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.
- package/dist/libs/pdf-form/img/logo.img.d.ts +1 -0
- package/dist/libs/pdf-form/img/logo.img.js +4 -0
- package/dist/libs/pdf-form/pdf-form.lib.js +2 -0
- package/dist/libs/pdf-form/templates/sio-form-kh.template.d.ts +1 -1
- package/dist/libs/pdf-form/templates/sio-form-kh.template.js +680 -527
- package/package.json +1 -1
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Object.defineProperty(exports, "__esModule", { value: true });
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exports.SIO_FORM_KH_TEMPLATE = void 0;
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exports.SIO_FORM_KH_TEMPLATE = `
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<!doctype html>
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<html lang="km">
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<head>
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<meta charset="UTF-8" />
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<meta name="viewport" content="width=device-width, initial-scale=1.0" />
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<title>ពាក្យស្នើសុំធានារ៉ាប់រងអាយុជីវិត</title>
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<style>
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@font-face {
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font-family: 'Khmer OS';
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src: url('data:font/truetype;base64,<%= font_base64 %>') format('truetype');
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font-weight: normal;
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font-style: normal;
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}
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body {
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font-family: "Khmer OS", system-ui, sans-serif;
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font-size: 14px;
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line-height: 1.4;
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margin: 1rem;
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/* Reduced from 2rem */
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background: #fff;
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color: #000;
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}
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.space {
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width: 8px;
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}
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.space-height {
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height: 60px;
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align-items: center;
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}
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.signature-space {
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height: 100px;
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margin-top: 10px;
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}
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/* === Page header === */
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.page-header {
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margin-bottom: 0.5rem;
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/* Reduced from 1rem */
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page-break-inside: avoid;
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}
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.header-container {
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display: flex;
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flex-direction: column;
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align-items: center;
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}
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.title-logo {
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width: 80px;
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/* Reduced from 100px */
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height: auto;
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}
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.title-container {
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text-align: center;
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}
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.title-container .title {
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font-weight: 700;
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font-size: 16px;
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line-height: 1.4;
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margin: 0;
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}
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/* === Card Header === */
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.card-header {
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background-color: #0d6efd;
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color: white;
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text-align: center;
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padding: 0.1rem 0;
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border-radius: 6px 6px 0 0;
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font-size: 1rem;
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font-weight: bold;
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margin-bottom: 0.5rem;
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/* Reduced */
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-webkit-print-color-adjust: exact;
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print-color-adjust: exact;
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}
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/* === Form Text === */
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.form-container {
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display: flex;
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flex-wrap: wrap;
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margin: 0;
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padding: 0;
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}
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.form-item {
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display: flex;
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align-items: flex-start;
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flex-wrap: wrap;
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width: 100%;
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margin-bottom: 0.5rem;
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}
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.label,
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.question-label {
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word-wrap: break-word;
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white-space: normal;
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font-weight: bold;
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}
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/* Underline for blanks */
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.underline {
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border-bottom: 1px dashed #000;
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flex: 1;
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min-width: 60px;
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min-height: 1em;
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display: inline-flex;
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align-items: center;
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justify-content: center;
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text-align: center;
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word-break: break-word;
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white-space: normal;
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-webkit-box-decoration-break: clone;
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box-decoration-break: clone;
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align-self: flex-end;
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}
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/* size variants */
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.underline.xs { flex: none; width: 30px; min-width: unset; }
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.underline.sm { flex: none; width: 80px; min-width: unset; }
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.underline.md { flex: none; width: 180px; min-width: unset; }
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.underline.lg { flex: 2; }
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.underline.with-unit {
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flex: 1;
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min-width: 0;
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display: block;
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word-break: break-word;
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white-space: normal;
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border-bottom: none;
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line-height: 1.6em;
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text-align: left;
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padding-left: 4px;
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}
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.with-unit .value {
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display: inline;
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text-decoration: underline;
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text-decoration-style: dashed;
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text-decoration-color: #000;
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text-underline-offset: 3px;
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-webkit-box-decoration-break: clone;
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box-decoration-break: clone;
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vertical-align: baseline;
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}
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.unit {
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display: inline;
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white-space: nowrap;
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margin-left: 4px;
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text-decoration: none;
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}
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/* Checkbox labels */
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.checkbox-label {
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display: inline-flex;
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align-items: center;
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gap: 0.5rem;
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position: relative;
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cursor: pointer;
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padding-left: 0.2rem;
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user-select: none;
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}
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.checkbox-label::before {
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content: "";
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display: inline-flex;
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align-items: center;
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justify-content: center;
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width: 20px;
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height: 20px;
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border: 2px solid #555;
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border-radius: 3px;
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background-color: #fff;
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box-sizing: border-box;
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flex-shrink: 0;
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}
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.checkbox-label.checked::after {
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content: "✔";
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position: absolute;
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top: 50%;
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left: 0.2rem;
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width: 20px;
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height: 20px;
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display: flex;
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align-items: center;
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justify-content: center;
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font-size: 14px;
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color: #0d6efd;
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transform: translateY(-50%);
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pointer-events: none;
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}
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/* === Table data === */
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.table-container {
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|
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margin: auto;
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margin-bottom: 4px;
|
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}
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table {
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width: 100%;
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border-collapse: collapse;
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}
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th,
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td {
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border: 1px solid #ccc;
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padding: 0;
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font-size: 14px;
|
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}
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|
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.cell {
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min-height: 10px;
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padding: 4px 8px;
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display: flex;
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justify-content: center;
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text-align: center;
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}
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th {
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font-weight: 600;
|
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|
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}
|
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235
|
+
|
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236
|
+
/* === Print-specific: Footer with Page Numbers on the RIGHT === */
|
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+
@media print {
|
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body {
|
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margin: 0;
|
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padding-top: 10mm;
|
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}
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+
|
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+
/* Make room for footer on the right side */
|
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+
@page {
|
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|
+
size: A4 portrait;
|
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|
+
margin: 15mm 15mm 20mm 10mm;
|
|
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|
+
/* increased right margin slightly for better spacing */
|
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248
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+
|
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249
|
+
@bottom-right {
|
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250
|
+
content: "ទំព័រ " counter(page) " នៃ " counter(pages);
|
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+
font-size: 11px;
|
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+
color: #555;
|
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|
+
font-family: "Battambang", sans-serif;
|
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|
+
}
|
|
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|
+
}
|
|
256
|
+
|
|
257
|
+
/* Increment page counter */
|
|
258
|
+
body {
|
|
259
|
+
counter-increment: page;
|
|
260
|
+
}
|
|
261
|
+
|
|
262
|
+
.page-header,
|
|
263
|
+
.title-container,
|
|
264
|
+
table {
|
|
265
|
+
page-break-inside: avoid;
|
|
266
|
+
}
|
|
267
|
+
|
|
268
|
+
.card-header {
|
|
269
|
+
-webkit-print-color-adjust: exact;
|
|
270
|
+
print-color-adjust: exact;
|
|
271
|
+
}
|
|
272
|
+
}
|
|
273
|
+
</style>
|
|
274
|
+
</head>
|
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275
|
+
|
|
276
|
+
<body>
|
|
277
|
+
<div class="page-header">
|
|
278
|
+
<img src="data:image/png;base64,<%= logo_base64 %>" alt="Logo" class="title-logo" />
|
|
279
|
+
<div class="title-container">
|
|
280
|
+
<h1 class="title">ពាក្យស្នើសុំធានារ៉ាប់រងអាយុជីវិត</h1>
|
|
281
|
+
<h1 class="title">
|
|
282
|
+
សម្រាប់ទម្រង់សាមញ្ញសម្រាប់អតិថិជនជោគជ័យហ្វាយនែន (SIO)
|
|
283
|
+
</h1>
|
|
255
284
|
</div>
|
|
256
285
|
</div>
|
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257
|
-
|
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258
|
-
|
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259
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-
|
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260
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-
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261
|
-
|
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262
|
-
|
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263
|
-
|
|
264
|
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<span
|
|
286
|
+
|
|
287
|
+
<div class="form-container">
|
|
288
|
+
<div class="form-item">
|
|
289
|
+
<span class="label">ឈ្មោះនិងលេខកូដសាខា</span>
|
|
290
|
+
<span class="underline">
|
|
291
|
+
<%= branch_staff_app_info.branch_name ?? '' %> / <%= branch_staff_app_info.branch_code ?? '' %>
|
|
292
|
+
</span>
|
|
293
|
+
<span class="label">ឈ្មោះនិងលេខកូដបុគ្គលិកធានារ៉ាប់រង់</span>
|
|
294
|
+
<span class="underline">
|
|
295
|
+
<%= branch_staff_app_info.advisor_name ?? '' %> / <%= branch_staff_app_info.advisor_code ?? '' %>
|
|
296
|
+
</span>
|
|
265
297
|
</div>
|
|
266
|
-
<div class="
|
|
267
|
-
<
|
|
268
|
-
<span
|
|
298
|
+
<div class="form-item">
|
|
299
|
+
<span class="label">ឈ្មោះនិងលេខកូដបុគ្គលិកធនាគារ</span>
|
|
300
|
+
<span class="underline">
|
|
301
|
+
<%= branch_staff_app_info.bank_staff_name ?? '' %> / <%= branch_staff_app_info.bank_staff_code ?? '' %>
|
|
302
|
+
</span>
|
|
303
|
+
<span class="label">លេខពាក្យស្នើសុំ</span>
|
|
304
|
+
<span class="underline"><%= branch_staff_app_info.application_no ?? '' %></span>
|
|
269
305
|
</div>
|
|
270
|
-
|
|
271
|
-
|
|
272
|
-
|
|
306
|
+
</div>
|
|
307
|
+
|
|
308
|
+
<!-- Section 1 -->
|
|
309
|
+
<div class="card-header">ព័ត៌មានអំពីអ្នកស្នើសុំពណ្ណសន្យារ៉ាប់រង់</div>
|
|
310
|
+
|
|
311
|
+
<div class="form-container">
|
|
312
|
+
<div class="form-item">
|
|
313
|
+
<span class="label">ឈ្មោះពេញដូចបង្ហាញនៅក្នុងឯកសារអត្តសញ្ញាណ ជាភាសាខ្មែរ:</span>
|
|
314
|
+
<span class="underline"><%= applicant_info.full_name_kh ?? '' %></span>
|
|
315
|
+
<span class="label">ជាភាសាអង់គ្លេស</span>
|
|
316
|
+
<span class="underline"><%= applicant_info.full_name ?? '' %></span>
|
|
317
|
+
<span class="question-label">ភេទ:</span>
|
|
318
|
+
<label class="checkbox-label <%= applicant_info.gender === 'M' ? 'checked' : '' %>">ប្រុស</label>
|
|
319
|
+
<label class="checkbox-label <%= applicant_info.gender === 'F' ? 'checked' : '' %>">ស្រី</label>
|
|
273
320
|
</div>
|
|
274
|
-
|
|
275
|
-
|
|
276
|
-
<span
|
|
321
|
+
|
|
322
|
+
<div class="form-item">
|
|
323
|
+
<span class="label">ស្ថានភាពគ្រួសារ:</span>
|
|
324
|
+
<label class="checkbox-label <%= applicant_info.marital_status === 'single' ? 'checked' : '' %>">
|
|
325
|
+
នៅលីវ
|
|
326
|
+
</label>
|
|
327
|
+
<label class="checkbox-label <%= applicant_info.marital_status === 'married' ? 'checked' : '' %>">
|
|
328
|
+
រៀបការហើយ
|
|
329
|
+
</label>
|
|
330
|
+
<label class="checkbox-label <%= applicant_info.marital_status === 'divorced' ? 'checked' : '' %>">
|
|
331
|
+
លែងលះ
|
|
332
|
+
</label>
|
|
333
|
+
<label class="checkbox-label <%= applicant_info.marital_status === 'widowed' ? 'checked' : '' %>">
|
|
334
|
+
មេម៉ាយ/ពោះម៉ាយ
|
|
335
|
+
</label>
|
|
336
|
+
|
|
337
|
+
<div class="space"></div>
|
|
338
|
+
|
|
339
|
+
<span class="label">តួនាទី និងប្រភេទការងារ:</span>
|
|
340
|
+
<span class="underline"><%= applicant_info.occupation ?? '' %></span>
|
|
277
341
|
</div>
|
|
278
|
-
|
|
279
|
-
|
|
280
|
-
|
|
281
|
-
|
|
282
|
-
|
|
283
|
-
|
|
284
|
-
|
|
285
|
-
|
|
286
|
-
|
|
287
|
-
<
|
|
288
|
-
|
|
342
|
+
|
|
343
|
+
<div class="form-item">
|
|
344
|
+
<span class="label">ឯកសារបញ្ចាក់អត្តសញ្ញាណ:</span>
|
|
345
|
+
<label class="checkbox-label <%= applicant_info.identity_type === 'nid' ? 'checked' : '' %>">
|
|
346
|
+
អត្តសញ្ញាណបណ្ណ
|
|
347
|
+
</label>
|
|
348
|
+
<label class="checkbox-label <%= applicant_info.identity_type === 'passport' ? 'checked' : '' %>">
|
|
349
|
+
លិខិតឆ្លងដែន
|
|
350
|
+
</label>
|
|
351
|
+
<label class="checkbox-label <%= applicant_info.identity_type === 'birth_cert' ? 'checked' : '' %>">
|
|
352
|
+
សំបុត្រកំណើត
|
|
353
|
+
</label>
|
|
354
|
+
|
|
355
|
+
<!-- other field stays separate since it has extra input -->
|
|
356
|
+
<label class="checkbox-label <%= applicant_info.identifier_type === 'other' ? 'checked' : '' %>">ផ្សេងទៀត:</label>
|
|
357
|
+
<label class="underline"><%= applicant_info.identity_other_description ?? '' %></label>
|
|
289
358
|
</div>
|
|
290
|
-
|
|
291
|
-
|
|
292
|
-
<span
|
|
359
|
+
|
|
360
|
+
<div class="form-item">
|
|
361
|
+
<span class="label">លេខអត្តសញ្ញាណ:</span>
|
|
362
|
+
<span class="underline"><%= applicant_info.identity_no ?? '' %></span>
|
|
363
|
+
<span class="label">ថ្ងៃខែឆ្នាំកំណើត:</span>
|
|
364
|
+
<span class="underline"><%= applicant_info.date_of_birth ?? '' %></span>
|
|
365
|
+
<span class="label">អាយុ:</span>
|
|
366
|
+
<span class="underline xs"><%= applicant_info.age ?? '' %></span>
|
|
367
|
+
<span class="label">សញ្ចាតិ:</span>
|
|
368
|
+
<span class="underline"><%= applicant_info.nationality ?? '' %></span>
|
|
369
|
+
<span class="label">លេខទូរស័ព្ទ:</span>
|
|
370
|
+
<span class="underline"><%= applicant_info.phone_number ?? '' %></span>
|
|
293
371
|
</div>
|
|
294
|
-
|
|
295
|
-
|
|
296
|
-
<span
|
|
372
|
+
|
|
373
|
+
<div class="form-item">
|
|
374
|
+
<span class="label">អាសយដ្ឋានបច្ចុប្បន្ន:</span>
|
|
375
|
+
<span class="underline"><%= applicant_info.current_address ?? '' %></span>
|
|
297
376
|
</div>
|
|
298
|
-
|
|
299
|
-
|
|
300
|
-
<span
|
|
377
|
+
|
|
378
|
+
<div class="form-item">
|
|
379
|
+
<span class="label">សេចក្ដីប្រកាសសម្រាប់ការអនុវត្ដ FATCA</span>
|
|
301
380
|
</div>
|
|
302
381
|
</div>
|
|
303
|
-
|
|
304
|
-
|
|
305
|
-
|
|
306
|
-
|
|
307
|
-
|
|
308
|
-
|
|
309
|
-
<
|
|
310
|
-
|
|
311
|
-
|
|
312
|
-
|
|
313
|
-
|
|
314
|
-
|
|
315
|
-
|
|
316
|
-
|
|
317
|
-
<span class="underline md"><%= applicant_info?.phone_number ?? '' %></span>
|
|
318
|
-
</div>
|
|
319
|
-
|
|
320
|
-
<div class="field-row">
|
|
321
|
-
<span class="label">អាសយដ្ឋានបច្ចុប្បន្ន:</span>
|
|
322
|
-
<span class="underline full"><%= applicant_info?.current_address ?? '' %></span>
|
|
323
|
-
</div>
|
|
324
|
-
|
|
325
|
-
<div class="section-header" style="background:#e8f0fb; color:#005bac; border:1px solid #aac4e0; font-size:8.5pt;">
|
|
326
|
-
សេចក្ដីប្រកាសសម្រាប់ការអនុវត្ដ FATCA
|
|
327
|
-
</div>
|
|
328
|
-
|
|
329
|
-
<div class="field-row">
|
|
330
|
-
អ្នកស្នើរសុំបណ្ណសន្យារ៉ាប់រង់មិនមែនជាពលរដ្ឋអាមេរិក ឬ ជាប់ពន្ធស្នាក់នៅអាមេរិក ឬ មានសិទ្ធិកាន់ Green Card នោះទេ។
|
|
331
|
-
</div>
|
|
332
|
-
|
|
333
|
-
<div class="field-row">
|
|
334
|
-
<div class="cb-group">
|
|
335
|
-
<div class="cb-item">
|
|
336
|
-
<div class="cb-box <%= fatca_info?.is_fatca === false ? 'checked' : '' %>"></div>
|
|
337
|
-
<span>មិនមែន</span>
|
|
338
|
-
</div>
|
|
339
|
-
<div class="cb-item">
|
|
340
|
-
<div class="cb-box <%= fatca_info?.is_fatca === true ? 'checked' : '' %>"></div>
|
|
341
|
-
<span>មែន</span>
|
|
382
|
+
|
|
383
|
+
<span class="label"
|
|
384
|
+
>អ្នកស្នើរសុំបណ្ណសន្យារ៉ាប់រង់មិនមែនជាពលរដ្ឋាអាមេរិក ឬ
|
|
385
|
+
ជាប់ពន្ធស្នាក់នៅអាមេរិក ឬ មានសិទ្ធិកាន់ Green Card នោះទេ។
|
|
386
|
+
</span>
|
|
387
|
+
|
|
388
|
+
<div class="form-container">
|
|
389
|
+
<div class="form-item">
|
|
390
|
+
<label class="checkbox-label <%= fatca_info.is_fatca === false ? 'checked' : '' %>">មិនមែន</label>
|
|
391
|
+
<label class="checkbox-label <%= fatca_info.is_fatca === true ? 'checked' : '' %>">មែន</label>
|
|
392
|
+
<span class="label">US TIN:</span>
|
|
393
|
+
<span class="underline"><%= fatca_info.us_tin_no ?? '' %></span>
|
|
394
|
+
<span class="label">លេខកូដលើកលែង FATCA (ប្រសិនមាន):</span>
|
|
395
|
+
<span class="underline"><%= fatca_info.fatca_exempt_code ?? '' %></span>
|
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342
396
|
</div>
|
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343
397
|
</div>
|
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344
|
-
|
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345
|
-
<span class="
|
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346
|
-
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347
|
-
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348
|
-
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349
|
-
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350
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-
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351
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-
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352
|
-
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353
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-
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354
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-
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355
|
-
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356
|
-
<table>
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357
|
-
<thead>
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358
|
-
<tr>
|
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359
|
-
<th>ឈ្មោះផលិតផល និងរយះពេលធានា</th>
|
|
360
|
-
<th>ទឹកប្រាក់ត្រូវធានា<br/>(ដុល្លារអាមេរិក)</th>
|
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361
|
-
<th>របៀបបង់បុព្វលាភ</th>
|
|
362
|
-
<th>បុព្វលាភធានារ៉ាប់រង់<br/>(ដុល្លារអាមេរិក)</th>
|
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363
|
-
</tr>
|
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364
|
-
</thead>
|
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365
|
-
<tbody>
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366
|
-
<% if (product_payment_info?.products && product_payment_info.products.length > 0) { %>
|
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367
|
-
<% product_payment_info.products.forEach((p) => { %>
|
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398
|
+
|
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399
|
+
<span class="label">
|
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400
|
+
ប្រសិនបើការបញ្ចាក់អះអាងណាមួយមិនត្រឹមត្រូវ
|
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401
|
+
ខ្ញុំនឹងប្រគល់ជូននូវឯកសារថ្មីក្នុងរយះពេល ៣០ថ្ងៃ
|
|
402
|
+
ហើយអះអាងថាខ្ញុំមិនជាប់ពន្ធកាត់ទុករបស់សហរដ្ឋអាមេរិកទេ
|
|
403
|
+
</span>
|
|
404
|
+
|
|
405
|
+
<!-- Section 2 -->
|
|
406
|
+
<div class="card-header">ព័ត៌មានអំពីផលិតផល</div>
|
|
407
|
+
<div class="table-container">
|
|
408
|
+
<table>
|
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409
|
+
<thead>
|
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368
410
|
<tr>
|
|
369
|
-
<
|
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370
|
-
<
|
|
371
|
-
<
|
|
372
|
-
<
|
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411
|
+
<th><div class="cell">ឈ្មោះផលិតផល និងរយះពេលធានា</div></th>
|
|
412
|
+
<th><div class="cell">ទឹកប្រាក់ត្រូវធានា(ដុល្លារអាមេរិក)</div></th>
|
|
413
|
+
<th><div class="cell">របៀបបង់បុព្វលាភ</div></th>
|
|
414
|
+
<th>
|
|
415
|
+
<div class="cell">បុព្វលាភធានារ៉ាប់រង់(ដុល្លារអាមេរិក)</div>
|
|
416
|
+
</th>
|
|
373
417
|
</tr>
|
|
374
|
-
|
|
375
|
-
|
|
376
|
-
|
|
377
|
-
<
|
|
378
|
-
|
|
379
|
-
|
|
380
|
-
|
|
381
|
-
|
|
382
|
-
|
|
383
|
-
|
|
384
|
-
|
|
385
|
-
|
|
386
|
-
|
|
387
|
-
|
|
388
|
-
|
|
389
|
-
|
|
390
|
-
|
|
391
|
-
|
|
392
|
-
|
|
393
|
-
|
|
394
|
-
|
|
395
|
-
|
|
396
|
-
<div class="cb-box <%= product_payment_info?.payment_method === 'transfer' ? 'checked' : '' %>"></div>
|
|
397
|
-
<span>ការផ្ទេរប្រាក់</span>
|
|
398
|
-
</div>
|
|
399
|
-
<div class="cb-item">
|
|
400
|
-
<div class="cb-box <%= product_payment_info?.payment_method === 'cash' ? 'checked' : '' %>"></div>
|
|
401
|
-
<span>សាច់ប្រាក់</span>
|
|
418
|
+
</thead>
|
|
419
|
+
<tbody>
|
|
420
|
+
<% product_payment_info?.products?.forEach(function(product) { %>
|
|
421
|
+
<tr>
|
|
422
|
+
<td><div class="cell"><%= product.name %> (<%= product.term ?? '' %>)</div></td>
|
|
423
|
+
<td><div class="cell"><%= product.sum_assured ?? '' %></div></td>
|
|
424
|
+
<td><div class="cell"><%= product.payment_mode ?? product.payment_mode %></div></td>
|
|
425
|
+
<td><div class="cell"><%= product.premium ?? '' %></div></td>
|
|
426
|
+
</tr>
|
|
427
|
+
<% }) %>
|
|
428
|
+
</tbody>
|
|
429
|
+
</table>
|
|
430
|
+
</div>
|
|
431
|
+
<div class="form-container">
|
|
432
|
+
<div class="form-item">
|
|
433
|
+
<span class="question-label">វិធីសាស្រ្ដបង់បុព្វលាភធានារ៉ាប់រង់:</span>
|
|
434
|
+
<label class="checkbox-label <%= product_payment_info.payment_method === 'transfer' ? 'checked' : '' %>">
|
|
435
|
+
ការផ្ទេរប្រាក់ចូលទៅក្នុងគណនីរបស់ហ្វីលីឡាយហ្វ៍
|
|
436
|
+
</label>
|
|
437
|
+
<label class="checkbox-label <%= product_payment_info.payment_method === 'partner' ? 'checked' : '' %>">
|
|
438
|
+
តាមរយះដៃគូររបស់ហ្វីលីឡាយហ្វ៍
|
|
439
|
+
</label>
|
|
402
440
|
</div>
|
|
403
441
|
</div>
|
|
404
|
-
|
|
405
|
-
|
|
406
|
-
|
|
407
|
-
|
|
408
|
-
|
|
409
|
-
|
|
410
|
-
<tr>
|
|
411
|
-
<th>ឈ្មោះពេញរបស់អ្នកទទួលផល</th>
|
|
412
|
-
<th>អាយុ</th>
|
|
413
|
-
<th>ទំនាក់ទំនង</th>
|
|
414
|
-
<th>លេខអតិថិជន/ឯកសារ</th>
|
|
415
|
-
<th>% នៃការបែងចែក</th>
|
|
416
|
-
</tr>
|
|
417
|
-
</thead>
|
|
418
|
-
<tbody>
|
|
419
|
-
<% if (beneficiary_info && beneficiary_info.length > 0) { %>
|
|
420
|
-
<% beneficiary_info.forEach((b) => { %>
|
|
442
|
+
|
|
443
|
+
<!-- Section 3 -->
|
|
444
|
+
<div class="card-header">ព័ត៌មានអំពីអ្នកទទួលផល</div>
|
|
445
|
+
<div class="table-container">
|
|
446
|
+
<table>
|
|
447
|
+
<thead>
|
|
421
448
|
<tr>
|
|
422
|
-
<
|
|
423
|
-
<
|
|
424
|
-
<
|
|
425
|
-
<
|
|
426
|
-
<
|
|
449
|
+
<th><div class="cell">ឈ្មោះពេញរបស់អ្នកទទួលផល</div></th>
|
|
450
|
+
<th><div class="cell">អាយុ</div></th>
|
|
451
|
+
<th><div class="cell">ទំនាក់ទំនង</div></th>
|
|
452
|
+
<th><div class="cell">លេខអតក្តសញ្ញាណ</div></th>
|
|
453
|
+
<th><div class="cell">% នៃការបែងចែក</div></th>
|
|
427
454
|
</tr>
|
|
428
|
-
|
|
429
|
-
|
|
430
|
-
|
|
431
|
-
<
|
|
432
|
-
|
|
433
|
-
|
|
434
|
-
|
|
435
|
-
|
|
436
|
-
|
|
437
|
-
|
|
438
|
-
|
|
439
|
-
|
|
440
|
-
|
|
441
|
-
|
|
442
|
-
|
|
443
|
-
|
|
444
|
-
|
|
445
|
-
|
|
446
|
-
|
|
447
|
-
|
|
448
|
-
|
|
449
|
-
|
|
450
|
-
|
|
451
|
-
|
|
452
|
-
|
|
453
|
-
|
|
454
|
-
|
|
455
|
-
<div class="note">
|
|
456
|
-
<span>កណត់សម្គាល់៖ ប្រសិនបើភាគរយមិនត្រូវបានបញ្ជាក់ចំនួនទឹកប្រាក់នឹងត្រូវបែងចែកស្មើៗគ្នា</span>
|
|
457
|
-
<span>% សរុបស្មើរ ១០០%</span>
|
|
458
|
-
</div>
|
|
459
|
-
|
|
460
|
-
<div class="section-header">ព័ត៌មានពាក់ព័ន្ទនឹងសុខភាពរបស់ អ្នកស្នើសុំបណ្ណសន្យារ៉ាប់រង់</div>
|
|
461
|
-
|
|
462
|
-
<div class="health-q">
|
|
463
|
-
<span class="q-text">1) កម្ពស់:</span>
|
|
464
|
-
<span class="underline xs"><%= health_info?.height ?? '' %></span> ស.ម
|
|
465
|
-
<span class="q-text" style="margin-left:8px;">ទម្ងន់:</span>
|
|
466
|
-
<span class="underline xs"><%= health_info?.weight ?? '' %></span> គ.ក
|
|
467
|
-
<span class="q-text" style="margin-left:8px;">តើលោកអ្នកពិសារបារីដែរឬទេ?:</span>
|
|
468
|
-
<div class="cb-group" style="display:inline-flex; margin-left:4px;">
|
|
469
|
-
<div class="cb-item">
|
|
470
|
-
<div class="cb-box <%= health_info?.is_smoke === false ? 'checked' : '' %>"></div>
|
|
471
|
-
<span>មិនមាន</span>
|
|
472
|
-
</div>
|
|
473
|
-
<div class="cb-item">
|
|
474
|
-
<div class="cb-box <%= health_info?.is_smoke === true ? 'checked' : '' %>"></div>
|
|
475
|
-
<span>មាន</span>
|
|
476
|
-
</div>
|
|
455
|
+
</thead>
|
|
456
|
+
<tbody>
|
|
457
|
+
<% beneficiary_info?.forEach(function(beneficiary) { %>
|
|
458
|
+
<tr>
|
|
459
|
+
<td><div class="cell"><%= beneficiary.full_name ?? '' %></div></td>
|
|
460
|
+
<td><div class="cell"><%= beneficiary.age ?? '' %></div></td>
|
|
461
|
+
<td>
|
|
462
|
+
<div class="cell"><%= beneficiary.relationship ?? '' %></div>
|
|
463
|
+
</td>
|
|
464
|
+
<td>
|
|
465
|
+
<div class="cell"><%= beneficiary.id_number ?? '' %></div>
|
|
466
|
+
</td>
|
|
467
|
+
<td><div class="cell"><%= beneficiary.percentage ?? '' %></div></td>
|
|
468
|
+
</tr>
|
|
469
|
+
<% }) %>
|
|
470
|
+
<tr>
|
|
471
|
+
<td colspan="4">
|
|
472
|
+
<div class="cell">
|
|
473
|
+
កណត់សម្គាល់៖
|
|
474
|
+
ប្រសិនបើភាគរយមិនត្រូវបានបញ្ជាក់ចំនួនទឹកប្រាក់នឹងត្រូវបែងចែកស្មើៗគ្នា
|
|
475
|
+
</div>
|
|
476
|
+
</td>
|
|
477
|
+
<td><div class="cell">% សរុបស្មើរ ១០០%</div></td>
|
|
478
|
+
</tr>
|
|
479
|
+
</tbody>
|
|
480
|
+
</table>
|
|
477
481
|
</div>
|
|
478
|
-
|
|
479
|
-
|
|
480
|
-
|
|
481
|
-
|
|
482
|
-
|
|
483
|
-
|
|
484
|
-
|
|
485
|
-
|
|
486
|
-
|
|
482
|
+
|
|
483
|
+
<!-- Section 4 -->
|
|
484
|
+
<div class="card-header">
|
|
485
|
+
ព័ត៌មានពាក់ព័ន្ទនឹងសុខភាពរបស់ អ្នកស្នើសុំបណ្ណសន្យារ៉ាប់រង់
|
|
486
|
+
</div>
|
|
487
|
+
|
|
488
|
+
<div class="form-container">
|
|
489
|
+
<!-- Question 1 -->
|
|
490
|
+
<div class="form-item">
|
|
491
|
+
<span class="label">1) កម្ពស់:</span>
|
|
492
|
+
<span class="underline sm"><%= health_info.height ?? '' %></span>
|
|
493
|
+
<span class="label">ស.ម</span>
|
|
494
|
+
<div class="space"></div>
|
|
495
|
+
<span class="label">ទម្ងន់:</span>
|
|
496
|
+
<span class="underline sm"><%= health_info.weight ?? '' %></span>
|
|
497
|
+
<span class="label">គ.ក</span>
|
|
498
|
+
<div class="space"></div>
|
|
499
|
+
<span class="question-label">តើលោកអ្នកពិសារបារីដែរឬទេ?:</span>
|
|
500
|
+
<label class="checkbox-label <%= health_info.is_smoke === false ? 'checked' : '' %>">
|
|
501
|
+
មិនមាន
|
|
502
|
+
</label>
|
|
503
|
+
<label class="checkbox-label <%= health_info.is_smoke === true ? 'checked' : '' %>">
|
|
504
|
+
មាន
|
|
505
|
+
</label>
|
|
487
506
|
</div>
|
|
488
|
-
|
|
489
|
-
|
|
490
|
-
<span
|
|
507
|
+
|
|
508
|
+
<div class="form-item">
|
|
509
|
+
<span class="label">ចំនួន៖</span>
|
|
510
|
+
<% if (health_info.smoke_detail) { %>
|
|
511
|
+
<span class="underline with-unit">
|
|
512
|
+
<span class="value"><%= health_info.smoke_detail %></span>
|
|
513
|
+
<span class="unit">ដើមក្នុងមួយសប្ដាហ៍</span>
|
|
514
|
+
</span>
|
|
515
|
+
<% } else { %>
|
|
516
|
+
<span class="underline"></span>
|
|
517
|
+
<% } %>
|
|
491
518
|
</div>
|
|
492
519
|
</div>
|
|
493
|
-
|
|
494
|
-
|
|
495
|
-
|
|
496
|
-
|
|
497
|
-
|
|
498
|
-
|
|
499
|
-
|
|
500
|
-
|
|
501
|
-
<
|
|
520
|
+
|
|
521
|
+
<div class="form-container">
|
|
522
|
+
<!-- Question 2 -->
|
|
523
|
+
<div class="form-item">
|
|
524
|
+
<span class="question-label">2) តើលោកអ្នកពិសារគ្រឿងស្រវឹងដែរឬទេ?:</span>
|
|
525
|
+
<label class="checkbox-label <%= health_info.is_drink_alcohol === false ? 'checked' : '' %>">
|
|
526
|
+
មិនមាន
|
|
527
|
+
</label>
|
|
528
|
+
<label class="checkbox-label <%= health_info.is_drink_alcohol === true ? 'checked' : '' %>">
|
|
529
|
+
មាន
|
|
530
|
+
</label>
|
|
502
531
|
</div>
|
|
503
|
-
<div class="
|
|
504
|
-
<
|
|
505
|
-
|
|
532
|
+
<div class="form-item">
|
|
533
|
+
<span class="label">ចំនួន</span>
|
|
534
|
+
<% if (health_info.hospitalized_detail) { %>
|
|
535
|
+
<span class="underline with-unit">
|
|
536
|
+
<span class="value"><%= health_info.hospitalized_detail %></span>
|
|
537
|
+
<span class="unit">ក្នុងមួយថ្ងៃ</span>
|
|
538
|
+
</span>
|
|
539
|
+
<% } else { %>
|
|
540
|
+
<span class="underline"></span>
|
|
541
|
+
<span class="label">ក្នុងមួយថ្ងៃ</span>
|
|
542
|
+
<% } %>
|
|
506
543
|
</div>
|
|
507
544
|
</div>
|
|
508
545
|
|
|
509
|
-
|
|
510
|
-
|
|
511
|
-
|
|
512
|
-
|
|
513
|
-
|
|
514
|
-
|
|
515
|
-
|
|
516
|
-
|
|
517
|
-
|
|
518
|
-
|
|
519
|
-
|
|
520
|
-
|
|
521
|
-
|
|
522
|
-
<
|
|
546
|
+
<div class="form-container">
|
|
547
|
+
<!-- Question 3 -->
|
|
548
|
+
<span class="question-label">
|
|
549
|
+
3) ក្នុងរយៈពេល០២(ពីរ)ឆ្នាំចុងក្រោយនេះតើលោកអ្នកធ្លាប់បានសម្រាកក្នុងមន្ទីរពេទ្យធ្លាប់បានទទួលការវះកាត់
|
|
550
|
+
ឬធ្លាប់ទទួលបានលទ្ធផលខុសប្រក្រតីអំពី ការវិភាគឈាម ការវិភាគទឹកនោម
|
|
551
|
+
ការថតកាំរស្មីអុិច (X-ray) ម៉ាសុិនវាស់ចង្វាក់បេះដូង អេកូសាស្រ្ដ
|
|
552
|
+
ស្កេនការច្រឹបសាច់យកពិនិត្យ
|
|
553
|
+
ឬលទ្ធផលវិភាគផ្សេងៗទៀតដែលមិនបានរៀបរាប់ខាងដើមពីគ្រូពេទ្យដែរឬទេ?:
|
|
554
|
+
</span>
|
|
555
|
+
<div class="form-item">
|
|
556
|
+
<label class="checkbox-label <%= health_info.is_hospitalized === false ? 'checked' : '' %>">
|
|
557
|
+
មិនមាន
|
|
558
|
+
</label>
|
|
559
|
+
<label class="checkbox-label <%= health_info.is_hospitalized === true ? 'checked' : '' %>">
|
|
560
|
+
មាន
|
|
561
|
+
</label>
|
|
523
562
|
</div>
|
|
524
|
-
|
|
525
|
-
|
|
526
|
-
<span
|
|
563
|
+
|
|
564
|
+
<div class="form-item">
|
|
565
|
+
<span class="label">បើមានសូមផ្ដល់ព័ត៍មានលម្អិត៖</span>
|
|
566
|
+
<% if (health_info.hospitalized_detail) { %>
|
|
567
|
+
<span class="underline with-unit">
|
|
568
|
+
<span class="value"><%= health_info.hospitalized_detail %></span>
|
|
569
|
+
<span class="unit">ក្នុងមួយថ្ងៃ</span>
|
|
570
|
+
</span>
|
|
571
|
+
<% } else { %>
|
|
572
|
+
<span class="underline"></span>
|
|
573
|
+
<% } %>
|
|
527
574
|
</div>
|
|
528
575
|
</div>
|
|
529
576
|
|
|
530
|
-
|
|
531
|
-
|
|
532
|
-
<
|
|
533
|
-
|
|
534
|
-
|
|
535
|
-
|
|
536
|
-
|
|
537
|
-
|
|
538
|
-
|
|
539
|
-
|
|
540
|
-
|
|
541
|
-
|
|
542
|
-
|
|
543
|
-
|
|
544
|
-
|
|
545
|
-
|
|
546
|
-
|
|
547
|
-
<div class="field-row">
|
|
548
|
-
<span class="label">ឈ្មោះ</span>
|
|
549
|
-
<span class="underline full"><%= signature_info?.applicant_name ?? '' %></span>
|
|
577
|
+
<div class="form-container">
|
|
578
|
+
<!-- Question 4 -->
|
|
579
|
+
<span class="question-label">
|
|
580
|
+
4) តើលោកអ្នកធ្លាប់បានធ្វើរោគវិនិច្ឆ័យ ពិគ្រោះជំងឺ ឬទទួលការព្យាបាលដូចជា
|
|
581
|
+
លើសសម្ពាធឈាម ទឹកនោមផ្អែម ជំងឺបេះដូង ចុកទ្រូង ជំងឺសួត ជំងឺថ្លើម
|
|
582
|
+
ជំងឺតម្រងនោម មហារីក ជំងឺដាច់សសៃឈាមខួរក្បាល ជំងឺអេដស៍ ជំងឺផ្លូវចិត្ត
|
|
583
|
+
ពិការភាព ឬរាងកាយមិនប្រក្រតី ប្រើប្រាស់ថ្នាំញៀន ឬញៀនស្រា
|
|
584
|
+
ឬជំងឺផ្សេងទៀតដែលមិនបានរៀបរាប់ខាងលើដែរឬទេ?
|
|
585
|
+
</span>
|
|
586
|
+
<div class="form-item">
|
|
587
|
+
<label class="checkbox-label <%= health_info.is_diagnosed === false ? 'checked' : '' %>">
|
|
588
|
+
មិនមាន
|
|
589
|
+
</label>
|
|
590
|
+
<label class="checkbox-label <%= health_info.is_diagnosed === true ? 'checked' : '' %>">
|
|
591
|
+
មាន
|
|
592
|
+
</label>
|
|
593
|
+
|
|
550
594
|
</div>
|
|
551
|
-
<div class="
|
|
552
|
-
<span class="label"
|
|
553
|
-
|
|
595
|
+
<div class="form-item">
|
|
596
|
+
<span class="label">បើមានសូមបញ្ជាក់លម្អិតខាងក្រោម៖</span>
|
|
597
|
+
<% if (health_info.diagnosed_detail) { %>
|
|
598
|
+
<span class="underline with-unit">
|
|
599
|
+
<span class="value"><%= health_info.diagnosed_detail %></span>
|
|
600
|
+
</span>
|
|
601
|
+
<% } else { %>
|
|
602
|
+
<span class="underline"></span>
|
|
603
|
+
<% } %>
|
|
554
604
|
</div>
|
|
555
605
|
</div>
|
|
556
|
-
|
|
557
|
-
|
|
558
|
-
|
|
559
|
-
|
|
560
|
-
|
|
561
|
-
<span class="
|
|
606
|
+
|
|
607
|
+
<!-- Section 5 -->
|
|
608
|
+
<div class="card-header">សេចក្ដីប្រកាសរបស់អ្នកស្នើសុំធានារ៉ាប់រង់</div>
|
|
609
|
+
<div class="form-container">
|
|
610
|
+
<div class="form-item">
|
|
611
|
+
<span class="label"
|
|
612
|
+
>1) ខ្ញុំអនុញ្ញាត និងយល់ព្រមឲ្យក្រុមហ៊ុនប្រើប្រាស់ព័ត៌មាន
|
|
613
|
+
និងទិន្នន័យទាំងស្រុងដែលខ្ញុំបានផ្ដល់នៅក្នុងពាក្យស្នើសុំរបស់ខ្ញុំ
|
|
614
|
+
ក្នុងគោលបំណង ស្របតាមច្បាប់ដូចជាការផ្សព្វផ្សាយទីផ្សារ ការសិក្សាទីផ្សារ
|
|
615
|
+
និង ការបម្រើអតិថិជនដោយក្រុមហ៊ុន សម្ព័ន្ធក្រុមហ៊ុន ឬ ជាដៃគូ
|
|
616
|
+
ពាណិជ្ជកម្មរបស់ក្រុមហ៊ុនដោយមិនចាំបាច់មានការយល់ព្រម
|
|
617
|
+
និងជូនដំណឹងបន្ថែមពីខ្ញុំឡើយ។ ក្រុមហ៊ុនមិនត្រូវបានអនុញ្ញាតឲ្យបញ្ចេញ
|
|
618
|
+
ព័ត៌មានណាមួយទៅភាគីទីបីណាមួយឬប្រើប្រាស់ព័ត៌មាននោះសម្រាប់គោលបំណងផ្សេងទៀតដែលមិនទាក់ទងនឹងគោលបំណង
|
|
619
|
+
ទាំងឡាយខាងលើឡើយ ប្រសិនបើគ្មានការយល់ព្រមព្រៀងជាលាយលក្ខណ៍អក្សរនោះ។</span
|
|
620
|
+
>
|
|
562
621
|
</div>
|
|
563
|
-
<div class="
|
|
564
|
-
<span class="label"
|
|
565
|
-
|
|
622
|
+
<div class="form-item">
|
|
623
|
+
<span class="label">
|
|
624
|
+
2) ខ្ញុំសូមអះអាងថាបានអាន និងយល់ស្របនូវគ្រប់ព័ត៌មានក្នុងឯកសារនេះ។
|
|
625
|
+
ខ្ញុំសូមប្រកាសថាគ្រប់ព័ត៌មានដែលបានផ្ដល់នៅក្នុងពាក្យស្នើសុំនេះ
|
|
626
|
+
ពិតជាមានភាពពេញលេញ និងត្រឹមត្រូវពិតប្រាកដមែន។
|
|
627
|
+
</span>
|
|
566
628
|
</div>
|
|
567
629
|
</div>
|
|
568
|
-
|
|
569
|
-
|
|
630
|
+
<div class="table-container">
|
|
631
|
+
<table>
|
|
632
|
+
<thead>
|
|
633
|
+
<tr>
|
|
634
|
+
<th style="width: 50%">
|
|
635
|
+
<div class="cell">
|
|
636
|
+
ហត្ថលេខា ឬស្នាមមេដៃរបស់អ្នកស្នើសុំធានារ៉ាប់រង
|
|
637
|
+
</div>
|
|
638
|
+
<div class="signature-space"></div>
|
|
639
|
+
</th>
|
|
640
|
+
<th style="width: 50%">
|
|
641
|
+
<div class="cell">ហត្ថលេខា ឬស្នាមមេដៃរបស់សាក្សី</div>
|
|
642
|
+
<div class="signature-space"></div>
|
|
643
|
+
</th>
|
|
644
|
+
</tr>
|
|
645
|
+
</thead>
|
|
646
|
+
<tbody>
|
|
647
|
+
<tr>
|
|
648
|
+
<td>
|
|
649
|
+
<div class="form-container space-height">
|
|
650
|
+
<div class="form-item">
|
|
651
|
+
<div class="space"></div>
|
|
652
|
+
<span class="label">ឈ្មោះ</span>
|
|
653
|
+
<!-- <span class="underline"></span> -->
|
|
654
|
+
<% if (signature_info.applicant_name) { %>
|
|
655
|
+
<span class="underline with-unit">
|
|
656
|
+
<span class="value"><%= signature_info.applicant_name %></span>
|
|
657
|
+
</span>
|
|
658
|
+
<% } else { %>
|
|
659
|
+
<span class="underline"></span>
|
|
660
|
+
<% } %>
|
|
661
|
+
<div class="space"></div>
|
|
662
|
+
</div>
|
|
663
|
+
</td>
|
|
664
|
+
<td>
|
|
665
|
+
<div class="form-container space-height">
|
|
666
|
+
<div class="form-item">
|
|
667
|
+
<div class="space"></div>
|
|
668
|
+
<span class="label">ឈ្មោះ</span>
|
|
669
|
+
<% if (signature_info.witness_name) { %>
|
|
670
|
+
<span class="underline with-unit">
|
|
671
|
+
<span class="value"><%= signature_info.witness_name %></span>
|
|
672
|
+
</span>
|
|
673
|
+
<% } else { %>
|
|
674
|
+
<span class="underline"></span>
|
|
675
|
+
<% } %>
|
|
676
|
+
<div class="space"></div>
|
|
677
|
+
</div>
|
|
678
|
+
</div>
|
|
679
|
+
</td>
|
|
680
|
+
</tr>
|
|
681
|
+
<tr>
|
|
682
|
+
<td>
|
|
683
|
+
<div class="form-container space-height">
|
|
684
|
+
<div class="form-item">
|
|
685
|
+
<div class="space"></div>
|
|
686
|
+
<span class="label">កាលបរិច្ឆេទ</span>
|
|
687
|
+
<% if (signature_info.applicant_signature_date) { %>
|
|
688
|
+
<span class="underline with-unit" >
|
|
689
|
+
<span class="value"><%= signature_info.applicant_signature_date %></span>
|
|
690
|
+
</span>
|
|
691
|
+
<% } else { %>
|
|
692
|
+
<span class="underline"></span>
|
|
693
|
+
<% } %>
|
|
694
|
+
<div class="space"></div>
|
|
695
|
+
</div>
|
|
696
|
+
</div>
|
|
697
|
+
</td>
|
|
698
|
+
<td>
|
|
699
|
+
<div class="form-container space-height">
|
|
700
|
+
<div class="form-item">
|
|
701
|
+
<div class="space"></div>
|
|
702
|
+
<span class="label">កាលបរិច្ឆេទ</span>
|
|
703
|
+
<% if (signature_info.witness_signature_date) { %>
|
|
704
|
+
<span class="underline with-unit">
|
|
705
|
+
<span class="value"><%= signature_info.witness_signature_date %></span>
|
|
706
|
+
</span>
|
|
707
|
+
<% } else { %>
|
|
708
|
+
<span class="underline"></span>
|
|
709
|
+
<% } %>
|
|
710
|
+
<div class="space"></div>
|
|
711
|
+
</div>
|
|
712
|
+
<!-- <div class="space"></div>
|
|
713
|
+
<span class="label">កាលបរិច្ឆេទ</span>
|
|
714
|
+
<span class="underline"></span>
|
|
715
|
+
<div class="space"></div> -->
|
|
716
|
+
</div>
|
|
717
|
+
</td>
|
|
718
|
+
</tr>
|
|
719
|
+
</tbody>
|
|
720
|
+
</table>
|
|
721
|
+
</div>
|
|
722
|
+
</body>
|
|
570
723
|
</html>
|
|
571
724
|
`;
|