plac-micro-common 1.3.96 → 1.3.98

This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
Files changed (7) hide show
  1. package/dist/libs/pdf-form/templates/sio-form-en.template.d.ts +1 -1
  2. package/dist/libs/pdf-form/templates/sio-form-en.template.js +835 -633
  3. package/dist/libs/pdf-form/templates/sio-form-kh.template.d.ts +1 -1
  4. package/dist/libs/pdf-form/templates/sio-form-kh.template.js +64 -130
  5. package/dist/libs/pdf-form/templates/uw-form.template.d.ts +1 -1
  6. package/dist/libs/pdf-form/templates/uw-form.template.js +23 -17
  7. package/package.json +1 -1
package/dist/libs/pdf-form/templates/sio-form-en.template.js CHANGED
@@ -4,730 +4,932 @@ exports.SIO_FORM_EN_TEMPLATE = void 0;
4
4
  exports.SIO_FORM_EN_TEMPLATE = `
5
5
  <!doctype html>
6
6
  <html lang="en">
7
- <head>
8
- <meta charset="UTF-8" />
9
- <meta name="viewport" content="width=device-width, initial-scale=1.0" />
10
- <title>SIO Insurance Application Form</title>
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">
14
- <style>
15
- body {
16
- font-family: Arial, Helvetica, system-ui, sans-serif;
17
- font-size: 12px;
18
- line-height: 1.4;
19
- margin: 1rem;
20
- /* Reduced from 2rem */
21
- background: #fff;
22
- color: #000;
23
- }
24
7
 
25
- .font-kh {
26
- font-family: 'Hanuman', sans-serif !important;
8
+ <head>
9
+ <meta charset="UTF-8" />
10
+ <meta name="viewport" content="width=device-width, initial-scale=1.0" />
11
+ <title>SIO Insurance Application Form</title>
12
+ <link rel="preconnect" href="https://fonts.googleapis.com">
13
+ <link rel="preconnect" href="https://fonts.gstatic.com" crossorigin>
14
+ <link href="https://fonts.googleapis.com/css2?family=Hanuman:wght@100..900&family=Moul&display=swap" rel="stylesheet">
15
+ <style>
16
+ body {
17
+ font-family: Arial, Helvetica, system-ui, sans-serif;
18
+ font-size: 12px;
19
+ line-height: 1.4;
20
+ margin: 1rem;
21
+ /* Reduced from 2rem */
22
+ background: #fff;
23
+ color: #000;
24
+ }
25
+
26
+ .font-kh {
27
+ font-family: 'Hanuman', sans-serif !important;
28
+ }
29
+
30
+ .space {
31
+ width: 8px;
32
+ }
33
+
34
+ /* margin */
35
+ .ml-4 {
36
+ margin-left: 1rem;
37
+ }
38
+
39
+ .ml-8 {
40
+ margin-left: 2rem;
41
+ }
42
+
43
+ .mr-4 {
44
+ margin-right: 1rem;
45
+ }
46
+
47
+ .mr-8 {
48
+ margin-right: 2rem;
49
+ }
50
+
51
+ .mt-4 {
52
+ margin-top: 1rem;
53
+ }
54
+
55
+ .mt-8 {
56
+ margin-top: 2rem;
57
+ }
58
+
59
+ .mb-4 {
60
+ margin-bottom: 1rem;
61
+ }
62
+
63
+ .mb-8 {
64
+ margin-bottom: 2rem;
65
+ }
66
+
67
+ /* alignment */
68
+ .align-left {
69
+ justify-content: flex-start !important;
70
+ text-align: left;
71
+ padding-left: 16px;
72
+ }
73
+
74
+ .align-right {
75
+ justify-content: flex-end !important;
76
+ text-align: right;
77
+ padding-right: 16px;
78
+ }
79
+
80
+ .align-center {
81
+ justify-content: center !important;
82
+ text-align: center;
83
+ }
84
+
85
+ .space-height {
86
+ height: 60px;
87
+ align-items: center;
88
+ }
89
+
90
+ .signature-space {
91
+ height: 100px;
92
+ margin-top: 10px;
93
+ }
94
+
95
+ /* === Page header === */
96
+ .page-header {
97
+ margin-bottom: 0.5rem;
98
+ page-break-inside: avoid;
99
+ }
100
+
101
+ .header-container {
102
+ display: flex;
103
+ flex-direction: column;
104
+ align-items: center;
105
+ }
106
+
107
+ .title-logo {
108
+ width: 125px;
109
+ height: auto;
110
+ }
111
+
112
+ .title {
113
+ font-weight: 700;
114
+ font-size: 14px;
115
+ line-height: 1;
116
+ }
117
+
118
+ .title-container {
119
+ text-align: center;
120
+ font-weight: 700;
121
+ font-size: 14px;
122
+ line-height: 1.4;
123
+ margin: 0;
124
+ }
125
+
126
+ /* === Card Header === */
127
+ .card-header {
128
+ background-color: #0d6efd;
129
+ color: white;
130
+ text-align: center;
131
+ padding: 0.1rem 0;
132
+ border-radius: 6px 6px 0 0;
133
+ font-size: 13px;
134
+ font-weight: bold;
135
+ margin-bottom: 0.5rem;
136
+ /* Reduced */
137
+ -webkit-print-color-adjust: exact;
138
+ print-color-adjust: exact;
139
+ }
140
+
141
+ /* === Form Text === */
142
+ .form-container {
143
+ display: flex;
144
+ flex-wrap: wrap;
145
+ margin: 0;
146
+ padding: 0;
147
+ gap: 0.5rem;
148
+ }
149
+
150
+ .form-item {
151
+ display: flex;
152
+ align-items: flex-start;
153
+ flex-wrap: wrap;
154
+ width: 100%;
155
+ }
156
+
157
+ .label,
158
+ .question-label {
159
+ word-wrap: break-word;
160
+ white-space: normal;
161
+ font-weight: 500;
162
+ color: #444;
163
+ }
164
+
165
+ /* Underline for blanks */
166
+ .underline {
167
+ border-bottom: 1px dashed #000;
168
+ flex: 1;
169
+ min-width: 60px;
170
+ min-height: 1em;
171
+ display: inline-flex;
172
+ align-items: center;
173
+ justify-content: center;
174
+ text-align: center;
175
+ word-break: break-word;
176
+ white-space: normal;
177
+ -webkit-box-decoration-break: clone;
178
+ box-decoration-break: clone;
179
+ align-self: flex-end;
180
+ color: #000;
181
+ }
182
+
183
+ /* size variants */
184
+ .underline.xs {
185
+ flex: none;
186
+ width: 30px;
187
+ min-width: unset;
188
+ }
189
+
190
+ .underline.sm {
191
+ flex: none;
192
+ width: 80px;
193
+ min-width: unset;
194
+ }
195
+
196
+ .underline.md {
197
+ flex: none;
198
+ width: 180px;
199
+ min-width: unset;
200
+ }
201
+
202
+ .underline.lg {
203
+ flex: 2;
204
+ }
205
+
206
+ .underline.with-unit {
207
+ flex: 1;
208
+ min-width: 0;
209
+ display: block;
210
+ word-break: break-word;
211
+ white-space: normal;
212
+ border-bottom: none;
213
+ line-height: 1.6em;
214
+ text-align: left;
215
+ padding-left: 4px;
216
+ }
217
+
218
+ .with-unit .value {
219
+ display: inline;
220
+ text-decoration: underline;
221
+ text-decoration-style: dashed;
222
+ text-decoration-color: #000;
223
+ text-underline-offset: 3px;
224
+ -webkit-box-decoration-break: clone;
225
+ box-decoration-break: clone;
226
+ vertical-align: baseline;
227
+ }
228
+
229
+ .unit {
230
+ display: inline;
231
+ white-space: nowrap;
232
+ margin-left: 4px;
233
+ text-decoration: none;
234
+ }
235
+
236
+ /* Checkbox labels */
237
+ .checkbox-label {
238
+ display: inline-flex;
239
+ align-items: center;
240
+ gap: 0.5rem;
241
+ position: relative;
242
+ cursor: pointer;
243
+ padding-left: 0.2rem;
244
+ user-select: none;
245
+ margin-right: 0.5rem;
246
+ }
247
+
248
+ .checkbox-label::before {
249
+ content: "";
250
+ display: inline-flex;
251
+ align-items: center;
252
+ justify-content: center;
253
+ width: 20px;
254
+ height: 20px;
255
+ border: 2px solid #555;
256
+ border-radius: 3px;
257
+ background-color: #fff;
258
+ box-sizing: border-box;
259
+ flex-shrink: 0;
260
+ }
261
+
262
+ .checkbox-label.checked::after {
263
+ content: "";
264
+ position: absolute;
265
+ top: 45%;
266
+ left: calc(0.2rem + 7px);
267
+ width: 6px;
268
+ height: 12px;
269
+ border: solid #0d6efd;
270
+ border-width: 0 2px 2px 0;
271
+ box-sizing: border-box;
272
+ transform: translateY(-50%) rotate(45deg);
273
+ pointer-events: none;
274
+ }
275
+
276
+ .page-break {
277
+ page-break-before: always;
278
+ }
279
+
280
+ /* === Table data === */
281
+ .table-container {
282
+ margin: auto;
283
+ margin-bottom: 4px;
284
+ }
285
+
286
+ table {
287
+ width: 100%;
288
+ border-collapse: collapse;
289
+ }
290
+
291
+ th,
292
+ td {
293
+ border: 1px solid #ccc;
294
+ padding: 0;
295
+ }
296
+
297
+ .cell {
298
+ min-height: 10px;
299
+ padding: 4px 8px;
300
+ display: flex;
301
+ justify-content: center;
302
+ text-align: center;
303
+ }
304
+
305
+ th {
306
+ font-weight: 600;
307
+ }
308
+
309
+ /* === Print-specific: Footer with Page Numbers on the RIGHT === */
310
+ @media print {
311
+ body {
312
+ margin: 0;
313
+ padding-top: 10mm;
27
314
  }
28
315
 
29
- .space {
30
- width: 8px;
316
+ /* Make room for footer on the right side */
317
+ @page {
318
+ size: A4 portrait;
319
+ margin: 15mm 15mm 20mm 10mm;
320
+ /* increased right margin slightly for better spacing */
321
+
322
+ /* @bottom-right {
323
+ content: "Page " counter(page) " of " counter(pages);
324
+ font-size: 11px;
325
+ color: #555;
326
+ } */
31
327
  }
32
328
 
33
- /* margin */
34
- .ml-4 {margin-left: 1rem; }
35
- .ml-8 {margin-left: 2rem; }
36
-
37
- .mr-4 {margin-right: 1rem; }
38
- .mr-8 {margin-right: 2rem; }
39
-
40
- .mt-4 {margin-top: 1rem; }
41
- .mt-8 {margin-top: 2rem; }
42
-
43
- .mb-4 {margin-bottom: 1rem; }
44
- .mb-8 {margin-bottom: 2rem; }
45
-
46
- /* alignment */
47
- .align-left { justify-content: flex-start !important; text-align: left; padding-left: 16px; }
48
- .align-right { justify-content: flex-end !important; text-align: right; padding-right: 16px; }
49
- .align-center { justify-content: center !important; text-align: center; }
50
-
51
- .space-height {
52
- height: 60px;
53
- align-items: center;
54
- }
55
-
56
- .signature-space {
57
- height: 100px;
58
- margin-top: 10px;
329
+ /* Increment page counter */
330
+ body {
331
+ counter-increment: page;
59
332
  }
60
333
 
61
- /* === Page header === */
62
- .page-header {
63
- margin-bottom: 0.5rem;
334
+ .page-header,
335
+ .title-container,
336
+ table {
64
337
  page-break-inside: avoid;
65
338
  }
66
339
 
67
- .header-container {
68
- display: flex;
69
- flex-direction: column;
70
- align-items: center;
71
- }
72
-
73
- .title-logo {
74
- width: 125px;
75
- height: auto;
76
- }
77
-
78
- .title {
79
- font-weight: 700;
80
- font-size: 14px;
81
- line-height: 1;
82
- }
83
-
84
- .title-container {
85
- text-align: center;
86
- font-weight: 700;
87
- font-size: 14px;
88
- line-height: 1.4;
89
- margin: 0;
90
- }
91
-
92
- /* === Card Header === */
93
340
  .card-header {
94
- background-color: #0d6efd;
95
- color: white;
96
- text-align: center;
97
- padding: 0.1rem 0;
98
- border-radius: 6px 6px 0 0;
99
- font-size: 13px;
100
- font-weight: bold;
101
- margin-bottom: 0.5rem;
102
- /* Reduced */
103
341
  -webkit-print-color-adjust: exact;
104
342
  print-color-adjust: exact;
105
343
  }
106
-
107
- /* === Form Text === */
108
- .form-container {
109
- display: flex;
110
- flex-wrap: wrap;
111
- margin: 0;
112
- padding: 0;
113
- gap: 0.5rem;
114
- }
115
-
116
- .form-item {
117
- display: flex;
118
- align-items: flex-start;
119
- flex-wrap: wrap;
120
- width: 100%;
121
- }
122
-
123
- .label,
124
- .question-label {
125
- word-wrap: break-word;
126
- white-space: normal;
127
- font-weight: 500;
128
- color: #444;
129
- }
130
-
131
- /* Underline for blanks */
132
- .underline {
133
- border-bottom: 1px dashed #000;
134
- flex: 1;
135
- min-width: 60px;
136
- min-height: 1em;
137
- display: inline-flex;
138
- align-items: center;
139
- justify-content: center;
140
- text-align: center;
141
- word-break: break-word;
142
- white-space: normal;
143
- -webkit-box-decoration-break: clone;
144
- box-decoration-break: clone;
145
- align-self: flex-end;
146
- color: #000;
147
- }
148
-
149
- /* size variants */
150
- .underline.xs { flex: none; width: 30px; min-width: unset; }
151
- .underline.sm { flex: none; width: 80px; min-width: unset; }
152
- .underline.md { flex: none; width: 180px; min-width: unset; }
153
- .underline.lg { flex: 2; }
154
-
155
- .underline.with-unit {
156
- flex: 1;
157
- min-width: 0;
158
- display: block;
159
- word-break: break-word;
160
- white-space: normal;
161
- border-bottom: none;
162
- line-height: 1.6em;
163
- text-align: left;
164
- padding-left: 4px;
165
- }
166
-
167
- .with-unit .value {
168
- display: inline;
169
- text-decoration: underline;
170
- text-decoration-style: dashed;
171
- text-decoration-color: #000;
172
- text-underline-offset: 3px;
173
- -webkit-box-decoration-break: clone;
174
- box-decoration-break: clone;
175
- vertical-align: baseline;
176
- }
177
-
178
- .unit {
179
- display: inline;
180
- white-space: nowrap;
181
- margin-left: 4px;
182
- text-decoration: none;
183
- }
184
-
185
- /* Checkbox labels */
186
- .checkbox-label {
187
- display: inline-flex;
188
- align-items: center;
189
- gap: 0.5rem;
190
- position: relative;
191
- cursor: pointer;
192
- padding-left: 0.2rem;
193
- user-select: none;
194
- margin-right: 0.5rem;
195
- }
196
-
197
- .checkbox-label::before {
198
- content: "";
199
- display: inline-flex;
200
- align-items: center;
201
- justify-content: center;
202
- width: 20px;
203
- height: 20px;
204
- border: 2px solid #555;
205
- border-radius: 3px;
206
- background-color: #fff;
207
- box-sizing: border-box;
208
- flex-shrink: 0;
209
- }
210
-
211
- .checkbox-label.checked::after {
212
- content: "";
213
- position: absolute;
214
- top: 45%;
215
- left: calc(0.2rem + 7px);
216
- width: 6px;
217
- height: 12px;
218
- border: solid #0d6efd;
219
- border-width: 0 2px 2px 0;
220
- box-sizing: border-box;
221
- transform: translateY(-50%) rotate(45deg);
222
- pointer-events: none;
223
- }
224
-
225
- .page-break {
226
- page-break-before: always;
227
- }
228
-
229
- /* === Table data === */
230
- .table-container {
231
- margin: auto;
232
- margin-bottom: 4px;
233
- }
234
-
235
- table {
236
- width: 100%;
237
- border-collapse: collapse;
238
- }
239
-
240
- th,
241
- td {
242
- border: 1px solid #ccc;
243
- padding: 0;
244
- }
245
-
246
- .cell {
247
- min-height: 10px;
248
- padding: 4px 8px;
249
- display: flex;
250
- justify-content: center;
251
- text-align: center;
252
- }
253
-
254
- th {
255
- font-weight: 600;
256
- }
257
-
258
- /* === Print-specific: Footer with Page Numbers on the RIGHT === */
259
- @media print {
260
- body {
261
- margin: 0;
262
- padding-top: 10mm;
263
- }
264
-
265
- /* Make room for footer on the right side */
266
- @page {
267
- size: A4 portrait;
268
- margin: 15mm 15mm 20mm 10mm;
269
- /* increased right margin slightly for better spacing */
270
-
271
- @bottom-right {
272
- content: "Page " counter(page) " of " counter(pages);
273
- font-size: 11px;
274
- color: #555;
275
- }
276
- }
277
-
278
- /* Increment page counter */
279
- body {
280
- counter-increment: page;
281
- }
282
-
283
- .page-header,
284
- .title-container,
285
- table {
286
- page-break-inside: avoid;
287
- }
288
-
289
- .card-header {
290
- -webkit-print-color-adjust: exact;
291
- print-color-adjust: exact;
292
- }
293
- }
294
- </style>
295
- </head>
296
-
297
- <body>
298
- <div class="page-header mb-8">
299
- <img src="data:image/png;base64,<%= logo_base64 %>" alt="Logo" class="title-logo" />
300
- <div class="title-container">
301
- <h1 class="title">LIFE ASSURANCE APPLICATION FORM</h1>
302
- <h1 class="title">
303
- SIMPLIFY FORM FOR CHOKCHEY FINANCE PLC (SIO)
304
- </h1>
305
- </div>
344
+ }
345
+ </style>
346
+ </head>
347
+
348
+ <body>
349
+ <div class="page-header mb-8">
350
+ <img src="data:image/png;base64,<%= logo_base64 %>" alt="Logo" class="title-logo" />
351
+ <div class="title-container">
352
+ <h1 class="title">LIFE ASSURANCE APPLICATION FORM</h1>
353
+ <h1 class="title">
354
+ SIMPLIFY FORM FOR CHOKCHEY FINANCE PLC (SIO)
355
+ </h1>
306
356
  </div>
357
+ </div>
307
358
 
308
- <div class="form-container">
309
- <div class="form-item">
310
- <span class="label">Branch Name and Code:</span>
311
- <span class="underline">
312
- <%= branch_staff_app_info.branch_name %> / <%= branch_staff_app_info.branch_code %>
313
- </span>
314
- <span class="label">Advisor's Name and Code:</span>
315
- <span class="underline">
316
- <%= branch_staff_app_info.advisor_name %> / <%= branch_staff_app_info.advisor_code %>
317
- </span>
318
- </div>
319
- <div class="form-item">
320
- <span class="label">Bank staff's name and code:</span>
321
- <span class="underline">
322
- <%= branch_staff_app_info.bank_staff_name %> / <%= branch_staff_app_info.bank_staff_code %>
323
- </span>
324
- <span class="label">Application Number:</span>
325
- <span class="underline">
326
- <%= branch_staff_app_info.application_no %>
327
- </span>
328
- </div>
359
+ <div class="form-container">
360
+ <div class="form-item">
361
+ <span class="label">Branch Name and Code:</span>
362
+ <span class="underline">
363
+ <%= branch_staff_app_info.branch_name %> / <%= branch_staff_app_info.branch_code %>
364
+ </span>
365
+ <span class="label">Advisor's Name and Code:</span>
366
+ <span class="underline">
367
+ <%= branch_staff_app_info.advisor_name %> / <%= branch_staff_app_info.advisor_code %>
368
+ </span>
369
+ </div>
370
+ <div class="form-item">
371
+ <span class="label">Bank staff's name and code:</span>
372
+ <span class="underline">
373
+ <%= branch_staff_app_info.bank_staff_name %> / <%= branch_staff_app_info.bank_staff_code %>
374
+ </span>
375
+ <span class="label">Application Number:</span>
376
+ <span class="underline">
377
+ <%= branch_staff_app_info.application_no %>
378
+ </span>
329
379
  </div>
380
+ </div>
330
381
 
331
- <!-- Section 1 -->
332
- <div class="card-header mt-4">INFORMATION ABOUT THE APPLICANT</div>
382
+ <!-- Section 1 -->
383
+ <div class="card-header mt-4">INFORMATION ABOUT THE APPLICANT</div>
333
384
 
334
- <div class="form-container">
335
- <div class="form-item">
336
- <span class="label">Full Name as shown in identity documents: in KH Language:</span>
337
- <span class="underline font-kh"><%= applicant_info.full_name_kh %></span>
338
- <span class="label">EN Language:</span>
339
- <span class="underline"><%= applicant_info.full_name %></span>
340
- </div>
385
+ <div class="form-container">
386
+ <div class="form-item">
387
+ <span class="label">Full Name as shown in identity documents: in KH Language:</span>
388
+ <span class="underline font-kh">
389
+ <%= applicant_info.full_name_kh %>
390
+ </span>
391
+ <span class="label">EN Language:</span>
392
+ <span class="underline">
393
+ <%= applicant_info.full_name %>
394
+ </span>
395
+ </div>
341
396
 
342
- <div class="form-item">
343
- <span class="label">Gender:</span>
344
- <label class="checkbox-label <%= applicant_info.gender === 'M' ? 'checked' : '' %>">M</label>
345
- <label class="checkbox-label <%= applicant_info.gender === 'F' ? 'checked' : '' %>">F</label>
346
-
347
- <div class="ml-8"></div>
348
-
349
- <div>
350
- <span class="label">Marital Status:</span>
351
- <label class="checkbox-label <%= applicant_info.marital_status === 'single' ? 'checked' : '' %>">
352
- Single
353
- </label>
354
- <label class="checkbox-label <%= applicant_info.marital_status === 'married' ? 'checked' : '' %>">
355
- Married
356
- </label>
357
- <label class="checkbox-label <%= applicant_info.marital_status === 'divorced' ? 'checked' : '' %>">
358
- Divorced
359
- </label>
360
- <label class="checkbox-label <%= applicant_info.marital_status === 'widowed' ? 'checked' : '' %>">
361
- Widowed
362
- </label>
363
- </div>
364
- </div>
397
+ <div class="form-item">
398
+ <span class="label">Gender:</span>
399
+ <label class="checkbox-label <%= applicant_info.gender === 'M' ? 'checked' : '' %>">M</label>
400
+ <label class="checkbox-label <%= applicant_info.gender === 'F' ? 'checked' : '' %>">F</label>
365
401
 
366
- <div class="form-item">
367
- <span class="label">Job Title and Nature of Work:</span>
368
- <span class="underline align-left"><%= applicant_info.occupation %></span>
369
- </div>
402
+ <div class="ml-8"></div>
370
403
 
371
- <div class="form-item">
372
- <span class="label">Identity documents:</span>
373
- <label class="checkbox-label <%= applicant_info.identity_type === 'nid' ? 'checked' : '' %>">
374
- National ID Card
404
+ <div>
405
+ <span class="label">Marital Status:</span>
406
+ <label class="checkbox-label <%= applicant_info.marital_status === 'single' ? 'checked' : '' %>">
407
+ Single
375
408
  </label>
376
- <label class="checkbox-label <%= applicant_info.identity_type === 'passport' ? 'checked' : '' %>">
377
- Passport
409
+ <label class="checkbox-label <%= applicant_info.marital_status === 'married' ? 'checked' : '' %>">
410
+ Married
378
411
  </label>
379
- <label class="checkbox-label <%= applicant_info.identity_type === 'birth' ? 'checked' : '' %>">
380
- Birth Certificate
412
+ <label class="checkbox-label <%= applicant_info.marital_status === 'divorced' ? 'checked' : '' %>">
413
+ Divorced
381
414
  </label>
382
- <label class="checkbox-label <%= applicant_info.identity_type === 'other' ? 'checked' : '' %>">
383
- Others :
415
+ <label class="checkbox-label <%= applicant_info.marital_status === 'widowed' ? 'checked' : '' %>">
416
+ Widowed
384
417
  </label>
385
-
386
-
387
- <!-- other field stays separate since it has extra input -->
388
- <label class="underline"><%= applicant_info.identity_other_description %></label>
389
- </div>
390
-
391
- <div class="form-item">
392
- <span class="label">Identity #</span>
393
- <span class="underline"><%= applicant_info.identity_no %></span>
394
- <span class="label">DOB:</span>
395
- <span class="underline"><%= applicant_info.date_of_birth %></span>
396
- <span class="label">Age:</span>
397
- <span class="underline xs"><%= applicant_info.age %></span>
398
- <span class="label">Nationality:</span>
399
- <span class="underline"><%= applicant_info.nationality %></span>
400
- <span class="label">Phone #:</span>
401
- <span class="underline"><%= applicant_info.phone_number %></span>
402
418
  </div>
419
+ </div>
403
420
 
404
- <div class="form-item">
405
- <span class="label">Current Address:</span>
406
- <span class="underline align-left"><%= applicant_info.current_address %></span>
407
- </div>
421
+ <div class="form-item">
422
+ <span class="label">Job Title and Nature of Work:</span>
423
+ <span class="underline align-left">
424
+ <%= applicant_info.occupation %>
425
+ </span>
426
+ </div>
408
427
 
428
+ <div class="form-item">
429
+ <span class="label">Identity documents:</span>
430
+ <label class="checkbox-label <%= applicant_info.identity_type === 'nid' ? 'checked' : '' %>">
431
+ National ID Card
432
+ </label>
433
+ <label class="checkbox-label <%= applicant_info.identity_type === 'passport' ? 'checked' : '' %>">
434
+ Passport
435
+ </label>
436
+ <label class="checkbox-label <%= applicant_info.identity_type === 'birth' ? 'checked' : '' %>">
437
+ Birth Certificate
438
+ </label>
439
+ <label class="checkbox-label <%= applicant_info.identity_type === 'other' ? 'checked' : '' %>">
440
+ Others :
441
+ </label>
442
+
443
+
444
+ <!-- other field stays separate since it has extra input -->
445
+ <label class="underline">
446
+ <%= applicant_info.identity_other_description %>
447
+ </label>
448
+ </div>
409
449
 
450
+ <div class="form-item">
451
+ <span class="label">Identity #</span>
452
+ <span class="underline">
453
+ <%= applicant_info.identity_no %>
454
+ </span>
455
+ <span class="label">DOB:</span>
456
+ <span class="underline">
457
+ <%= applicant_info.date_of_birth %>
458
+ </span>
459
+ <span class="label">Age:</span>
460
+ <span class="underline xs">
461
+ <%= applicant_info.age %>
462
+ </span>
463
+ <span class="label">Nationality:</span>
464
+ <span class="underline">
465
+ <%= applicant_info.nationality %>
466
+ </span>
467
+ <span class="label">Phone #:</span>
468
+ <span class="underline">
469
+ <%= applicant_info.phone_number %>
470
+ </span>
410
471
  </div>
411
472
 
473
+ <div class="form-item">
474
+ <span class="label">Current Address:</span>
475
+ <span class="underline align-left">
476
+ <%= applicant_info.current_address %>
477
+ </span>
478
+ </div>
412
479
 
413
480
 
414
- <div class="form-container">
415
- <div class="form-item mt-4">
416
- <span class="label">Declaration on FATCA implementation</span>
417
- </div>
418
- <div class="form-item">
419
- <span class="label">
420
- The Policyholder is not USA citizen / USA resident for tax purpose or holding Green Card.
421
- </span>
422
- </div>
423
- <div class="form-item">
424
- <label class="checkbox-label <%= fatca_info.is_fatca === false ? 'checked' : '' %>">No</label>
425
- <label class="checkbox-label <%= fatca_info.is_fatca === true ? 'checked' : '' %>">Yes</label>
426
- <span class="label">US TIN #:</span>
427
- <span class="underline"><%= fatca_info.us_tin_no %></span>
428
- <span class="label">FATCA Exemption Code (If have):</span>
429
- <span class="underline"><%= fatca_info.fatca_exempt_code %></span>
430
- </div>
431
- <div class="form-item">
432
- <span class="label">
433
- If any of the certifications I have provided are incorrect, I will submit a new document within 30 days, and I certify that I am not subject to U.S. withholding tax.
434
- </span>
435
- </div>
436
- </div>
481
+ </div>
437
482
 
438
483
 
439
484
 
440
- <!-- Section 2 -->
441
- <div class="card-header mt-4">INFORMATION ABOUT THE PRODUCT
485
+ <div class="form-container">
486
+ <div class="form-item mt-4">
487
+ <span class="label">Declaration on FATCA implementation</span>
442
488
  </div>
443
- <div class="table-container">
444
- <table>
445
- <thead>
446
- <tr>
447
- <th><div class="cell">NAME OF PRODUCT AND TERMS</div></th>
448
- <th><div class="cell">SUM ASSURED (USD)</div></th>
449
- <th><div class="cell">MODE OF PAYMENT</div></th>
450
- <th>
451
- <div class="cell">PREMIUM (USD)</div>
452
- </th>
453
- </tr>
454
- </thead>
455
- <tbody>
456
- <% product_payment_info?.products?.forEach(function(product) { %>
457
- <tr>
458
- <td><div class="cell"><%= product.name %> <%= product.term %></div></td>
459
- <td><div class="cell"><%= product.sum_assured %></div></td>
460
- <td><div class="cell"><%= product.payment_mode %></div></td>
461
- <td><div class="cell"><%= product.premium %></div></td>
462
- </tr>
463
- <% }) %>
464
- </tbody>
465
- </table>
466
- </div>
467
- <div class="form-container">
468
- <div class="form-item">
469
- <span class="question-label">Method of payment:</span>
470
- <label class="checkbox-label <%= product_payment_info.payment_method === 'transfer_to_plac' ? 'checked' : '' %>">
471
- Credit to Phillip Life Account
472
- </label>
473
- <label class="checkbox-label <%= product_payment_info.payment_method === 'other' ? 'checked' : '' %>">
474
- Through Phillip Life's partner
475
- </label>
476
- </div>
489
+ <div class="form-item">
490
+ <span class="label">
491
+ The Policyholder is USA citizen / USA resident for tax purpose or holding Green Card.
492
+ </span>
493
+ </div>
494
+ <div class="form-item">
495
+ <label class="checkbox-label <%= fatca_info.is_fatca === false ? 'checked' : '' %>">No</label>
496
+ <label class="checkbox-label <%= fatca_info.is_fatca === true ? 'checked' : '' %>">Yes</label>
497
+ <span class="label">US TIN #:</span>
498
+ <span class="underline">
499
+ <%= fatca_info.us_tin_no %>
500
+ </span>
501
+ <span class="label">FATCA Exemption Code (If have):</span>
502
+ <span class="underline">
503
+ <%= fatca_info.fatca_exempt_code %>
504
+ </span>
477
505
  </div>
506
+ <div class="form-item">
507
+ <span class="label">
508
+ If any of the certifications I have provided are incorrect, I will submit a new document within 30 days, and I
509
+ certify that I am not subject to U.S. withholding tax.
510
+ </span>
511
+ </div>
512
+ </div>
513
+
514
+
515
+
516
+ <!-- Section 2 -->
517
+ <div class="card-header mt-4">INFORMATION ABOUT THE PRODUCT
518
+ </div>
519
+ <div class="table-container">
520
+ <table>
521
+ <thead>
522
+ <tr>
523
+ <th>
524
+ <div class="cell">NAME OF PRODUCT AND TERMS</div>
525
+ </th>
526
+ <th>
527
+ <div class="cell">SUM ASSURED (USD)</div>
528
+ </th>
529
+ <th>
530
+ <div class="cell">MODE OF PAYMENT</div>
531
+ </th>
532
+ <th>
533
+ <div class="cell">PREMIUM (USD)</div>
534
+ </th>
535
+ </tr>
536
+ </thead>
537
+ <tbody>
538
+ <% product_payment_info?.products?.forEach(function(product) { %>
539
+ <tr>
540
+ <td>
541
+ <div class="cell">
542
+ <%= product.name %>
543
+ <%= product.term %>
544
+ </div>
545
+ </td>
546
+ <td>
547
+ <div class="cell">
548
+ <%= product.sum_assured %>
549
+ </div>
550
+ </td>
551
+ <td>
552
+ <div class="cell">
553
+ <%= product.payment_mode %>
554
+ </div>
555
+ </td>
556
+ <td>
557
+ <div class="cell">
558
+ <%= product.premium %>
559
+ </div>
560
+ </td>
561
+ </tr>
562
+ <% }) %>
563
+ </tbody>
564
+ </table>
565
+ </div>
566
+ <div class="form-container">
567
+ <div class="form-item">
568
+ <span class="question-label">Method of payment:</span>
569
+ <label class="checkbox-label <%= product_payment_info.payment_method === 'transfer_to_plac' ? 'checked' : '' %>">
570
+ Credit to Phillip Life Account
571
+ </label>
572
+ <label class="checkbox-label <%= product_payment_info.payment_method === 'other' ? 'checked' : '' %>">
573
+ Through Phillip Life's partner
574
+ </label>
575
+ </div>
576
+ </div>
478
577
 
479
- <!-- Section 3 -->
480
- <div class="card-header mt-4">INFORMATION ABOUT THE BENEFICIARY(IES)</div>
578
+ <% if (loan_info) { %>
579
+ <div class="card-header mt-4">LOAN INFORMATION</div>
481
580
  <div class="table-container">
482
581
  <table>
483
582
  <thead>
484
583
  <tr>
485
- <th><div class="cell">FULL NAME OF BENEFICIARY</div></th>
486
- <th><div class="cell">AGE</div></th>
487
- <th><div class="cell">RELATIONSHIP</div></th>
488
- <th><div class="cell">IDENTITY NUMBER</div></th>
489
- <th><div class="cell">% OF SHARE</div></th>
584
+ <th>
585
+ <div class="cell">LOAN AMOUNT</div>
586
+ </th>
587
+ <th>
588
+ <div class="cell">LOAN TERM</div>
589
+ </th>
590
+ <th>
591
+ <div class="cell">LOAN TYPE</div>
592
+ </th>
490
593
  </tr>
491
594
  </thead>
492
595
  <tbody>
493
- <% beneficiary_info?.forEach(function(beneficiary) { %>
494
596
  <tr>
495
- <td><div class="cell"><%= beneficiary.full_name %></div></td>
496
- <td><div class="cell"><%= beneficiary.age %></div></td>
497
- <td><div class="cell"><%= beneficiary.relationship %></div></td>
498
- <td><div class="cell"><%= beneficiary.id_number %></div></td>
499
- <td><div class="cell"><%= beneficiary.percentage %></div></td>
500
- </tr>
501
- <% }) %>
502
- <tr>
503
- <td colspan="4">
597
+ <td>
598
+ <div class="cell">
599
+ <%= loan_info.loan_amount %>
600
+ </div>
601
+ </td>
602
+ <td>
504
603
  <div class="cell">
505
- Note:
506
- If the percentage is not specified the amount will be shared equally
604
+ <%= loan_info.loan_duration %>
605
+ </div>
606
+ </td>
607
+ <td>
608
+ <div class="cell">
609
+ <%= loan_info.loan_type %>
507
610
  </div>
508
611
  </td>
509
- <td><div class="cell">% Total 100 %</div></td>
510
612
  </tr>
511
613
  </tbody>
512
614
  </table>
513
615
  </div>
514
-
515
- <!-- Section 4 -->
516
- <div class="page-break"></div>
517
- <div class="card-header">
518
- HEALTH RELATED QUESTIONS
616
+
617
+ <% } %>
618
+
619
+ <!-- Section 3 -->
620
+ <div class="card-header mt-4">INFORMATION ABOUT THE BENEFICIARY(IES)</div>
621
+ <div class="table-container">
622
+ <table>
623
+ <thead>
624
+ <tr>
625
+ <th>
626
+ <div class="cell">FULL NAME OF BENEFICIARY</div>
627
+ </th>
628
+ <th>
629
+ <div class="cell">AGE</div>
630
+ </th>
631
+ <th>
632
+ <div class="cell">RELATIONSHIP</div>
633
+ </th>
634
+ <th>
635
+ <div class="cell">IDENTITY NUMBER</div>
636
+ </th>
637
+ <th>
638
+ <div class="cell">SHARE</div>
639
+ </th>
640
+ </tr>
641
+ </thead>
642
+ <tbody>
643
+ <% beneficiary_info?.forEach(function(beneficiary) { %>
644
+ <tr>
645
+ <td>
646
+ <div class="align-left">
647
+ <%= beneficiary.full_name %>
648
+ </div>
649
+ </td>
650
+ <td>
651
+ <div class="cell">
652
+ <%= beneficiary.age %>
653
+ </div>
654
+ </td>
655
+ <td>
656
+ <div class="cell">
657
+ <%= beneficiary.relationship %>
658
+ </div>
659
+ </td>
660
+ <td>
661
+ <div class="cell">
662
+ <%= beneficiary.id_number %>
663
+ </div>
664
+ </td>
665
+ <td>
666
+ <div class="cell">
667
+ <%= beneficiary.percentage %>
668
+ </div>
669
+ </td>
670
+ </tr>
671
+ <% }) %>
672
+ <tr>
673
+ <td colspan="5">
674
+ <div class="cell align-left"
675
+ style="text-align: start !important; padding-top: 5px; padding-bottom: 5px;">
676
+ The company will pay benefits to the primary beneficiary first before paying any remaining benefits to
677
+ the secondary beneficiary designated by the applicant or to the heirs of the insured if no beneficiary
678
+ is appointed.
679
+ </div>
680
+ </td>
681
+ </tr>
682
+ </tbody>
683
+ </table>
684
+ </div>
685
+
686
+ <!-- Section 4 -->
687
+ <div class="page-break"></div>
688
+ <div class="card-header">
689
+ HEALTH RELATED QUESTIONS
690
+ </div>
691
+
692
+ <!-- Question 1 -->
693
+ <div class="form-container">
694
+ <div class="form-item">
695
+ <span class="label">1) Height:</span>
696
+ <span class="underline sm">
697
+ <%= health_info.height %>
698
+ </span>
699
+ <span class="label">cm</span>
700
+ <div class="space"></div>
701
+ <span class="label">Weight:</span>
702
+ <span class="underline sm">
703
+ <%= health_info.weight %>
704
+ </span>
705
+ <span class="label">Kg</span>
706
+ <div class="space"></div>
707
+ <span class="question-label">A) Do you smoke?</span>
708
+ <label class="checkbox-label <%= health_info.is_smoke === false ? 'checked' : '' %>">
709
+ No
710
+ </label>
711
+ <label class="checkbox-label <%= health_info.is_smoke === true ? 'checked' : '' %>">
712
+ Yes
713
+ </label>
519
714
  </div>
520
715
 
521
- <!-- Question 1 -->
522
- <div class="form-container">
523
- <div class="form-item">
524
- <span class="label">1) Height:</span>
525
- <span class="underline sm"><%= health_info.height %></span>
526
- <span class="label">cm</span>
527
- <div class="space"></div>
528
- <span class="label">Weight:</span>
529
- <span class="underline sm"><%= health_info.weight %></span>
530
- <span class="label">Kg</span>
531
- <div class="space"></div>
532
- <span class="question-label">A) Do you smoke?</span>
533
- <label class="checkbox-label <%= health_info.is_smoke === false ? 'checked' : '' %>">
534
- No
535
- </label>
536
- <label class="checkbox-label <%= health_info.is_smoke === true ? 'checked' : '' %>">
537
- Yes
538
- </label>
539
- </div>
540
-
541
- <div class="form-item mb-4">
542
- <span class="label">How many</span>
543
- <% if (health_info.smoke_detail) { %>
544
- <span class="underline with-unit">
545
- <span class="value"><%= health_info.smoke_detail %></span>
546
- <span class="unit">per day</span>
716
+ <div class="form-item mb-4">
717
+ <span class="label">How many</span>
718
+ <% if (health_info.smoke_detail) { %>
719
+ <span class="underline with-unit">
720
+ <span class="value">
721
+ <%= health_info.smoke_detail %>
547
722
  </span>
723
+ <span class="unit">per day</span>
724
+ </span>
548
725
  <% } else { %>
549
726
  <span class="underline"></span>
550
- <% } %>
551
- </div>
727
+ <% } %>
552
728
  </div>
553
-
554
- <!-- Question 2 -->
555
- <div class="form-container">
556
- <div class="form-item">
557
- <span class="question-label">2) Do you drink alcohol?</span>
558
- <label class="checkbox-label <%= health_info.is_drink_alcohol === false ? 'checked' : '' %>">
559
- No
560
- </label>
561
- <label class="checkbox-label <%= health_info.is_drink_alcohol === true ? 'checked' : '' %>">
562
- Yes
563
- </label>
564
- </div>
565
- <div class="form-item mb-4">
566
- <span class="label">Please specify amount of drink per week</span>
567
- <% if (health_info.drink_alcohol_detail) { %>
568
- <span class="underline with-unit">
569
- <span class="value"><%= health_info.drink_alcohol_detail %></span>
729
+ </div>
730
+
731
+ <!-- Question 2 -->
732
+ <div class="form-container">
733
+ <div class="form-item">
734
+ <span class="question-label">2) Do you drink alcohol?</span>
735
+ <label class="checkbox-label <%= health_info.is_drink_alcohol === false ? 'checked' : '' %>">
736
+ No
737
+ </label>
738
+ <label class="checkbox-label <%= health_info.is_drink_alcohol === true ? 'checked' : '' %>">
739
+ Yes
740
+ </label>
741
+ </div>
742
+ <div class="form-item mb-4">
743
+ <span class="label">Please specify amount of drink per week</span>
744
+ <% if (health_info.drink_alcohol_detail) { %>
745
+ <span class="underline with-unit">
746
+ <span class="value">
747
+ <%= health_info.drink_alcohol_detail %>
570
748
  </span>
749
+ </span>
571
750
  <% } else { %>
572
751
  <span class="underline"></span>
573
- <% } %>
574
- </div>
752
+ <% } %>
753
+ </div>
754
+ </div>
755
+
756
+ <!-- Question 3 -->
757
+ <div class="form-container">
758
+ <span class="question-label">
759
+ 3) In the past 2 years, have you ever been hospitalized, undergone any surgical operation, or had abnormal results
760
+ such as: Blood test, Urine test, X-ray, ECG, Ultrasound, Scan, Biopsy or any other test results.
761
+ </span>
762
+ <div class="form-item">
763
+ <label class="checkbox-label <%= health_info.is_hospitalized === false ? 'checked' : '' %>">
764
+ No
765
+ </label>
766
+ <label class="checkbox-label <%= health_info.is_hospitalized === true ? 'checked' : '' %>">
767
+ Yes
768
+ </label>
575
769
  </div>
576
770
 
577
- <!-- Question 3 -->
578
- <div class="form-container">
579
- <span class="question-label">
580
- 3) In the past 2 years, have you ever been hospitalized, undergone any surgical operation, or had abnormal results such as: Blood test, Urine test, X-ray, ECG, Ultrasound, Scan, Biopsy or any other test results.
581
- </span>
582
- <div class="form-item">
583
- <label class="checkbox-label <%= health_info.is_hospitalized === false ? 'checked' : '' %>">
584
- No
585
- </label>
586
- <label class="checkbox-label <%= health_info.is_hospitalized === true ? 'checked' : '' %>">
587
- Yes
588
- </label>
589
- </div>
590
-
591
- <div class="form-item mb-4">
592
- <span class="label">provided more details:</span>
593
- <% if (health_info.hospitalized_detail) { %>
594
- <span class="underline with-unit">
595
- <span class="value"><%= health_info.hospitalized_detail %></span>
771
+ <div class="form-item mb-4">
772
+ <span class="label">provided more details:</span>
773
+ <% if (health_info.hospitalized_detail) { %>
774
+ <span class="underline with-unit">
775
+ <span class="value">
776
+ <%= health_info.hospitalized_detail %>
596
777
  </span>
778
+ </span>
597
779
  <% } else { %>
598
780
  <span class="underline"></span>
599
- <% } %>
600
- </div>
781
+ <% } %>
601
782
  </div>
783
+ </div>
784
+
785
+ <!-- Question 4 -->
786
+ <div class="form-container">
787
+ <span class="question-label">
788
+ 4) Have you ever been diagnosed with, consulted a medical practitioner or been given treatment for any of the
789
+ following conditions: Hypertension, Diabetes, Heart diseases, Chest pain, Lung diseases, Liver disease, Renal
790
+ diseases, Cancer, Stroke, AIDS, Mental illness, Disability or Deformity, Drug or Alcohol Abuse or Any other
791
+ diseases are not mentioned above.
792
+ </span>
793
+ <div class="form-item">
794
+ <label class="checkbox-label <%= health_info.is_diagnosed === false ? 'checked' : '' %>">
795
+ No
796
+ </label>
797
+ <label class="checkbox-label <%= health_info.is_diagnosed === true ? 'checked' : '' %>">
798
+ Yes
799
+ </label>
602
800
 
603
- <!-- Question 4 -->
604
- <div class="form-container">
605
- <span class="question-label">
606
- 4) Have you ever been diagnosed with, consulted a medical practitioner or been given treatment for any of the following conditions: Hypertension, Diabetes, Heart diseases, Chest pain, Lung diseases, Liver disease, Renal diseases, Cancer, Stroke, AIDS, Mental illness, Disability or Deformity, Drug or Alcohol Abuse or Any other diseases are not mentioned above.
607
- </span>
608
- <div class="form-item">
609
- <label class="checkbox-label <%= health_info.is_diagnosed === false ? 'checked' : '' %>">
610
- No
611
- </label>
612
- <label class="checkbox-label <%= health_info.is_diagnosed === true ? 'checked' : '' %>">
613
- Yes
614
- </label>
615
-
616
- </div>
617
- <div class="form-item mb-4">
618
- <span class="label">if yes, please provided more details:</span>
619
- <% if (health_info.diagnosed_detail) { %>
620
- <span class="underline with-unit">
621
- <span class="value"><%= health_info.diagnosed_detail %></span>
801
+ </div>
802
+ <div class="form-item mb-4">
803
+ <span class="label">if yes, please provided more details:</span>
804
+ <% if (health_info.diagnosed_detail) { %>
805
+ <span class="underline with-unit">
806
+ <span class="value">
807
+ <%= health_info.diagnosed_detail %>
622
808
  </span>
809
+ </span>
623
810
  <% } else { %>
624
811
  <span class="underline"></span>
625
- <% } %>
626
- </div>
812
+ <% } %>
627
813
  </div>
628
-
629
- <!-- Section 5 -->
630
- <div class="card-header mt-4">DECLARATION BY THE APPLICANT</div>
631
- <div class="form-container">
632
- <div class="form-item">
633
- <span class="label">
634
- 1) I authorize and consent the Company to use all of my information provided in my application form for legal purposes such as marketing, market survey and customer service by company, affiliate, or business partner without my prior consent or notification. The Company shall not allow to disclose any information of any other purpose not related to the above-mentioned purpose without prior consent in writing.
635
- </span>
636
- </div>
637
- <div class="form-item">
638
- <span class="label">
639
- 2) I hereby confirm that I have read and understood all the information in this document. I declare that all the information provided in this application form is complete, accurate, and true.
640
- </span>
641
- </div>
814
+ </div>
815
+
816
+ <!-- Section 5 -->
817
+ <div class="card-header mt-4">DECLARATION BY THE APPLICANT</div>
818
+ <div class="form-container" style="margin: 15px 0px 15px 0px;">
819
+ <div class="form-item">
820
+ <ol style="padding-left: 1.2rem; margin: 0;">
821
+ <li class="label" style="margin-bottom: 5px;">
822
+ I authorize and consent the Company to use all of my information provided in my application form for legal
823
+ purposes such as marketing, market survey and customer service by company, affiliate, or business partner
824
+ without my prior consent or notification. The Company shall not allow to disclose any information of any other
825
+ purpose not related to the above-mentioned purpose without prior consent in writing.
826
+ </li>
827
+ <li class="label">
828
+ I hereby confirm that I have read and understood all the information in this document. I declare that all the
829
+ information provided in this application form is complete, accurate, and true.
830
+ </li>
831
+ </ol>
642
832
  </div>
643
- <div class="table-container mt-4">
644
- <table>
645
- <thead>
646
- <tr>
647
- <th style="width: 50%">
648
- <div class="cell">
649
- Signature or Thumb print of the Applicant
650
- </div>
651
- <div class="signature-space"></div>
652
- </th>
653
- <th style="width: 50%">
654
- <div class="cell">Signature or Thumb print of the witness</div>
655
- <div class="signature-space"></div>
656
- </th>
657
- </tr>
658
- </thead>
659
- <tbody>
660
- <tr>
661
- <td>
662
- <div class="form-container space-height">
663
- <div class="form-item">
664
- <div class="space"></div>
665
- <span class="label">Name</span>
666
- <% if (signature_info.applicant_name) { %>
667
- <span class="underline with-unit">
668
- <span class="value"><%= signature_info.applicant_name %></span>
833
+ </div>
834
+
835
+
836
+ <div class="table-container mt-4">
837
+ <table>
838
+ <thead>
839
+ <tr>
840
+ <th style="width: 50%">
841
+ <div class="cell">
842
+ Signature or Thumb print of the Applicant
843
+ </div>
844
+ <div class="signature-space"></div>
845
+ </th>
846
+ <th style="width: 50%">
847
+ <div class="cell">Signature or Thumb print of the witness</div>
848
+ <div class="signature-space"></div>
849
+ </th>
850
+ </tr>
851
+ </thead>
852
+ <tbody>
853
+ <tr>
854
+ <td>
855
+ <div class="form-container space-height">
856
+ <div class="form-item">
857
+ <div class="space"></div>
858
+ <span class="label">Name</span>
859
+ <% if (signature_info.applicant_name) { %>
860
+ <span class="underline with-unit">
861
+ <span class="value">
862
+ <%= signature_info.applicant_name %>
669
863
  </span>
864
+ </span>
670
865
  <% } else { %>
671
866
  <span class="underline"></span>
672
- <% } %>
673
- <div class="space"></div>
674
- </div>
867
+ <% } %>
868
+ <div class="space"></div>
675
869
  </div>
676
- </td>
677
- <td>
678
- <div class="form-container space-height">
679
- <div class="form-item">
680
- <div class="space"></div>
681
- <span class="label">Name</span>
682
- <% if (signature_info.witness_name) { %>
683
- <span class="underline with-unit">
684
- <span class="value"><%= signature_info.witness_name %></span>
870
+ </div>
871
+ </td>
872
+ <td>
873
+ <div class="form-container space-height">
874
+ <div class="form-item">
875
+ <div class="space"></div>
876
+ <span class="label">Name</span>
877
+ <% if (signature_info.witness_name) { %>
878
+ <span class="underline with-unit">
879
+ <span class="value">
880
+ <%= signature_info.witness_name %>
685
881
  </span>
882
+ </span>
686
883
  <% } else { %>
687
884
  <span class="underline"></span>
688
- <% } %>
689
- <div class="space"></div>
690
- </div>
885
+ <% } %>
886
+ <div class="space"></div>
691
887
  </div>
692
- </td>
693
- </tr>
694
- <tr>
695
- <td>
696
- <div class="form-container space-height">
697
- <div class="form-item">
698
- <div class="space"></div>
699
- <span class="label">Date</span>
700
- <% if (signature_info.applicant_signature_date) { %>
701
- <span class="underline with-unit" >
702
- <span class="value"><%= signature_info.applicant_signature_date %></span>
888
+ </div>
889
+ </td>
890
+ </tr>
891
+ <tr>
892
+ <td>
893
+ <div class="form-container space-height">
894
+ <div class="form-item">
895
+ <div class="space"></div>
896
+ <span class="label">Date</span>
897
+ <% if (signature_info.applicant_signature_date) { %>
898
+ <span class="underline with-unit">
899
+ <span class="value">
900
+ <%= signature_info.applicant_signature_date %>
703
901
  </span>
902
+ </span>
704
903
  <% } else { %>
705
904
  <span class="underline"></span>
706
- <% } %>
707
- <div class="space"></div>
708
- </div>
905
+ <% } %>
906
+ <div class="space"></div>
709
907
  </div>
710
- </td>
711
- <td>
712
- <div class="form-container space-height">
713
- <div class="form-item">
714
- <div class="space"></div>
715
- <span class="label">Date</span>
716
- <% if (signature_info.witness_signature_date) { %>
717
- <span class="underline with-unit">
718
- <span class="value"><%= signature_info.witness_signature_date %></span>
908
+ </div>
909
+ </td>
910
+ <td>
911
+ <div class="form-container space-height">
912
+ <div class="form-item">
913
+ <div class="space"></div>
914
+ <span class="label">Date</span>
915
+ <% if (signature_info.witness_signature_date) { %>
916
+ <span class="underline with-unit">
917
+ <span class="value">
918
+ <%= signature_info.witness_signature_date %>
719
919
  </span>
920
+ </span>
720
921
  <% } else { %>
721
922
  <span class="underline"></span>
722
- <% } %>
723
- <div class="space"></div>
724
- </div>
923
+ <% } %>
924
+ <div class="space"></div>
725
925
  </div>
726
- </td>
727
- </tr>
728
- </tbody>
729
- </table>
730
- </div>
731
- </body>
926
+ </div>
927
+ </td>
928
+ </tr>
929
+ </tbody>
930
+ </table>
931
+ </div>
932
+ </body>
933
+
732
934
  </html>
733
935
  `;