plac-micro-common 1.3.15 → 1.3.17

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Files changed (4) hide show
  1. package/dist/libs/pdf-form/templates/sio-form-kh.template.d.ts +1 -1
  2. package/dist/libs/pdf-form/templates/sio-form-kh.template.js +129 -105
  3. package/dist/types/pdf-form/sio-form.type.d.ts +1 -1
  4. package/package.json +1 -1
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\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: 13px;\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";
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 <link rel=\"preconnect\" href=\"https://fonts.googleapis.com\">\n <link rel=\"preconnect\" href=\"https://fonts.gstatic.com\" crossorigin>\n <link href=\"https://fonts.googleapis.com/css2?family=Hanuman:wght@100..900&family=Moul&display=swap\" rel=\"stylesheet\">\n <style>\n body {\n font-family: \"Hanuman\", 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 /* margin */\n .ml-4 {margin-left: 1rem; }\n .ml-8 {margin-left: 2rem; }\n\n .mr-4 {margin-right: 1rem; }\n .mr-8 {margin-right: 2rem; }\n\n .mt-4 {margin-top: 1rem; }\n .mt-8 {margin-top: 2rem; }\n\n .mb-4 {margin-bottom: 1rem; }\n .mb-8 {margin-bottom: 2rem; }\n\n /* alignment */\n .align-left { justify-content: flex-start !important; text-align: left; padding-left: 16px; }\n .align-right { justify-content: flex-end !important; text-align: right; padding-right: 16px; }\n .align-center { justify-content: center !important; text-align: center; }\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 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: 125px;\n height: auto;\n }\n\n .title {\n font-weight: 700;\n font-size: 18px;\n line-height: 1;\n }\n\n .title-container {\n text-align: center;\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 gap: 0.5rem;\n }\n\n .form-item {\n display: flex;\n align-items: flex-start;\n flex-wrap: wrap;\n width: 100%;\n }\n\n .label,\n .question-label {\n word-wrap: break-word;\n white-space: normal;\n font-weight: 500;\n color: #444;\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 color: #000;\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 mb-8\">\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\">\n <%= branch_staff_app_info.application_no %>\n </span>\n </div>\n </div>\n\n <!-- Section 1 -->\n <div class=\"card-header mt-4\">\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u17A2\u17C6\u1796\u17B8\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=\"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 </div>\n\n <div class=\"form-item\">\n <span class=\"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\n <div class=\"ml-8\"></div>\n\n <div>\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 </div>\n </div>\n\n <div class=\"form-item\">\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 align-left\"><%= 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' ? 'checked' : '' %>\">\n \u179F\u17C6\u1794\u17BB\u178F\u17D2\u179A\u1780\u17C6\u178E\u17BE\u178F\n </label>\n <label class=\"checkbox-label <%= applicant_info.identity_type === 'other' ? 'checked' : '' %>\">\n \u1795\u17D2\u179F\u17C1\u1784\u1791\u17C0\u178F:\n </label>\n\n\n <!-- other field stays separate since it has extra input -->\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 align-left\"><%= applicant_info.current_address %></span>\n </div>\n\n\n </div>\n\n\n\n <div class=\"form-container\">\n <div class=\"form-item mt-4\">\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 class=\"form-item\">\n <span class=\"label\">\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 </div>\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 class=\"form-item\">\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 </div>\n </div>\n\n\n\n <!-- Section 2 -->\n <div class=\"card-header mt-4\">\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 %></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_to_plac' ? '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 === 'other' ? '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 mt-4\">\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\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><div class=\"cell\"><%= beneficiary.relationship %></div></td>\n <td><div class=\"cell\"><%= beneficiary.id_number %></div></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 <!-- Question 1 -->\n <div class=\"form-container mt-4\">\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 <!-- Question 2 -->\n <div class=\"form-container mt-4\">\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.drink_alcohol_detail) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\"><%= health_info.drink_alcohol_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 <!-- Question 3 -->\n <div class=\"form-container mt-4\">\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 <!-- Question 4 -->\n <div class=\"form-container mt-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 mt-8\">\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 mt-4\">\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 <% 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 </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>\n </td>\n </tr>\n </tbody>\n </table>\n </div>\n </body>\n</html>\n";
package/dist/libs/pdf-form/templates/sio-form-kh.template.js CHANGED
@@ -8,18 +8,13 @@ exports.SIO_FORM_KH_TEMPLATE = `
8
8
  <meta charset="UTF-8" />
9
9
  <meta name="viewport" content="width=device-width, initial-scale=1.0" />
10
10
  <title>ពាក្យស្នើសុំធានារ៉ាប់រងអាយុជីវិត</title>
11
-
11
+ <link rel="preconnect" href="https://fonts.googleapis.com">
12
+ <link rel="preconnect" href="https://fonts.gstatic.com" crossorigin>
13
+ <link href="https://fonts.googleapis.com/css2?family=Hanuman:wght@100..900&family=Moul&display=swap" rel="stylesheet">
12
14
  <style>
13
- @font-face {
14
- font-family: 'Khmer OS';
15
- src: url('data:font/truetype;base64,<%= font_base64 %>') format('truetype');
16
- font-weight: normal;
17
- font-style: normal;
18
- }
19
-
20
15
  body {
21
- font-family: "Khmer OS", system-ui, sans-serif;
22
- font-size: 13px;
16
+ font-family: "Hanuman", system-ui, sans-serif;
17
+ font-size: 14px;
23
18
  line-height: 1.4;
24
19
  margin: 1rem;
25
20
  /* Reduced from 2rem */
@@ -31,6 +26,24 @@ exports.SIO_FORM_KH_TEMPLATE = `
31
26
  width: 8px;
32
27
  }
33
28
 
29
+ /* margin */
30
+ .ml-4 {margin-left: 1rem; }
31
+ .ml-8 {margin-left: 2rem; }
32
+
33
+ .mr-4 {margin-right: 1rem; }
34
+ .mr-8 {margin-right: 2rem; }
35
+
36
+ .mt-4 {margin-top: 1rem; }
37
+ .mt-8 {margin-top: 2rem; }
38
+
39
+ .mb-4 {margin-bottom: 1rem; }
40
+ .mb-8 {margin-bottom: 2rem; }
41
+
42
+ /* alignment */
43
+ .align-left { justify-content: flex-start !important; text-align: left; padding-left: 16px; }
44
+ .align-right { justify-content: flex-end !important; text-align: right; padding-right: 16px; }
45
+ .align-center { justify-content: center !important; text-align: center; }
46
+
34
47
  .space-height {
35
48
  height: 60px;
36
49
  align-items: center;
@@ -44,7 +57,6 @@ exports.SIO_FORM_KH_TEMPLATE = `
44
57
  /* === Page header === */
45
58
  .page-header {
46
59
  margin-bottom: 0.5rem;
47
- /* Reduced from 1rem */
48
60
  page-break-inside: avoid;
49
61
  }
50
62
 
@@ -55,16 +67,18 @@ exports.SIO_FORM_KH_TEMPLATE = `
55
67
  }
56
68
 
57
69
  .title-logo {
58
- width: 80px;
59
- /* Reduced from 100px */
70
+ width: 125px;
60
71
  height: auto;
61
72
  }
62
73
 
63
- .title-container {
64
- text-align: center;
74
+ .title {
75
+ font-weight: 700;
76
+ font-size: 18px;
77
+ line-height: 1;
65
78
  }
66
79
 
67
- .title-container .title {
80
+ .title-container {
81
+ text-align: center;
68
82
  font-weight: 700;
69
83
  font-size: 16px;
70
84
  line-height: 1.4;
@@ -92,6 +106,7 @@ exports.SIO_FORM_KH_TEMPLATE = `
92
106
  flex-wrap: wrap;
93
107
  margin: 0;
94
108
  padding: 0;
109
+ gap: 0.5rem;
95
110
  }
96
111
 
97
112
  .form-item {
@@ -99,14 +114,14 @@ exports.SIO_FORM_KH_TEMPLATE = `
99
114
  align-items: flex-start;
100
115
  flex-wrap: wrap;
101
116
  width: 100%;
102
- margin-bottom: 0.5rem;
103
117
  }
104
118
 
105
119
  .label,
106
120
  .question-label {
107
121
  word-wrap: break-word;
108
122
  white-space: normal;
109
- font-weight: bold;
123
+ font-weight: 500;
124
+ color: #444;
110
125
  }
111
126
 
112
127
  /* Underline for blanks */
@@ -124,6 +139,7 @@ exports.SIO_FORM_KH_TEMPLATE = `
124
139
  -webkit-box-decoration-break: clone;
125
140
  box-decoration-break: clone;
126
141
  align-self: flex-end;
142
+ color: #000;
127
143
  }
128
144
 
129
145
  /* size variants */
@@ -274,7 +290,7 @@ exports.SIO_FORM_KH_TEMPLATE = `
274
290
  </head>
275
291
 
276
292
  <body>
277
- <div class="page-header">
293
+ <div class="page-header mb-8">
278
294
  <img src="data:image/png;base64,<%= logo_base64 %>" alt="Logo" class="title-logo" />
279
295
  <div class="title-container">
280
296
  <h1 class="title">ពាក្យស្នើសុំធានារ៉ាប់រងអាយុជីវិត</h1>
@@ -288,56 +304,63 @@ exports.SIO_FORM_KH_TEMPLATE = `
288
304
  <div class="form-item">
289
305
  <span class="label">ឈ្មោះនិងលេខកូដសាខា</span>
290
306
  <span class="underline">
291
- <%= branch_staff_app_info.branch_name ?? '' %> / <%= branch_staff_app_info.branch_code ?? '' %>
307
+ <%= branch_staff_app_info.branch_name %> / <%= branch_staff_app_info.branch_code %>
292
308
  </span>
293
309
  <span class="label">ឈ្មោះនិងលេខកូដបុគ្គលិកធានារ៉ាប់រង់</span>
294
310
  <span class="underline">
295
- <%= branch_staff_app_info.advisor_name ?? '' %> / <%= branch_staff_app_info.advisor_code ?? '' %>
311
+ <%= branch_staff_app_info.advisor_name %> / <%= branch_staff_app_info.advisor_code %>
296
312
  </span>
297
313
  </div>
298
314
  <div class="form-item">
299
315
  <span class="label">ឈ្មោះនិងលេខកូដបុគ្គលិកធនាគារ</span>
300
316
  <span class="underline">
301
- <%= branch_staff_app_info.bank_staff_name ?? '' %> / <%= branch_staff_app_info.bank_staff_code ?? '' %>
317
+ <%= branch_staff_app_info.bank_staff_name %> / <%= branch_staff_app_info.bank_staff_code %>
302
318
  </span>
303
319
  <span class="label">លេខពាក្យស្នើសុំ</span>
304
- <span class="underline"><%= branch_staff_app_info.application_no ?? '' %></span>
320
+ <span class="underline">
321
+ <%= branch_staff_app_info.application_no %>
322
+ </span>
305
323
  </div>
306
324
  </div>
307
325
 
308
326
  <!-- Section 1 -->
309
- <div class="card-header">ព័ត៌មានអំពីអ្នកស្នើសុំពណ្ណសន្យារ៉ាប់រង់</div>
327
+ <div class="card-header mt-4">ព័ត៌មានអំពីអ្នកស្នើសុំបណ្ណសន្យារ៉ាប់រង់</div>
310
328
 
311
329
  <div class="form-container">
312
330
  <div class="form-item">
313
331
  <span class="label">ឈ្មោះពេញដូចបង្ហាញនៅក្នុងឯកសារអត្តសញ្ញាណ ជាភាសាខ្មែរ:</span>
314
- <span class="underline"><%= applicant_info.full_name_kh ?? '' %></span>
332
+ <span class="underline"><%= applicant_info.full_name_kh %></span>
315
333
  <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>
334
+ <span class="underline"><%= applicant_info.full_name %></span>
320
335
  </div>
321
336
 
322
337
  <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>
338
+ <span class="label">ភេទ:</span>
339
+ <label class="checkbox-label <%= applicant_info.gender === 'M' ? 'checked' : '' %>">ប្រុស</label>
340
+ <label class="checkbox-label <%= applicant_info.gender === 'F' ? 'checked' : '' %>">ស្រី</label>
336
341
 
337
- <div class="space"></div>
342
+ <div class="ml-8"></div>
338
343
 
344
+ <div>
345
+ <span class="label">ស្ថានភាពគ្រួសារ:</span>
346
+ <label class="checkbox-label <%= applicant_info.marital_status === 'single' ? 'checked' : '' %>">
347
+ នៅលីវ
348
+ </label>
349
+ <label class="checkbox-label <%= applicant_info.marital_status === 'married' ? 'checked' : '' %>">
350
+ រៀបការហើយ
351
+ </label>
352
+ <label class="checkbox-label <%= applicant_info.marital_status === 'divorced' ? 'checked' : '' %>">
353
+ លែងលះ
354
+ </label>
355
+ <label class="checkbox-label <%= applicant_info.marital_status === 'widowed' ? 'checked' : '' %>">
356
+ មេម៉ាយ/ពោះម៉ាយ
357
+ </label>
358
+ </div>
359
+ </div>
360
+
361
+ <div class="form-item">
339
362
  <span class="label">តួនាទី និងប្រភេទការងារ:</span>
340
- <span class="underline"><%= applicant_info.occupation ?? '' %></span>
363
+ <span class="underline align-left"><%= applicant_info.occupation %></span>
341
364
  </div>
342
365
 
343
366
  <div class="form-item">
@@ -348,62 +371,71 @@ exports.SIO_FORM_KH_TEMPLATE = `
348
371
  <label class="checkbox-label <%= applicant_info.identity_type === 'passport' ? 'checked' : '' %>">
349
372
  លិខិតឆ្លងដែន
350
373
  </label>
351
- <label class="checkbox-label <%= applicant_info.identity_type === 'birth_cert' ? 'checked' : '' %>">
374
+ <label class="checkbox-label <%= applicant_info.identity_type === 'birth' ? 'checked' : '' %>">
352
375
  សំបុត្រកំណើត
353
376
  </label>
377
+ <label class="checkbox-label <%= applicant_info.identity_type === 'other' ? 'checked' : '' %>">
378
+ ផ្សេងទៀត:
379
+ </label>
380
+
354
381
 
355
382
  <!-- 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>
383
+ <label class="underline"><%= applicant_info.identity_other_description %></label>
358
384
  </div>
359
385
 
360
386
  <div class="form-item">
361
387
  <span class="label">លេខអត្តសញ្ញាណ:</span>
362
- <span class="underline"><%= applicant_info.identity_no ?? '' %></span>
388
+ <span class="underline"><%= applicant_info.identity_no %></span>
363
389
  <span class="label">ថ្ងៃខែឆ្នាំកំណើត:</span>
364
- <span class="underline"><%= applicant_info.date_of_birth ?? '' %></span>
390
+ <span class="underline"><%= applicant_info.date_of_birth %></span>
365
391
  <span class="label">អាយុ:</span>
366
- <span class="underline xs"><%= applicant_info.age ?? '' %></span>
392
+ <span class="underline xs"><%= applicant_info.age %></span>
367
393
  <span class="label">សញ្ចាតិ:</span>
368
- <span class="underline"><%= applicant_info.nationality ?? '' %></span>
394
+ <span class="underline"><%= applicant_info.nationality %></span>
369
395
  <span class="label">លេខទូរស័ព្ទ:</span>
370
- <span class="underline"><%= applicant_info.phone_number ?? '' %></span>
396
+ <span class="underline"><%= applicant_info.phone_number %></span>
371
397
  </div>
372
398
 
373
399
  <div class="form-item">
374
400
  <span class="label">អាសយដ្ឋានបច្ចុប្បន្ន:</span>
375
- <span class="underline"><%= applicant_info.current_address ?? '' %></span>
401
+ <span class="underline align-left"><%= applicant_info.current_address %></span>
376
402
  </div>
377
403
 
378
- <div class="form-item">
379
- <span class="label">សេចក្ដីប្រកាសសម្រាប់ការអនុវត្ដ FATCA</span>
380
- </div>
404
+
381
405
  </div>
382
406
 
383
- <span class="label"
384
- >អ្នកស្នើរសុំបណ្ណសន្យារ៉ាប់រង់មិនមែនជាពលរដ្ឋាអាមេរិក ឬ
385
- ជាប់ពន្ធស្នាក់នៅអាមេរិក ឬ មានសិទ្ធិកាន់ Green Card នោះទេ។
386
- </span>
407
+
387
408
 
388
409
  <div class="form-container">
410
+ <div class="form-item mt-4">
411
+ <span class="label">សេចក្ដីប្រកាសសម្រាប់ការអនុវត្ដ FATCA</span>
412
+ </div>
413
+ <div class="form-item">
414
+ <span class="label">អ្នកស្នើរសុំបណ្ណសន្យារ៉ាប់រង់មិនមែនជាពលរដ្ឋាអាមេរិក ឬ
415
+ ជាប់ពន្ធស្នាក់នៅអាមេរិក ឬ មានសិទ្ធិកាន់ Green Card នោះទេ។
416
+ </span>
417
+ </div>
389
418
  <div class="form-item">
390
419
  <label class="checkbox-label <%= fatca_info.is_fatca === false ? 'checked' : '' %>">មិនមែន</label>
391
420
  <label class="checkbox-label <%= fatca_info.is_fatca === true ? 'checked' : '' %>">មែន</label>
392
421
  <span class="label">US TIN:</span>
393
- <span class="underline"><%= fatca_info.us_tin_no ?? '' %></span>
422
+ <span class="underline"><%= fatca_info.us_tin_no %></span>
394
423
  <span class="label">លេខកូដលើកលែង FATCA (ប្រសិនមាន):</span>
395
- <span class="underline"><%= fatca_info.fatca_exempt_code ?? '' %></span>
424
+ <span class="underline"><%= fatca_info.fatca_exempt_code %></span>
425
+ </div>
426
+ <div class="form-item">
427
+ <span class="label">
428
+ ប្រសិនបើការបញ្ចាក់អះអាងណាមួយមិនត្រឹមត្រូវ
429
+ ខ្ញុំនឹងប្រគល់ជូននូវឯកសារថ្មីក្នុងរយះពេល ៣០ថ្ងៃ
430
+ ហើយអះអាងថាខ្ញុំមិនជាប់ពន្ធកាត់ទុករបស់សហរដ្ឋអាមេរិកទេ
431
+ </span>
396
432
  </div>
397
433
  </div>
398
434
 
399
- <span class="label">
400
- ប្រសិនបើការបញ្ចាក់អះអាងណាមួយមិនត្រឹមត្រូវ
401
- ខ្ញុំនឹងប្រគល់ជូននូវឯកសារថ្មីក្នុងរយះពេល ៣០ថ្ងៃ
402
- ហើយអះអាងថាខ្ញុំមិនជាប់ពន្ធកាត់ទុករបស់សហរដ្ឋអាមេរិកទេ
403
- </span>
435
+
404
436
 
405
437
  <!-- Section 2 -->
406
- <div class="card-header">ព័ត៌មានអំពីផលិតផល</div>
438
+ <div class="card-header mt-4">ព័ត៌មានអំពីផលិតផល</div>
407
439
  <div class="table-container">
408
440
  <table>
409
441
  <thead>
@@ -419,10 +451,10 @@ exports.SIO_FORM_KH_TEMPLATE = `
419
451
  <tbody>
420
452
  <% product_payment_info?.products?.forEach(function(product) { %>
421
453
  <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>
454
+ <td><div class="cell"><%= product.name %> <%= product.term %></div></td>
455
+ <td><div class="cell"><%= product.sum_assured %></div></td>
456
+ <td><div class="cell"><%= product.payment_mode %></div></td>
457
+ <td><div class="cell"><%= product.premium %></div></td>
426
458
  </tr>
427
459
  <% }) %>
428
460
  </tbody>
@@ -431,17 +463,17 @@ exports.SIO_FORM_KH_TEMPLATE = `
431
463
  <div class="form-container">
432
464
  <div class="form-item">
433
465
  <span class="question-label">វិធីសាស្រ្ដបង់បុព្វលាភធានារ៉ាប់រង់:</span>
434
- <label class="checkbox-label <%= product_payment_info.payment_method === 'transfer' ? 'checked' : '' %>">
466
+ <label class="checkbox-label <%= product_payment_info.payment_method === 'transfer_to_plac' ? 'checked' : '' %>">
435
467
  ការផ្ទេរប្រាក់ចូលទៅក្នុងគណនីរបស់ហ្វីលីឡាយហ្វ៍
436
468
  </label>
437
- <label class="checkbox-label <%= product_payment_info.payment_method === 'partner' ? 'checked' : '' %>">
469
+ <label class="checkbox-label <%= product_payment_info.payment_method === 'other' ? 'checked' : '' %>">
438
470
  តាមរយះដៃគូររបស់ហ្វីលីឡាយហ្វ៍
439
471
  </label>
440
472
  </div>
441
473
  </div>
442
474
 
443
475
  <!-- Section 3 -->
444
- <div class="card-header">ព័ត៌មានអំពីអ្នកទទួលផល</div>
476
+ <div class="card-header mt-4">ព័ត៌មានអំពីអ្នកទទួលផល</div>
445
477
  <div class="table-container">
446
478
  <table>
447
479
  <thead>
@@ -449,22 +481,18 @@ exports.SIO_FORM_KH_TEMPLATE = `
449
481
  <th><div class="cell">ឈ្មោះពេញរបស់អ្នកទទួលផល</div></th>
450
482
  <th><div class="cell">អាយុ</div></th>
451
483
  <th><div class="cell">ទំនាក់ទំនង</div></th>
452
- <th><div class="cell">លេខអតក្តសញ្ញាណ</div></th>
484
+ <th><div class="cell">លេខអត្តសញ្ញាណ</div></th>
453
485
  <th><div class="cell">% នៃការបែងចែក</div></th>
454
486
  </tr>
455
487
  </thead>
456
488
  <tbody>
457
489
  <% beneficiary_info?.forEach(function(beneficiary) { %>
458
490
  <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>
491
+ <td><div class="cell"><%= beneficiary.full_name %></div></td>
492
+ <td><div class="cell"><%= beneficiary.age %></div></td>
493
+ <td><div class="cell"><%= beneficiary.relationship %></div></td>
494
+ <td><div class="cell"><%= beneficiary.id_number %></div></td>
495
+ <td><div class="cell"><%= beneficiary.percentage %></div></td>
468
496
  </tr>
469
497
  <% }) %>
470
498
  <tr>
@@ -485,15 +513,15 @@ exports.SIO_FORM_KH_TEMPLATE = `
485
513
  ព័ត៌មានពាក់ព័ន្ទនឹងសុខភាពរបស់ អ្នកស្នើសុំបណ្ណសន្យារ៉ាប់រង់
486
514
  </div>
487
515
 
488
- <div class="form-container">
489
- <!-- Question 1 -->
516
+ <!-- Question 1 -->
517
+ <div class="form-container mt-4">
490
518
  <div class="form-item">
491
519
  <span class="label">1) កម្ពស់:</span>
492
- <span class="underline sm"><%= health_info.height ?? '' %></span>
520
+ <span class="underline sm"><%= health_info.height %></span>
493
521
  <span class="label">ស.ម</span>
494
522
  <div class="space"></div>
495
523
  <span class="label">ទម្ងន់:</span>
496
- <span class="underline sm"><%= health_info.weight ?? '' %></span>
524
+ <span class="underline sm"><%= health_info.weight %></span>
497
525
  <span class="label">គ.ក</span>
498
526
  <div class="space"></div>
499
527
  <span class="question-label">តើលោកអ្នកពិសារបារីដែរឬទេ?:</span>
@@ -518,8 +546,8 @@ exports.SIO_FORM_KH_TEMPLATE = `
518
546
  </div>
519
547
  </div>
520
548
 
521
- <div class="form-container">
522
- <!-- Question 2 -->
549
+ <!-- Question 2 -->
550
+ <div class="form-container mt-4">
523
551
  <div class="form-item">
524
552
  <span class="question-label">2) តើលោកអ្នកពិសារគ្រឿងស្រវឹងដែរឬទេ?:</span>
525
553
  <label class="checkbox-label <%= health_info.is_drink_alcohol === false ? 'checked' : '' %>">
@@ -531,9 +559,9 @@ exports.SIO_FORM_KH_TEMPLATE = `
531
559
  </div>
532
560
  <div class="form-item">
533
561
  <span class="label">ចំនួន</span>
534
- <% if (health_info.hospitalized_detail) { %>
562
+ <% if (health_info.drink_alcohol_detail) { %>
535
563
  <span class="underline with-unit">
536
- <span class="value"><%= health_info.hospitalized_detail %></span>
564
+ <span class="value"><%= health_info.drink_alcohol_detail %></span>
537
565
  <span class="unit">ក្នុងមួយថ្ងៃ</span>
538
566
  </span>
539
567
  <% } else { %>
@@ -543,8 +571,8 @@ exports.SIO_FORM_KH_TEMPLATE = `
543
571
  </div>
544
572
  </div>
545
573
 
546
- <div class="form-container">
547
- <!-- Question 3 -->
574
+ <!-- Question 3 -->
575
+ <div class="form-container mt-4">
548
576
  <span class="question-label">
549
577
  3) ក្នុងរយៈពេល០២(ពីរ)ឆ្នាំចុងក្រោយនេះតើលោកអ្នកធ្លាប់បានសម្រាកក្នុងមន្ទីរពេទ្យធ្លាប់បានទទួលការវះកាត់
550
578
  ឬធ្លាប់ទទួលបានលទ្ធផលខុសប្រក្រតីអំពី ការវិភាគឈាម ការវិភាគទឹកនោម
@@ -574,8 +602,8 @@ exports.SIO_FORM_KH_TEMPLATE = `
574
602
  </div>
575
603
  </div>
576
604
 
577
- <div class="form-container">
578
- <!-- Question 4 -->
605
+ <!-- Question 4 -->
606
+ <div class="form-container mt-4">
579
607
  <span class="question-label">
580
608
  4) តើលោកអ្នកធ្លាប់បានធ្វើរោគវិនិច្ឆ័យ ពិគ្រោះជំងឺ ឬទទួលការព្យាបាលដូចជា
581
609
  លើសសម្ពាធឈាម ទឹកនោមផ្អែម ជំងឺបេះដូង ចុកទ្រូង ជំងឺសួត ជំងឺថ្លើម
@@ -605,7 +633,7 @@ exports.SIO_FORM_KH_TEMPLATE = `
605
633
  </div>
606
634
 
607
635
  <!-- Section 5 -->
608
- <div class="card-header">សេចក្ដីប្រកាសរបស់អ្នកស្នើសុំធានារ៉ាប់រង់</div>
636
+ <div class="card-header mt-8">សេចក្ដីប្រកាសរបស់អ្នកស្នើសុំធានារ៉ាប់រង់</div>
609
637
  <div class="form-container">
610
638
  <div class="form-item">
611
639
  <span class="label"
@@ -627,7 +655,7 @@ exports.SIO_FORM_KH_TEMPLATE = `
627
655
  </span>
628
656
  </div>
629
657
  </div>
630
- <div class="table-container">
658
+ <div class="table-container mt-4">
631
659
  <table>
632
660
  <thead>
633
661
  <tr>
@@ -650,8 +678,7 @@ exports.SIO_FORM_KH_TEMPLATE = `
650
678
  <div class="form-item">
651
679
  <div class="space"></div>
652
680
  <span class="label">ឈ្មោះ</span>
653
- <!-- <span class="underline"></span> -->
654
- <% if (signature_info.applicant_name) { %>
681
+ <% if (signature_info.applicant_name) { %>
655
682
  <span class="underline with-unit">
656
683
  <span class="value"><%= signature_info.applicant_name %></span>
657
684
  </span>
@@ -660,6 +687,7 @@ exports.SIO_FORM_KH_TEMPLATE = `
660
687
  <% } %>
661
688
  <div class="space"></div>
662
689
  </div>
690
+ </div>
663
691
  </td>
664
692
  <td>
665
693
  <div class="form-container space-height">
@@ -709,10 +737,6 @@ exports.SIO_FORM_KH_TEMPLATE = `
709
737
  <% } %>
710
738
  <div class="space"></div>
711
739
  </div>
712
- <!-- <div class="space"></div>
713
- <span class="label">កាលបរិច្ឆេទ</span>
714
- <span class="underline"></span>
715
- <div class="space"></div> -->
716
740
  </div>
717
741
  </td>
718
742
  </tr>
package/dist/types/pdf-form/sio-form.type.d.ts CHANGED
@@ -1,7 +1,7 @@
1
1
  export type SIOGender = "M" | "F";
2
2
  export type SIOMaritalStatus = "single" | "married" | "divorced" | "widowed";
3
3
  export type SIOIdentityType = "nid" | "passport" | "birth" | "other";
4
- export type SIOPaymentMethodType = "transfer" | "cash";
4
+ export type SIOPaymentMethodType = "transfer_to_plac" | "other";
5
5
  export interface ISIOBranchStaffAppInfo {
6
6
  branch_name: string;
7
7
  branch_code: string;
package/package.json CHANGED
@@ -1,6 +1,6 @@
1
1
  {
2
2
  "name": "plac-micro-common",
3
- "version": "1.3.15",
3
+ "version": "1.3.17",
4
4
  "types": "dist/index.d.ts",
5
5
  "main": "dist/index.js",
6
6
  "scripts": {