2(\u1796\u17B8\u179A)\u1786\u17D2\u1793\u17B6\u17C6\u1785\u17BB\u1784\u1780\u17D2\u179A\u17C4\u1799\u1793\u17C1\u17C7\u178F\u17BE\u179B\u17C4\u1780\u17A2\u17D2\u1793\u1780\u1792\u17D2\u179B\u17B6\u1794\u17CB\u1794\u17B6\u1793\u179F\u1798\u17D2\u179A\u17B6\u1780\u1780\u17D2\u1793\u17BB\u1784\u1798\u1793\u17D2\u1791\u17B8\u179A\u1796\u17C1\u1791\u17D2\u1799 \u1792\u17D2\u179B\u17B6\u1794\u17CB\u1794\u17B6\u1793\u1791\u1791\u17BD\u179B\u1780\u17B6\u179A\u179C\u17C7\u1780\u17B6\u178F\u17CB \u17AC\u1792\u17D2\u179B\u17B6\u1794\u17CB\u1791\u1791\u17BD\u179B\u1794\u17B6\u1793\u179B\u1791\u17D2\u1792\u1795\u179B\u1781\u17BB\u179F\u1794\u17D2\u179A\u1780\u17D2\u179A\u178F\u17B8\u17A2\u17C6\u1796\u17B8\u1780\u17B6\u179A\u179C\u17B7\u1797\u17B6\u1782\u1788\u17B6\u1798 \u1780\u17B6\u179A\u179C\u17B7\u1797\u17B6\u1782\u1791\u17B9\u1780\u1793\u17C4\u1798 \u1780\u17B6\u179A\u1790\u178F\u1780\u17B6\u17C6\u179A\u179F\u17D2\u1798\u17B8\u17A2\u17BB\u17B7\u1785 (X-ray) \u1798\u17C9\u17B6\u179F\u17CA\u17B8\u1793\u179C\u17B6\u179F\u17CB\u1785\u1784\u17D2\u179C\u17B6\u1780\u17CB\u1794\u17C1\u17C7\u178A\u17BC\u1784 \u17A2\u17C1\u1780\u17BC\u179F\u17B6\u179F\u17D2\u179A\u17D2\u178A\u179F\u17D2\u1780\u17C1\u1793 \u1780\u17B6\u179A\u1785\u17D2\u179A\u17B9\u1794\u179F\u17B6\u1785\u17CB\u1799\u1780\u1796\u17B7\u1793\u17B7\u178F\u17D2\u1799 \u17AC\u179B\u1791\u17D2\u1792\u1795\u179B\u179C\u17B7\u1797\u17B6\u1782\u1795\u17D2\u179F\u17C1\u1784\u17D7\u1791\u17C0\u178F\u178A\u17C2\u179B\u1798\u17B7\u1793\u1794\u17B6\u1793\u179A\u17C0\u1794\u179A\u17B6\u1794\u17CB\u1781\u17B6\u1784\u178A\u17BE\u1798\u1796\u17B8\u1782\u17D2\u179A\u17BC\u1796\u17C1\u1791\u17D2\u1799\u178A\u17C2\u179A\u17AC\u1791\u17C1?:</span>\n <div class=\"cb-group\" style=\"display:inline-flex; margin-left:4px;\">\n <div class=\"cb-item\">\n <div class=\"cb-box <%= health_info?.is_hospitalized === false ? 'checked' : '' %>\"></div>\n <span>\u1798\u17B7\u1793\u1798\u17B6\u1793</span>\n </div>\n <div class=\"cb-item\">\n <div class=\"cb-box <%= health_info?.is_hospitalized === true ? 'checked' : '' %>\"></div>\n <span>\u1798\u17B6\u1793</span>\n </div>\n </div>\n\n <% if (health_info?.is_hospitalized) { %>\n <div class=\"detail-line\"><%= health_info?.hospitalized_detail ?? '' %></div>\n <% } %>\n </div>\n\n <div class=\"page-break\"></div>\n <div class=\"page-num\">\u1791\u17C6\u1796\u17D0\u179A 2 \u1793\u17C3 2</div>\n\n <div class=\"health-q\">\n <span class=\"q-text\">4) \u178F\u17BE\u179B\u17C4\u1780\u17A2\u17D2\u1793\u1780\u1792\u17D2\u179B\u17B6\u1794\u17CB\u1794\u17B6\u1793\u1792\u17D2\u179C\u17BE\u179A\u17C4\u1782\u179C\u17B7\u1793\u17B7\u1785\u17D2\u1786\u17D0\u1799 \u1796\u17B7\u1782\u17D2\u179A\u17C4\u17C7\u1787\u17C6\u1784\u17BA\u17AC\u1791\u1791\u17BD\u179B\u1780\u17B6\u179A\u1796\u17D2\u1799\u17B6\u1794\u17B6\u179B\u178A\u17BC\u1785\u1787\u17B6 \u179B\u17BE\u179F\u179F\u1798\u17D2\u1796\u17B6\u1792\u1788\u17B6\u1798 \u1791\u17B9\u1780\u1793\u17C4\u1798\u1795\u17D2\u17A2\u17C2\u1798 \u1787\u17C6\u1784\u17BA\u1794\u17C1\u17C7\u178A\u17BC\u1784 \u1785\u17BB\u1780\u1791\u17D2\u179A\u17BC\u1784 \u1787\u17C6\u1784\u17BA\u179F\u17BD\u178F \u1787\u17C6\u1784\u17BA\u1790\u17D2\u179B\u17BE\u1798 \u1787\u17C6\u1784\u17BA\u178F\u1798\u17D2\u179A\u1784\u1793\u17C4\u1798 \u1798\u17A0\u17B6\u179A\u17B8\u1780 \u1787\u17C6\u1784\u17BA\u178A\u17B6\u1785\u17CB\u179F\u179F\u17C3\u1788\u17B6\u1798\u1781\u17BD\u179A\u1780\u17D2\u1794\u17B6\u179B \u1787\u17C6\u1784\u17BA\u17A2\u17C1\u178A\u179F\u17CD \u1787\u17C6\u1784\u17BA\u1795\u17D2\u179B\u17BC\u179C\u1785\u17B7\u178F\u17D2\u178F \u1796\u17B7\u1780\u17B6\u179A\u1797\u17B6\u1796 \u17AC\u179A\u17B6\u1784\u1780\u17B6\u1799\u1798\u17B7\u1793\u1794\u17D2\u179A\u1780\u17D2\u179A\u178F\u17B8 \u1794\u17D2\u179A\u17BE\u1794\u17D2\u179A\u17B6\u179F\u17CB\u1790\u17D2\u1793\u17B6\u17C6\u1789\u17C0\u1793 \u17AC\u1789\u17C0\u1793\u179F\u17D2\u179A\u17B6 \u17AC\u1787\u17C6\u1784\u17BA\u1795\u17D2\u179F\u17C1\u1784\u1791\u17C0\u178F\u178A\u17C2\u179B\u1798\u17B7\u1793\u1794\u17B6\u1793\u179A\u17C0\u1794\u179A\u17B6\u1794\u17CB\u1781\u17B6\u1784\u179B\u17BE\u178A\u17C2\u179A\u17AC\u1791\u17C1?</span>\n <div class=\"cb-group\" style=\"display:inline-flex; margin-left:4px;\">\n <div class=\"cb-item\">\n <div class=\"cb-box <%= health_info?.is_diagnosed === false ? 'checked' : '' %>\"></div>\n <span>\u1798\u17B7\u1793\u1798\u17B6\u1793</span>\n </div>\n <div class=\"cb-item\">\n <div class=\"cb-box <%= health_info?.is_diagnosed === true ? 'checked' : '' %>\"></div>\n <span>\u1798\u17B6\u1793</span>\n </div>\n </div>\n\n <% if (health_info?.is_diagnosed) { %>\n <div style=\"margin-top:4px; font-size:8pt;\">\u1794\u17BE\u1798\u17B6\u1793\u179F\u17BC\u1798\u1794\u1789\u17D2\u1787\u17B6\u1780\u17CB\u179B\u1798\u17D2\u17A2\u17B7\u178F\u1781\u17B6\u1784\u1780\u17D2\u179A\u17C4\u1798\u17D6</div>\n <div class=\"detail-line\"><%= health_info?.diagnosed_detail ?? '' %></div>\n <% } %>\n </div>\n\n <div class=\"section-header\">\u179F\u17C1\u1785\u1780\u17D2\u178A\u17B8\u1794\u17D2\u179A\u1780\u17B6\u179F\u179A\u1794\u179F\u17CB\u17A2\u17D2\u1793\u1780\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17CB</div>\n\n <div class=\"declaration\">\n <p>1) \u1781\u17D2\u1789\u17BB\u17C6\u17A2\u1793\u17BB\u1789\u17D2\u1789\u17B6\u178F \u1793\u17B7\u1784\u1799\u179B\u17CB\u1796\u17D2\u179A\u1798\u17B2\u17D2\u1799\u1780\u17D2\u179A\u17BB\u1798\u17A0\u17CA\u17BB\u1793\u1794\u17D2\u179A\u17BE\u1794\u17D2\u179A\u17B6\u179F\u17CB\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793 \u1793\u17B7\u1784\u1791\u17B7\u1793\u17D2\u1793\u1793\u17D0\u1799\u1791\u17B6\u17C6\u1784\u179F\u17D2\u179A\u17BB\u1784\u178A\u17C2\u179B\u1781\u17D2\u1789\u17BB\u17C6\u1794\u17B6\u1793\u1795\u17D2\u178A\u179B\u17CB\u1793\u17C5\u1780\u17D2\u1793\u17BB\u1784\u1796\u17B6\u1780\u17D2\u1799\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u179A\u1794\u179F\u17CB\u1781\u17D2\u1789\u17BB\u17C6\u1780\u17D2\u1793\u17BB\u1784\u1782\u17C4\u179B\u1794\u17C6\u178E\u1784 \u179F\u17D2\u179A\u1794\u178F\u17B6\u1798\u1785\u17D2\u1794\u17B6\u1794\u17CB \u178A\u17BC\u1785\u1787\u17B6 \u1780\u17B6\u179A\u1795\u17D2\u179F\u1796\u17D2\u179C\u1795\u17D2\u179F\u17B6\u1799\u1791\u17B8\u1795\u17D2\u179F\u17B6\u179A \u1780\u17B6\u179A\u179F\u17B7\u1780\u17D2\u179F\u17B6\u1791\u17B8\u1795\u17D2\u179F\u17B6\u179A \u1793\u17B7\u1784 \u1780\u17B6\u179A\u1794\u1798\u17D2\u179A\u17BE\u17A2\u178F\u17B7\u1790\u17B7\u1787\u1793\u178A\u17C4\u1799\u1780\u17D2\u179A\u17BB\u1798\u17A0\u17CA\u17BB\u1793 \u179F\u1798\u17D2\u1796\u17D0\u1793\u17D2\u1792\u1780\u17D2\u179A\u17BB\u1798\u17A0\u17CA\u17BB\u1793 \u17AC \u1787\u17B6\u178A\u17C3\u1782\u17BC\u1796\u17B6\u178E\u17B7\u1787\u17D2\u1787\u1780\u1798\u17D2\u1798\u179A\u1794\u179F\u17CB\u1780\u17D2\u179A\u17BB\u1798\u17A0\u17CA\u17BB\u1793 \u178A\u17C4\u1799\u1798\u17B7\u1793\u1785\u17B6\u17C6\u1794\u17B6\u1785\u17CB\u1798\u17B6\u1793\u1780\u17B6\u179A\u1799\u179B\u17CB\u1796\u17D2\u179A\u1798 \u1793\u17B7\u1784\u1787\u17BC\u1793\u178A\u17C6\u178E\u17B9\u1784\u1794\u1793\u17D2\u1790\u17C2\u1798\u1796\u17B8\u1781\u17D2\u1789\u17BB\u17C6\u17A1\u17BE\u1799\u17D4 \u1780\u17D2\u179A\u17BB\u1798\u17A0\u17CA\u17BB\u1793\u1798\u17B7\u1793\u178F\u17D2\u179A\u17BC\u179C\u1794\u17B6\u1793\u17A2\u1793\u17BB\u1789\u17D2\u1789\u17B6\u178F\u17B2\u17D2\u1799\u1794\u1789\u17D2\u1785\u17C1\u1789\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u178E\u17B6\u1798\u17BD\u1799\u1791\u17C5\u1797\u17B6\u1782\u17B8\u1791\u17B8\u1794\u17B8\u178E\u17B6\u1798\u17BD\u1799 \u17AC\u1794\u17D2\u179A\u17BE\u1794\u17D2\u179A\u17B6\u179F\u17CB\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u1793\u17C4\u17C7\u179F\u1798\u17D2\u179A\u17B6\u1794\u17CB\u1782\u17C4\u179B\u1794\u17C6\u178E\u1784\u1795\u17D2\u179F\u17C1\u1784\u1791\u17C0\u178F\u178A\u17C2\u179B\u1798\u17B7\u1793\u1791\u17B6\u1780\u17CB\u1791\u1784\u1793\u17B9\u1784\u1782\u17C4\u179B\u1794\u17C6\u178E\u1784\u1791\u17B6\u17C6\u1784\u17A1\u17B6\u1799\u1781\u17B6\u1784\u179B\u17BE\u17A1\u17BE\u1799 \u1794\u17D2\u179A\u179F\u17B7\u1793\u1794\u17BE\u1782\u17D2\u1798\u17B6\u1793\u1780\u17B6\u179A\u1799\u179B\u17CB\u1796\u17D2\u179A\u1798\u1796\u17D2\u179A\u17C0\u1784\u1787\u17B6\u179B\u17B6\u1799\u179B\u1780\u17D2\u1781\u178E\u17CD\u17A2\u1780\u17D2\u179F\u179A\u1793\u17C4\u17C7\u17D4</p>\n <p>2) \u1781\u17D2\u1789\u17BB\u17C6\u179F\u17BC\u1798\u17A2\u17C7\u17A2\u17B6\u1784\u1790\u17B6\u1794\u17B6\u1793\u17A2\u17B6\u1793 \u1793\u17B7\u1784\u1799\u179B\u17CB\u179F\u17D2\u179A\u1794\u1793\u17BC\u179C\u1782\u17D2\u179A\u1794\u17CB\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u1780\u17D2\u1793\u17BB\u1784\u17AF\u1780\u179F\u17B6\u179A\u1793\u17C1\u17C7\u17D4 \u1781\u17D2\u1789\u17BB\u17C6\u179F\u17BC\u1798\u1794\u17D2\u179A\u1780\u17B6\u179F\u1790\u17B6\u1782\u17D2\u179A\u1794\u17CB\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u178A\u17C2\u179B\u1794\u17B6\u1793\u1795\u17D2\u178A\u179B\u17CB\u1793\u17C5\u1780\u17D2\u1793\u17BB\u1784\u1796\u17B6\u1780\u17D2\u1799\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1793\u17C1\u17C7 \u1796\u17B7\u178F\u1787\u17B6\u1798\u17B6\u1793\u1797\u17B6\u1796\u1796\u17C1\u1789\u179B\u17C1\u1789 \u1793\u17B7\u1784\u178F\u17D2\u179A\u17B9\u1798\u178F\u17D2\u179A\u17BC\u179C\u1796\u17B7\u178F\u1794\u17D2\u179A\u17B6\u1780\u178A\u1798\u17C2\u1793\u17D4</p>\n </div>\n\n <div class=\"sig-row\">\n <div class=\"sig-block\">\n <div>\u17A0\u178F\u17D2\u1790\u179B\u17C1\u1781\u17B6 \u17AC\u179F\u17D2\u1793\u17B6\u1798\u1798\u17C1\u178A\u17C3\u179A\u1794\u179F\u17CB\u17A2\u17D2\u1793\u1780\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784</div>\n <div class=\"sig-line\"></div>\n <div class=\"field-row\">\n <span class=\"label\">\u1788\u17D2\u1798\u17C4\u17C7</span>\n <span class=\"underline full\"><%= signature_info?.applicant_name ?? '' %></span>\n </div>\n <div class=\"field-row\">\n <span class=\"label\">\u1780\u17B6\u179B\u1794\u179A\u17B7\u1785\u17D2\u1786\u17C1\u1791</span>\n <span class=\"underline full\"><%= signature_info?.applicant_signature_date ?? '' %></span>\n </div>\n </div>\n <div class=\"sig-block\">\n <div>\u17A0\u178F\u17D2\u1790\u179B\u17C1\u1781\u17B6 \u17AC\u179F\u17D2\u1793\u17B6\u1798\u1798\u17C1\u178A\u17C3\u179A\u1794\u179F\u17CB\u179F\u17B6\u1780\u17D2\u179F\u17B8</div>\n <div class=\"sig-line\"></div>\n <div class=\"field-row\">\n <span class=\"label\">\u1788\u17D2\u1798\u17C4\u17C7</span>\n <span class=\"underline full\"><%= signature_info?.witness_name ?? '' %></span>\n </div>\n <div class=\"field-row\">\n <span class=\"label\">\u1780\u17B6\u179B\u1794\u179A\u17B7\u1785\u17D2\u1786\u17C1\u1791</span>\n <span class=\"underline full\"><%= signature_info?.witness_signature_date ?? '' %></span>\n </div>\n </div>\n </div>\n</body>\n</html>\n";
1
+ export declare const SIO_FORM_KH_TEMPLATE = "\n<!doctype html>\n<html lang=\"km\">\n <head>\n <meta charset=\"UTF-8\" />\n <meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\" />\n <title>\u1796\u17B6\u1780\u17D2\u1799\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17A2\u17B6\u1799\u17BB\u1787\u17B8\u179C\u17B7\u178F</title>\n\n <style>\n @font-face {\n font-family: 'Khmer OS';\n src: url('data:font/truetype;base64,<%= font_base64 %>') format('truetype');\n font-weight: normal;\n font-style: normal;\n }\n\n body {\n font-family: \"Khmer OS\", system-ui, sans-serif;\n font-size: 14px;\n line-height: 1.4;\n margin: 1rem;\n /* Reduced from 2rem */\n background: #fff;\n color: #000;\n }\n\n .space {\n width: 8px;\n }\n\n .space-height {\n height: 60px;\n align-items: center;\n }\n\n .signature-space {\n height: 100px;\n margin-top: 10px;\n }\n\n /* === Page header === */\n .page-header {\n margin-bottom: 0.5rem;\n /* Reduced from 1rem */\n page-break-inside: avoid;\n }\n\n .header-container {\n display: flex;\n flex-direction: column;\n align-items: center;\n }\n\n .title-logo {\n width: 80px;\n /* Reduced from 100px */\n height: auto;\n }\n\n .title-container {\n text-align: center;\n }\n\n .title-container .title {\n font-weight: 700;\n font-size: 16px;\n line-height: 1.4;\n margin: 0;\n }\n\n /* === Card Header === */\n .card-header {\n background-color: #0d6efd;\n color: white;\n text-align: center;\n padding: 0.1rem 0;\n border-radius: 6px 6px 0 0;\n font-size: 1rem;\n font-weight: bold;\n margin-bottom: 0.5rem;\n /* Reduced */\n -webkit-print-color-adjust: exact;\n print-color-adjust: exact;\n }\n\n /* === Form Text === */\n .form-container {\n display: flex;\n flex-wrap: wrap;\n margin: 0;\n padding: 0;\n }\n\n .form-item {\n display: flex;\n align-items: flex-start;\n flex-wrap: wrap;\n width: 100%;\n margin-bottom: 0.5rem;\n }\n\n .label,\n .question-label {\n word-wrap: break-word;\n white-space: normal;\n font-weight: bold;\n }\n\n /* Underline for blanks */\n .underline {\n border-bottom: 1px dashed #000;\n flex: 1;\n min-width: 60px;\n min-height: 1em;\n display: inline-flex;\n align-items: center;\n justify-content: center;\n text-align: center;\n word-break: break-word;\n white-space: normal;\n -webkit-box-decoration-break: clone;\n box-decoration-break: clone;\n align-self: flex-end;\n }\n\n /* size variants */\n .underline.xs { flex: none; width: 30px; min-width: unset; }\n .underline.sm { flex: none; width: 80px; min-width: unset; }\n .underline.md { flex: none; width: 180px; min-width: unset; }\n .underline.lg { flex: 2; }\n\n .underline.with-unit {\n flex: 1;\n min-width: 0;\n display: block;\n word-break: break-word;\n white-space: normal;\n border-bottom: none;\n line-height: 1.6em;\n text-align: left;\n padding-left: 4px;\n }\n\n .with-unit .value {\n display: inline;\n text-decoration: underline;\n text-decoration-style: dashed;\n text-decoration-color: #000; \n text-underline-offset: 3px; \n -webkit-box-decoration-break: clone;\n box-decoration-break: clone;\n vertical-align: baseline;\n }\n\n .unit {\n display: inline;\n white-space: nowrap;\n margin-left: 4px;\n text-decoration: none; \n }\n\n /* Checkbox labels */\n .checkbox-label {\n display: inline-flex;\n align-items: center;\n gap: 0.5rem;\n position: relative;\n cursor: pointer;\n padding-left: 0.2rem;\n user-select: none;\n }\n\n .checkbox-label::before {\n content: \"\";\n display: inline-flex;\n align-items: center;\n justify-content: center;\n width: 20px;\n height: 20px;\n border: 2px solid #555;\n border-radius: 3px;\n background-color: #fff;\n box-sizing: border-box;\n flex-shrink: 0;\n }\n\n .checkbox-label.checked::after {\n content: \"\u2714\";\n position: absolute;\n top: 50%;\n left: 0.2rem;\n width: 20px;\n height: 20px;\n display: flex;\n align-items: center;\n justify-content: center;\n font-size: 14px;\n color: #0d6efd;\n transform: translateY(-50%);\n pointer-events: none;\n }\n\n /* === Table data === */\n .table-container {\n margin: auto;\n margin-bottom: 4px;\n }\n\n table {\n width: 100%;\n border-collapse: collapse;\n }\n\n th,\n td {\n border: 1px solid #ccc;\n padding: 0;\n font-size: 14px;\n }\n\n .cell {\n min-height: 10px;\n padding: 4px 8px;\n display: flex;\n justify-content: center;\n text-align: center;\n }\n\n th {\n font-weight: 600;\n }\n\n /* === Print-specific: Footer with Page Numbers on the RIGHT === */\n @media print {\n body {\n margin: 0;\n padding-top: 10mm;\n }\n\n /* Make room for footer on the right side */\n @page {\n size: A4 portrait;\n margin: 15mm 15mm 20mm 10mm;\n /* increased right margin slightly for better spacing */\n\n @bottom-right {\n content: \"\u1791\u17C6\u1796\u17D0\u179A \" counter(page) \" \u1793\u17C3 \" counter(pages);\n font-size: 11px;\n color: #555;\n font-family: \"Battambang\", sans-serif;\n }\n }\n\n /* Increment page counter */\n body {\n counter-increment: page;\n }\n\n .page-header,\n .title-container,\n table {\n page-break-inside: avoid;\n }\n\n .card-header {\n -webkit-print-color-adjust: exact;\n print-color-adjust: exact;\n }\n }\n </style>\n </head>\n\n <body>\n <div class=\"page-header\">\n <img src=\"data:image/png;base64,<%= logo_base64 %>\" alt=\"Logo\" class=\"title-logo\" />\n <div class=\"title-container\">\n <h1 class=\"title\">\u1796\u17B6\u1780\u17D2\u1799\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17A2\u17B6\u1799\u17BB\u1787\u17B8\u179C\u17B7\u178F</h1>\n <h1 class=\"title\">\n \u179F\u1798\u17D2\u179A\u17B6\u1794\u17CB\u1791\u1798\u17D2\u179A\u1784\u17CB\u179F\u17B6\u1798\u1789\u17D2\u1789\u179F\u1798\u17D2\u179A\u17B6\u1794\u17CB\u17A2\u178F\u17B7\u1790\u17B7\u1787\u1793\u1787\u17C4\u1782\u1787\u17D0\u1799\u17A0\u17D2\u179C\u17B6\u1799\u1793\u17C2\u1793 (SIO)\n </h1>\n </div>\n </div>\n\n <div class=\"form-container\">\n <div class=\"form-item\">\n <span class=\"label\">\u1788\u17D2\u1798\u17C4\u17C7\u1793\u17B7\u1784\u179B\u17C1\u1781\u1780\u17BC\u178A\u179F\u17B6\u1781\u17B6</span>\n <span class=\"underline\">\n <%= branch_staff_app_info.branch_name ?? '' %> / <%= branch_staff_app_info.branch_code ?? '' %>\n </span>\n <span class=\"label\">\u1788\u17D2\u1798\u17C4\u17C7\u1793\u17B7\u1784\u179B\u17C1\u1781\u1780\u17BC\u178A\u1794\u17BB\u1782\u17D2\u1782\u179B\u17B7\u1780\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17CB</span>\n <span class=\"underline\">\n <%= branch_staff_app_info.advisor_name ?? '' %> / <%= branch_staff_app_info.advisor_code ?? '' %>\n </span>\n </div>\n <div class=\"form-item\">\n <span class=\"label\">\u1788\u17D2\u1798\u17C4\u17C7\u1793\u17B7\u1784\u179B\u17C1\u1781\u1780\u17BC\u178A\u1794\u17BB\u1782\u17D2\u1782\u179B\u17B7\u1780\u1792\u1793\u17B6\u1782\u17B6\u179A</span>\n <span class=\"underline\">\n <%= branch_staff_app_info.bank_staff_name ?? '' %> / <%= branch_staff_app_info.bank_staff_code ?? '' %>\n </span>\n <span class=\"label\">\u179B\u17C1\u1781\u1796\u17B6\u1780\u17D2\u1799\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6</span>\n <span class=\"underline\"><%= branch_staff_app_info.application_no ?? '' %></span>\n </div>\n </div>\n\n <!-- Section 1 -->\n <div class=\"card-header\">\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u17A2\u17C6\u1796\u17B8\u17A2\u17D2\u1793\u1780\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1796\u178E\u17D2\u178E\u179F\u1793\u17D2\u1799\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17CB</div>\n\n <div class=\"form-container\">\n <div class=\"form-item\">\n <span class=\"label\">\u1788\u17D2\u1798\u17C4\u17C7\u1796\u17C1\u1789\u178A\u17BC\u1785\u1794\u1784\u17D2\u17A0\u17B6\u1789\u1793\u17C5\u1780\u17D2\u1793\u17BB\u1784\u17AF\u1780\u179F\u17B6\u179A\u17A2\u178F\u17D2\u178F\u179F\u1789\u17D2\u1789\u17B6\u178E \u1787\u17B6\u1797\u17B6\u179F\u17B6\u1781\u17D2\u1798\u17C2\u179A:</span>\n <span class=\"underline\"><%= applicant_info.full_name_kh ?? '' %></span>\n <span class=\"label\">\u1787\u17B6\u1797\u17B6\u179F\u17B6\u17A2\u1784\u17CB\u1782\u17D2\u179B\u17C1\u179F</span>\n <span class=\"underline\"><%= applicant_info.full_name ?? '' %></span>\n <span class=\"question-label\">\u1797\u17C1\u1791:</span>\n <label class=\"checkbox-label <%= applicant_info.gender === 'M' ? 'checked' : '' %>\">\u1794\u17D2\u179A\u17BB\u179F</label>\n <label class=\"checkbox-label <%= applicant_info.gender === 'F' ? 'checked' : '' %>\">\u179F\u17D2\u179A\u17B8</label>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">\u179F\u17D2\u1790\u17B6\u1793\u1797\u17B6\u1796\u1782\u17D2\u179A\u17BD\u179F\u17B6\u179A:</span>\n <label class=\"checkbox-label <%= applicant_info.marital_status === 'single' ? 'checked' : '' %>\">\n \u1793\u17C5\u179B\u17B8\u179C\n </label>\n <label class=\"checkbox-label <%= applicant_info.marital_status === 'married' ? 'checked' : '' %>\">\n \u179A\u17C0\u1794\u1780\u17B6\u179A\u17A0\u17BE\u1799\n </label>\n <label class=\"checkbox-label <%= applicant_info.marital_status === 'divorced' ? 'checked' : '' %>\">\n \u179B\u17C2\u1784\u179B\u17C7\n </label>\n <label class=\"checkbox-label <%= applicant_info.marital_status === 'widowed' ? 'checked' : '' %>\">\n \u1798\u17C1\u1798\u17C9\u17B6\u1799/\u1796\u17C4\u17C7\u1798\u17C9\u17B6\u1799\n </label>\n\n <div class=\"space\"></div>\n\n <span class=\"label\">\u178F\u17BD\u1793\u17B6\u1791\u17B8 \u1793\u17B7\u1784\u1794\u17D2\u179A\u1797\u17C1\u1791\u1780\u17B6\u179A\u1784\u17B6\u179A:</span>\n <span class=\"underline\"><%= applicant_info.occupation ?? '' %></span>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">\u17AF\u1780\u179F\u17B6\u179A\u1794\u1789\u17D2\u1785\u17B6\u1780\u17CB\u17A2\u178F\u17D2\u178F\u179F\u1789\u17D2\u1789\u17B6\u178E:</span>\n <label class=\"checkbox-label <%= applicant_info.identity_type === 'nid' ? 'checked' : '' %>\">\n \u17A2\u178F\u17D2\u178F\u179F\u1789\u17D2\u1789\u17B6\u178E\u1794\u178E\u17D2\u178E\n </label>\n <label class=\"checkbox-label <%= applicant_info.identity_type === 'passport' ? 'checked' : '' %>\">\n \u179B\u17B7\u1781\u17B7\u178F\u1786\u17D2\u179B\u1784\u178A\u17C2\u1793\n </label>\n <label class=\"checkbox-label <%= applicant_info.identity_type === 'birth_cert' ? 'checked' : '' %>\">\n \u179F\u17C6\u1794\u17BB\u178F\u17D2\u179A\u1780\u17C6\u178E\u17BE\u178F\n </label>\n\n <!-- other field stays separate since it has extra input -->\n <label class=\"checkbox-label <%= applicant_info.identifier_type === 'other' ? 'checked' : '' %>\">\u1795\u17D2\u179F\u17C1\u1784\u1791\u17C0\u178F:</label>\n <label class=\"underline\"><%= applicant_info.identity_other_description ?? '' %></label>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">\u179B\u17C1\u1781\u17A2\u178F\u17D2\u178F\u179F\u1789\u17D2\u1789\u17B6\u178E:</span>\n <span class=\"underline\"><%= applicant_info.identity_no ?? '' %></span>\n <span class=\"label\">\u1790\u17D2\u1784\u17C3\u1781\u17C2\u1786\u17D2\u1793\u17B6\u17C6\u1780\u17C6\u178E\u17BE\u178F:</span>\n <span class=\"underline\"><%= applicant_info.date_of_birth ?? '' %></span>\n <span class=\"label\">\u17A2\u17B6\u1799\u17BB:</span>\n <span class=\"underline xs\"><%= applicant_info.age ?? '' %></span>\n <span class=\"label\">\u179F\u1789\u17D2\u1785\u17B6\u178F\u17B7:</span>\n <span class=\"underline\"><%= applicant_info.nationality ?? '' %></span>\n <span class=\"label\">\u179B\u17C1\u1781\u1791\u17BC\u179A\u179F\u17D0\u1796\u17D2\u1791:</span>\n <span class=\"underline\"><%= applicant_info.phone_number ?? '' %></span>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">\u17A2\u17B6\u179F\u1799\u178A\u17D2\u178B\u17B6\u1793\u1794\u1785\u17D2\u1785\u17BB\u1794\u17D2\u1794\u1793\u17D2\u1793:</span>\n <span class=\"underline\"><%= applicant_info.current_address ?? '' %></span>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">\u179F\u17C1\u1785\u1780\u17D2\u178A\u17B8\u1794\u17D2\u179A\u1780\u17B6\u179F\u179F\u1798\u17D2\u179A\u17B6\u1794\u17CB\u1780\u17B6\u179A\u17A2\u1793\u17BB\u179C\u178F\u17D2\u178A FATCA</span>\n </div>\n </div>\n\n <span class=\"label\"\n >\u17A2\u17D2\u1793\u1780\u179F\u17D2\u1793\u17BE\u179A\u179F\u17BB\u17C6\u1794\u178E\u17D2\u178E\u179F\u1793\u17D2\u1799\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17CB\u1798\u17B7\u1793\u1798\u17C2\u1793\u1787\u17B6\u1796\u179B\u179A\u178A\u17D2\u178B\u17B6\u17A2\u17B6\u1798\u17C1\u179A\u17B7\u1780 \u17AC\n \u1787\u17B6\u1794\u17CB\u1796\u1793\u17D2\u1792\u179F\u17D2\u1793\u17B6\u1780\u17CB\u1793\u17C5\u17A2\u17B6\u1798\u17C1\u179A\u17B7\u1780 \u17AC \u1798\u17B6\u1793\u179F\u17B7\u1791\u17D2\u1792\u17B7\u1780\u17B6\u1793\u17CB Green Card \u1793\u17C4\u17C7\u1791\u17C1\u17D4\n </span>\n\n <div class=\"form-container\">\n <div class=\"form-item\">\n <label class=\"checkbox-label <%= fatca_info.is_fatca === false ? 'checked' : '' %>\">\u1798\u17B7\u1793\u1798\u17C2\u1793</label>\n <label class=\"checkbox-label <%= fatca_info.is_fatca === true ? 'checked' : '' %>\">\u1798\u17C2\u1793</label>\n <span class=\"label\">US TIN:</span>\n <span class=\"underline\"><%= fatca_info.us_tin_no ?? '' %></span>\n <span class=\"label\">\u179B\u17C1\u1781\u1780\u17BC\u178A\u179B\u17BE\u1780\u179B\u17C2\u1784 FATCA (\u1794\u17D2\u179A\u179F\u17B7\u1793\u1798\u17B6\u1793):</span>\n <span class=\"underline\"><%= fatca_info.fatca_exempt_code ?? '' %></span>\n </div>\n </div>\n\n <span class=\"label\">\n \u1794\u17D2\u179A\u179F\u17B7\u1793\u1794\u17BE\u1780\u17B6\u179A\u1794\u1789\u17D2\u1785\u17B6\u1780\u17CB\u17A2\u17C7\u17A2\u17B6\u1784\u178E\u17B6\u1798\u17BD\u1799\u1798\u17B7\u1793\u178F\u17D2\u179A\u17B9\u1798\u178F\u17D2\u179A\u17BC\u179C\n \u1781\u17D2\u1789\u17BB\u17C6\u1793\u17B9\u1784\u1794\u17D2\u179A\u1782\u179B\u17CB\u1787\u17BC\u1793\u1793\u17BC\u179C\u17AF\u1780\u179F\u17B6\u179A\u1790\u17D2\u1798\u17B8\u1780\u17D2\u1793\u17BB\u1784\u179A\u1799\u17C7\u1796\u17C1\u179B \u17E3\u17E0\u1790\u17D2\u1784\u17C3\n \u17A0\u17BE\u1799\u17A2\u17C7\u17A2\u17B6\u1784\u1790\u17B6\u1781\u17D2\u1789\u17BB\u17C6\u1798\u17B7\u1793\u1787\u17B6\u1794\u17CB\u1796\u1793\u17D2\u1792\u1780\u17B6\u178F\u17CB\u1791\u17BB\u1780\u179A\u1794\u179F\u17CB\u179F\u17A0\u179A\u178A\u17D2\u178B\u17A2\u17B6\u1798\u17C1\u179A\u17B7\u1780\u1791\u17C1\n </span>\n\n <!-- Section 2 -->\n <div class=\"card-header\">\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u17A2\u17C6\u1796\u17B8\u1795\u179B\u17B7\u178F\u1795\u179B</div>\n <div class=\"table-container\">\n <table>\n <thead>\n <tr>\n <th><div class=\"cell\">\u1788\u17D2\u1798\u17C4\u17C7\u1795\u179B\u17B7\u178F\u1795\u179B \u1793\u17B7\u1784\u179A\u1799\u17C7\u1796\u17C1\u179B\u1792\u17B6\u1793\u17B6</div></th>\n <th><div class=\"cell\">\u1791\u17B9\u1780\u1794\u17D2\u179A\u17B6\u1780\u17CB\u178F\u17D2\u179A\u17BC\u179C\u1792\u17B6\u1793\u17B6(\u178A\u17BB\u179B\u17D2\u179B\u17B6\u179A\u17A2\u17B6\u1798\u17C1\u179A\u17B7\u1780)</div></th>\n <th><div class=\"cell\">\u179A\u1794\u17C0\u1794\u1794\u1784\u17CB\u1794\u17BB\u1796\u17D2\u179C\u179B\u17B6\u1797</div></th>\n <th>\n <div class=\"cell\">\u1794\u17BB\u1796\u17D2\u179C\u179B\u17B6\u1797\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17CB(\u178A\u17BB\u179B\u17D2\u179B\u17B6\u179A\u17A2\u17B6\u1798\u17C1\u179A\u17B7\u1780)</div>\n </th>\n </tr>\n </thead>\n <tbody>\n <% product_payment_info?.products?.forEach(function(product) { %>\n <tr>\n <td><div class=\"cell\"><%= product.name %> (<%= product.term ?? '' %>)</div></td>\n <td><div class=\"cell\"><%= product.sum_assured ?? '' %></div></td>\n <td><div class=\"cell\"><%= product.payment_mode ?? product.payment_mode %></div></td>\n <td><div class=\"cell\"><%= product.premium ?? '' %></div></td>\n </tr>\n <% }) %>\n </tbody>\n </table>\n </div>\n <div class=\"form-container\">\n <div class=\"form-item\">\n <span class=\"question-label\">\u179C\u17B7\u1792\u17B8\u179F\u17B6\u179F\u17D2\u179A\u17D2\u178A\u1794\u1784\u17CB\u1794\u17BB\u1796\u17D2\u179C\u179B\u17B6\u1797\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17CB:</span>\n <label class=\"checkbox-label <%= product_payment_info.payment_method === 'transfer' ? 'checked' : '' %>\">\n \u1780\u17B6\u179A\u1795\u17D2\u1791\u17C1\u179A\u1794\u17D2\u179A\u17B6\u1780\u17CB\u1785\u17BC\u179B\u1791\u17C5\u1780\u17D2\u1793\u17BB\u1784\u1782\u178E\u1793\u17B8\u179A\u1794\u179F\u17CB\u17A0\u17D2\u179C\u17B8\u179B\u17B8\u17A1\u17B6\u1799\u17A0\u17D2\u179C\u17CD\n </label>\n <label class=\"checkbox-label <%= product_payment_info.payment_method === 'partner' ? 'checked' : '' %>\">\n \u178F\u17B6\u1798\u179A\u1799\u17C7\u178A\u17C3\u1782\u17BC\u179A\u179A\u1794\u179F\u17CB\u17A0\u17D2\u179C\u17B8\u179B\u17B8\u17A1\u17B6\u1799\u17A0\u17D2\u179C\u17CD\n </label>\n </div>\n </div>\n\n <!-- Section 3 -->\n <div class=\"card-header\">\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u17A2\u17C6\u1796\u17B8\u17A2\u17D2\u1793\u1780\u1791\u1791\u17BD\u179B\u1795\u179B</div>\n <div class=\"table-container\">\n <table>\n <thead>\n <tr>\n <th><div class=\"cell\">\u1788\u17D2\u1798\u17C4\u17C7\u1796\u17C1\u1789\u179A\u1794\u179F\u17CB\u17A2\u17D2\u1793\u1780\u1791\u1791\u17BD\u179B\u1795\u179B</div></th>\n <th><div class=\"cell\">\u17A2\u17B6\u1799\u17BB</div></th>\n <th><div class=\"cell\">\u1791\u17C6\u1793\u17B6\u1780\u17CB\u1791\u17C6\u1793\u1784</div></th>\n <th><div class=\"cell\">\u179B\u17C1\u1781\u17A2\u178F\u1780\u17D2\u178F\u179F\u1789\u17D2\u1789\u17B6\u178E</div></th>\n <th><div class=\"cell\">% \u1793\u17C3\u1780\u17B6\u179A\u1794\u17C2\u1784\u1785\u17C2\u1780</div></th>\n </tr>\n </thead>\n <tbody>\n <% beneficiary_info?.forEach(function(beneficiary) { %>\n <tr>\n <td><div class=\"cell\"><%= beneficiary.full_name ?? '' %></div></td>\n <td><div class=\"cell\"><%= beneficiary.age ?? '' %></div></td>\n <td>\n <div class=\"cell\"><%= beneficiary.relationship ?? '' %></div>\n </td>\n <td>\n <div class=\"cell\"><%= beneficiary.id_number ?? '' %></div>\n </td>\n <td><div class=\"cell\"><%= beneficiary.percentage ?? '' %></div></td>\n </tr>\n <% }) %>\n <tr>\n <td colspan=\"4\">\n <div class=\"cell\">\n \u1780\u178E\u178F\u17CB\u179F\u1798\u17D2\u1782\u17B6\u179B\u17CB\u17D6\n \u1794\u17D2\u179A\u179F\u17B7\u1793\u1794\u17BE\u1797\u17B6\u1782\u179A\u1799\u1798\u17B7\u1793\u178F\u17D2\u179A\u17BC\u179C\u1794\u17B6\u1793\u1794\u1789\u17D2\u1787\u17B6\u1780\u17CB\u1785\u17C6\u1793\u17BD\u1793\u1791\u17B9\u1780\u1794\u17D2\u179A\u17B6\u1780\u17CB\u1793\u17B9\u1784\u178F\u17D2\u179A\u17BC\u179C\u1794\u17C2\u1784\u1785\u17C2\u1780\u179F\u17D2\u1798\u17BE\u17D7\u1782\u17D2\u1793\u17B6\n </div>\n </td>\n <td><div class=\"cell\">% \u179F\u179A\u17BB\u1794\u179F\u17D2\u1798\u17BE\u179A \u17E1\u17E0\u17E0%</div></td>\n </tr>\n </tbody>\n </table>\n </div>\n\n <!-- Section 4 -->\n <div class=\"card-header\">\n \u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u1796\u17B6\u1780\u17CB\u1796\u17D0\u1793\u17D2\u1791\u1793\u17B9\u1784\u179F\u17BB\u1781\u1797\u17B6\u1796\u179A\u1794\u179F\u17CB \u17A2\u17D2\u1793\u1780\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1794\u178E\u17D2\u178E\u179F\u1793\u17D2\u1799\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17CB\n </div>\n\n <div class=\"form-container\">\n <!-- Question 1 -->\n <div class=\"form-item\">\n <span class=\"label\">1) \u1780\u1798\u17D2\u1796\u179F\u17CB:</span>\n <span class=\"underline sm\"><%= health_info.height ?? '' %></span>\n <span class=\"label\">\u179F.\u1798</span>\n <div class=\"space\"></div>\n <span class=\"label\">\u1791\u1798\u17D2\u1784\u1793\u17CB:</span>\n <span class=\"underline sm\"><%= health_info.weight ?? '' %></span>\n <span class=\"label\">\u1782.\u1780</span>\n <div class=\"space\"></div>\n <span class=\"question-label\">\u178F\u17BE\u179B\u17C4\u1780\u17A2\u17D2\u1793\u1780\u1796\u17B7\u179F\u17B6\u179A\u1794\u17B6\u179A\u17B8\u178A\u17C2\u179A\u17AC\u1791\u17C1?:</span>\n <label class=\"checkbox-label <%= health_info.is_smoke === false ? 'checked' : '' %>\">\n \u1798\u17B7\u1793\u1798\u17B6\u1793\n </label>\n <label class=\"checkbox-label <%= health_info.is_smoke === true ? 'checked' : '' %>\">\n \u1798\u17B6\u1793\n </label>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">\u1785\u17C6\u1793\u17BD\u1793\u17D6</span>\n <% if (health_info.smoke_detail) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\"><%= health_info.smoke_detail %></span>\n <span class=\"unit\">\u178A\u17BE\u1798\u1780\u17D2\u1793\u17BB\u1784\u1798\u17BD\u1799\u179F\u1794\u17D2\u178A\u17B6\u17A0\u17CD</span>\n </span>\n <% } else { %>\n <span class=\"underline\"></span>\n <% } %>\n </div>\n </div>\n\n <div class=\"form-container\">\n <!-- Question 2 -->\n <div class=\"form-item\">\n <span class=\"question-label\">2) \u178F\u17BE\u179B\u17C4\u1780\u17A2\u17D2\u1793\u1780\u1796\u17B7\u179F\u17B6\u179A\u1782\u17D2\u179A\u17BF\u1784\u179F\u17D2\u179A\u179C\u17B9\u1784\u178A\u17C2\u179A\u17AC\u1791\u17C1?:</span>\n <label class=\"checkbox-label <%= health_info.is_drink_alcohol === false ? 'checked' : '' %>\">\n \u1798\u17B7\u1793\u1798\u17B6\u1793\n </label>\n <label class=\"checkbox-label <%= health_info.is_drink_alcohol === true ? 'checked' : '' %>\">\n \u1798\u17B6\u1793\n </label>\n </div>\n <div class=\"form-item\">\n <span class=\"label\">\u1785\u17C6\u1793\u17BD\u1793</span>\n <% if (health_info.hospitalized_detail) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\"><%= health_info.hospitalized_detail %></span>\n <span class=\"unit\">\u1780\u17D2\u1793\u17BB\u1784\u1798\u17BD\u1799\u1790\u17D2\u1784\u17C3</span>\n </span>\n <% } else { %>\n <span class=\"underline\"></span>\n <span class=\"label\">\u1780\u17D2\u1793\u17BB\u1784\u1798\u17BD\u1799\u1790\u17D2\u1784\u17C3</span>\n <% } %>\n </div>\n </div>\n\n <div class=\"form-container\">\n <!-- Question 3 -->\n <span class=\"question-label\">\n 3) \u1780\u17D2\u1793\u17BB\u1784\u179A\u1799\u17C8\u1796\u17C1\u179B\u17E0\u17E2(\u1796\u17B8\u179A)\u1786\u17D2\u1793\u17B6\u17C6\u1785\u17BB\u1784\u1780\u17D2\u179A\u17C4\u1799\u1793\u17C1\u17C7\u178F\u17BE\u179B\u17C4\u1780\u17A2\u17D2\u1793\u1780\u1792\u17D2\u179B\u17B6\u1794\u17CB\u1794\u17B6\u1793\u179F\u1798\u17D2\u179A\u17B6\u1780\u1780\u17D2\u1793\u17BB\u1784\u1798\u1793\u17D2\u1791\u17B8\u179A\u1796\u17C1\u1791\u17D2\u1799\u1792\u17D2\u179B\u17B6\u1794\u17CB\u1794\u17B6\u1793\u1791\u1791\u17BD\u179B\u1780\u17B6\u179A\u179C\u17C7\u1780\u17B6\u178F\u17CB\n \u17AC\u1792\u17D2\u179B\u17B6\u1794\u17CB\u1791\u1791\u17BD\u179B\u1794\u17B6\u1793\u179B\u1791\u17D2\u1792\u1795\u179B\u1781\u17BB\u179F\u1794\u17D2\u179A\u1780\u17D2\u179A\u178F\u17B8\u17A2\u17C6\u1796\u17B8 \u1780\u17B6\u179A\u179C\u17B7\u1797\u17B6\u1782\u1788\u17B6\u1798 \u1780\u17B6\u179A\u179C\u17B7\u1797\u17B6\u1782\u1791\u17B9\u1780\u1793\u17C4\u1798\n \u1780\u17B6\u179A\u1790\u178F\u1780\u17B6\u17C6\u179A\u179F\u17D2\u1798\u17B8\u17A2\u17BB\u17B7\u1785 (X-ray) \u1798\u17C9\u17B6\u179F\u17BB\u17B7\u1793\u179C\u17B6\u179F\u17CB\u1785\u1784\u17D2\u179C\u17B6\u1780\u17CB\u1794\u17C1\u17C7\u178A\u17BC\u1784 \u17A2\u17C1\u1780\u17BC\u179F\u17B6\u179F\u17D2\u179A\u17D2\u178A\n \u179F\u17D2\u1780\u17C1\u1793\u1780\u17B6\u179A\u1785\u17D2\u179A\u17B9\u1794\u179F\u17B6\u1785\u17CB\u1799\u1780\u1796\u17B7\u1793\u17B7\u178F\u17D2\u1799\n \u17AC\u179B\u1791\u17D2\u1792\u1795\u179B\u179C\u17B7\u1797\u17B6\u1782\u1795\u17D2\u179F\u17C1\u1784\u17D7\u1791\u17C0\u178F\u178A\u17C2\u179B\u1798\u17B7\u1793\u1794\u17B6\u1793\u179A\u17C0\u1794\u179A\u17B6\u1794\u17CB\u1781\u17B6\u1784\u178A\u17BE\u1798\u1796\u17B8\u1782\u17D2\u179A\u17BC\u1796\u17C1\u1791\u17D2\u1799\u178A\u17C2\u179A\u17AC\u1791\u17C1?:\n </span>\n <div class=\"form-item\">\n <label class=\"checkbox-label <%= health_info.is_hospitalized === false ? 'checked' : '' %>\">\n \u1798\u17B7\u1793\u1798\u17B6\u1793\n </label>\n <label class=\"checkbox-label <%= health_info.is_hospitalized === true ? 'checked' : '' %>\">\n \u1798\u17B6\u1793\n </label>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">\u1794\u17BE\u1798\u17B6\u1793\u179F\u17BC\u1798\u1795\u17D2\u178A\u179B\u17CB\u1796\u17D0\u178F\u17CD\u1798\u17B6\u1793\u179B\u1798\u17D2\u17A2\u17B7\u178F\u17D6</span>\n <% if (health_info.hospitalized_detail) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\"><%= health_info.hospitalized_detail %></span>\n <span class=\"unit\">\u1780\u17D2\u1793\u17BB\u1784\u1798\u17BD\u1799\u1790\u17D2\u1784\u17C3</span>\n </span>\n <% } else { %>\n <span class=\"underline\"></span>\n <% } %>\n </div>\n </div>\n\n <div class=\"form-container\">\n <!-- Question 4 -->\n <span class=\"question-label\">\n 4) \u178F\u17BE\u179B\u17C4\u1780\u17A2\u17D2\u1793\u1780\u1792\u17D2\u179B\u17B6\u1794\u17CB\u1794\u17B6\u1793\u1792\u17D2\u179C\u17BE\u179A\u17C4\u1782\u179C\u17B7\u1793\u17B7\u1785\u17D2\u1786\u17D0\u1799 \u1796\u17B7\u1782\u17D2\u179A\u17C4\u17C7\u1787\u17C6\u1784\u17BA \u17AC\u1791\u1791\u17BD\u179B\u1780\u17B6\u179A\u1796\u17D2\u1799\u17B6\u1794\u17B6\u179B\u178A\u17BC\u1785\u1787\u17B6\n \u179B\u17BE\u179F\u179F\u1798\u17D2\u1796\u17B6\u1792\u1788\u17B6\u1798 \u1791\u17B9\u1780\u1793\u17C4\u1798\u1795\u17D2\u17A2\u17C2\u1798 \u1787\u17C6\u1784\u17BA\u1794\u17C1\u17C7\u178A\u17BC\u1784 \u1785\u17BB\u1780\u1791\u17D2\u179A\u17BC\u1784 \u1787\u17C6\u1784\u17BA\u179F\u17BD\u178F \u1787\u17C6\u1784\u17BA\u1790\u17D2\u179B\u17BE\u1798\n \u1787\u17C6\u1784\u17BA\u178F\u1798\u17D2\u179A\u1784\u1793\u17C4\u1798 \u1798\u17A0\u17B6\u179A\u17B8\u1780 \u1787\u17C6\u1784\u17BA\u178A\u17B6\u1785\u17CB\u179F\u179F\u17C3\u1788\u17B6\u1798\u1781\u17BD\u179A\u1780\u17D2\u1794\u17B6\u179B \u1787\u17C6\u1784\u17BA\u17A2\u17C1\u178A\u179F\u17CD \u1787\u17C6\u1784\u17BA\u1795\u17D2\u179B\u17BC\u179C\u1785\u17B7\u178F\u17D2\u178F\n \u1796\u17B7\u1780\u17B6\u179A\u1797\u17B6\u1796 \u17AC\u179A\u17B6\u1784\u1780\u17B6\u1799\u1798\u17B7\u1793\u1794\u17D2\u179A\u1780\u17D2\u179A\u178F\u17B8 \u1794\u17D2\u179A\u17BE\u1794\u17D2\u179A\u17B6\u179F\u17CB\u1790\u17D2\u1793\u17B6\u17C6\u1789\u17C0\u1793 \u17AC\u1789\u17C0\u1793\u179F\u17D2\u179A\u17B6\n \u17AC\u1787\u17C6\u1784\u17BA\u1795\u17D2\u179F\u17C1\u1784\u1791\u17C0\u178F\u178A\u17C2\u179B\u1798\u17B7\u1793\u1794\u17B6\u1793\u179A\u17C0\u1794\u179A\u17B6\u1794\u17CB\u1781\u17B6\u1784\u179B\u17BE\u178A\u17C2\u179A\u17AC\u1791\u17C1?\n </span>\n <div class=\"form-item\">\n <label class=\"checkbox-label <%= health_info.is_diagnosed === false ? 'checked' : '' %>\">\n \u1798\u17B7\u1793\u1798\u17B6\u1793\n </label>\n <label class=\"checkbox-label <%= health_info.is_diagnosed === true ? 'checked' : '' %>\">\n \u1798\u17B6\u1793\n </label>\n \n </div>\n <div class=\"form-item\">\n <span class=\"label\">\u1794\u17BE\u1798\u17B6\u1793\u179F\u17BC\u1798\u1794\u1789\u17D2\u1787\u17B6\u1780\u17CB\u179B\u1798\u17D2\u17A2\u17B7\u178F\u1781\u17B6\u1784\u1780\u17D2\u179A\u17C4\u1798\u17D6</span>\n <% if (health_info.diagnosed_detail) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\"><%= health_info.diagnosed_detail %></span>\n </span>\n <% } else { %>\n <span class=\"underline\"></span>\n <% } %>\n </div>\n </div>\n\n <!-- Section 5 -->\n <div class=\"card-header\">\u179F\u17C1\u1785\u1780\u17D2\u178A\u17B8\u1794\u17D2\u179A\u1780\u17B6\u179F\u179A\u1794\u179F\u17CB\u17A2\u17D2\u1793\u1780\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17CB</div>\n <div class=\"form-container\">\n <div class=\"form-item\">\n <span class=\"label\"\n >1) \u1781\u17D2\u1789\u17BB\u17C6\u17A2\u1793\u17BB\u1789\u17D2\u1789\u17B6\u178F \u1793\u17B7\u1784\u1799\u179B\u17CB\u1796\u17D2\u179A\u1798\u17B2\u17D2\u1799\u1780\u17D2\u179A\u17BB\u1798\u17A0\u17CA\u17BB\u1793\u1794\u17D2\u179A\u17BE\u1794\u17D2\u179A\u17B6\u179F\u17CB\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\n \u1793\u17B7\u1784\u1791\u17B7\u1793\u17D2\u1793\u1793\u17D0\u1799\u1791\u17B6\u17C6\u1784\u179F\u17D2\u179A\u17BB\u1784\u178A\u17C2\u179B\u1781\u17D2\u1789\u17BB\u17C6\u1794\u17B6\u1793\u1795\u17D2\u178A\u179B\u17CB\u1793\u17C5\u1780\u17D2\u1793\u17BB\u1784\u1796\u17B6\u1780\u17D2\u1799\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u179A\u1794\u179F\u17CB\u1781\u17D2\u1789\u17BB\u17C6\n \u1780\u17D2\u1793\u17BB\u1784\u1782\u17C4\u179B\u1794\u17C6\u178E\u1784 \u179F\u17D2\u179A\u1794\u178F\u17B6\u1798\u1785\u17D2\u1794\u17B6\u1794\u17CB\u178A\u17BC\u1785\u1787\u17B6\u1780\u17B6\u179A\u1795\u17D2\u179F\u1796\u17D2\u179C\u1795\u17D2\u179F\u17B6\u1799\u1791\u17B8\u1795\u17D2\u179F\u17B6\u179A \u1780\u17B6\u179A\u179F\u17B7\u1780\u17D2\u179F\u17B6\u1791\u17B8\u1795\u17D2\u179F\u17B6\u179A\n \u1793\u17B7\u1784 \u1780\u17B6\u179A\u1794\u1798\u17D2\u179A\u17BE\u17A2\u178F\u17B7\u1790\u17B7\u1787\u1793\u178A\u17C4\u1799\u1780\u17D2\u179A\u17BB\u1798\u17A0\u17CA\u17BB\u1793 \u179F\u1798\u17D2\u1796\u17D0\u1793\u17D2\u1792\u1780\u17D2\u179A\u17BB\u1798\u17A0\u17CA\u17BB\u1793 \u17AC \u1787\u17B6\u178A\u17C3\u1782\u17BC\n \u1796\u17B6\u178E\u17B7\u1787\u17D2\u1787\u1780\u1798\u17D2\u1798\u179A\u1794\u179F\u17CB\u1780\u17D2\u179A\u17BB\u1798\u17A0\u17CA\u17BB\u1793\u178A\u17C4\u1799\u1798\u17B7\u1793\u1785\u17B6\u17C6\u1794\u17B6\u1785\u17CB\u1798\u17B6\u1793\u1780\u17B6\u179A\u1799\u179B\u17CB\u1796\u17D2\u179A\u1798\n \u1793\u17B7\u1784\u1787\u17BC\u1793\u178A\u17C6\u178E\u17B9\u1784\u1794\u1793\u17D2\u1790\u17C2\u1798\u1796\u17B8\u1781\u17D2\u1789\u17BB\u17C6\u17A1\u17BE\u1799\u17D4 \u1780\u17D2\u179A\u17BB\u1798\u17A0\u17CA\u17BB\u1793\u1798\u17B7\u1793\u178F\u17D2\u179A\u17BC\u179C\u1794\u17B6\u1793\u17A2\u1793\u17BB\u1789\u17D2\u1789\u17B6\u178F\u17B2\u17D2\u1799\u1794\u1789\u17D2\u1785\u17C1\u1789\n \u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u178E\u17B6\u1798\u17BD\u1799\u1791\u17C5\u1797\u17B6\u1782\u17B8\u1791\u17B8\u1794\u17B8\u178E\u17B6\u1798\u17BD\u1799\u17AC\u1794\u17D2\u179A\u17BE\u1794\u17D2\u179A\u17B6\u179F\u17CB\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u1793\u17C4\u17C7\u179F\u1798\u17D2\u179A\u17B6\u1794\u17CB\u1782\u17C4\u179B\u1794\u17C6\u178E\u1784\u1795\u17D2\u179F\u17C1\u1784\u1791\u17C0\u178F\u178A\u17C2\u179B\u1798\u17B7\u1793\u1791\u17B6\u1780\u17CB\u1791\u1784\u1793\u17B9\u1784\u1782\u17C4\u179B\u1794\u17C6\u178E\u1784\n \u1791\u17B6\u17C6\u1784\u17A1\u17B6\u1799\u1781\u17B6\u1784\u179B\u17BE\u17A1\u17BE\u1799 \u1794\u17D2\u179A\u179F\u17B7\u1793\u1794\u17BE\u1782\u17D2\u1798\u17B6\u1793\u1780\u17B6\u179A\u1799\u179B\u17CB\u1796\u17D2\u179A\u1798\u1796\u17D2\u179A\u17C0\u1784\u1787\u17B6\u179B\u17B6\u1799\u179B\u1780\u17D2\u1781\u178E\u17CD\u17A2\u1780\u17D2\u179F\u179A\u1793\u17C4\u17C7\u17D4</span\n >\n </div>\n <div class=\"form-item\">\n <span class=\"label\">\n 2) \u1781\u17D2\u1789\u17BB\u17C6\u179F\u17BC\u1798\u17A2\u17C7\u17A2\u17B6\u1784\u1790\u17B6\u1794\u17B6\u1793\u17A2\u17B6\u1793 \u1793\u17B7\u1784\u1799\u179B\u17CB\u179F\u17D2\u179A\u1794\u1793\u17BC\u179C\u1782\u17D2\u179A\u1794\u17CB\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u1780\u17D2\u1793\u17BB\u1784\u17AF\u1780\u179F\u17B6\u179A\u1793\u17C1\u17C7\u17D4\n \u1781\u17D2\u1789\u17BB\u17C6\u179F\u17BC\u1798\u1794\u17D2\u179A\u1780\u17B6\u179F\u1790\u17B6\u1782\u17D2\u179A\u1794\u17CB\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u178A\u17C2\u179B\u1794\u17B6\u1793\u1795\u17D2\u178A\u179B\u17CB\u1793\u17C5\u1780\u17D2\u1793\u17BB\u1784\u1796\u17B6\u1780\u17D2\u1799\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1793\u17C1\u17C7\n \u1796\u17B7\u178F\u1787\u17B6\u1798\u17B6\u1793\u1797\u17B6\u1796\u1796\u17C1\u1789\u179B\u17C1\u1789 \u1793\u17B7\u1784\u178F\u17D2\u179A\u17B9\u1798\u178F\u17D2\u179A\u17BC\u179C\u1796\u17B7\u178F\u1794\u17D2\u179A\u17B6\u1780\u178A\u1798\u17C2\u1793\u17D4\n </span>\n </div>\n </div>\n <div class=\"table-container\">\n <table>\n <thead>\n <tr>\n <th style=\"width: 50%\">\n <div class=\"cell\">\n \u17A0\u178F\u17D2\u1790\u179B\u17C1\u1781\u17B6 \u17AC\u179F\u17D2\u1793\u17B6\u1798\u1798\u17C1\u178A\u17C3\u179A\u1794\u179F\u17CB\u17A2\u17D2\u1793\u1780\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\n </div>\n <div class=\"signature-space\"></div>\n </th>\n <th style=\"width: 50%\">\n <div class=\"cell\">\u17A0\u178F\u17D2\u1790\u179B\u17C1\u1781\u17B6 \u17AC\u179F\u17D2\u1793\u17B6\u1798\u1798\u17C1\u178A\u17C3\u179A\u1794\u179F\u17CB\u179F\u17B6\u1780\u17D2\u179F\u17B8</div>\n <div class=\"signature-space\"></div>\n </th>\n </tr>\n </thead>\n <tbody>\n <tr>\n <td>\n <div class=\"form-container space-height\">\n <div class=\"form-item\">\n <div class=\"space\"></div>\n <span class=\"label\">\u1788\u17D2\u1798\u17C4\u17C7</span>\n <!-- <span class=\"underline\"></span> -->\n <% if (signature_info.applicant_name) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\"><%= signature_info.applicant_name %></span>\n </span>\n <% } else { %>\n <span class=\"underline\"></span>\n <% } %>\n <div class=\"space\"></div> \n </div>\n </td>\n <td>\n <div class=\"form-container space-height\">\n <div class=\"form-item\">\n <div class=\"space\"></div>\n <span class=\"label\">\u1788\u17D2\u1798\u17C4\u17C7</span>\n <% if (signature_info.witness_name) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\"><%= signature_info.witness_name %></span>\n </span>\n <% } else { %>\n <span class=\"underline\"></span>\n <% } %>\n <div class=\"space\"></div> \n </div>\n </div>\n </td>\n </tr>\n <tr>\n <td>\n <div class=\"form-container space-height\">\n <div class=\"form-item\">\n <div class=\"space\"></div>\n <span class=\"label\">\u1780\u17B6\u179B\u1794\u179A\u17B7\u1785\u17D2\u1786\u17C1\u1791</span>\n <% if (signature_info.applicant_signature_date) { %>\n <span class=\"underline with-unit\" >\n <span class=\"value\"><%= signature_info.applicant_signature_date %></span>\n </span>\n <% } else { %>\n <span class=\"underline\"></span>\n <% } %>\n <div class=\"space\"></div> \n </div>\n </div>\n </td>\n <td>\n <div class=\"form-container space-height\">\n <div class=\"form-item\">\n <div class=\"space\"></div>\n <span class=\"label\">\u1780\u17B6\u179B\u1794\u179A\u17B7\u1785\u17D2\u1786\u17C1\u1791</span>\n <% if (signature_info.witness_signature_date) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\"><%= signature_info.witness_signature_date %></span>\n </span>\n <% } else { %>\n <span class=\"underline\"></span>\n <% } %>\n <div class=\"space\"></div> \n </div>\n <!-- <div class=\"space\"></div>\n <span class=\"label\">\u1780\u17B6\u179B\u1794\u179A\u17B7\u1785\u17D2\u1786\u17C1\u1791</span>\n <span class=\"underline\"></span>\n <div class=\"space\"></div> -->\n </div>\n </td>\n </tr>\n </tbody>\n </table>\n </div>\n </body>\n</html>\n";