plac-micro-common 1.3.99 → 1.3.101
This diff represents the content of publicly available package versions that have been released to one of the supported registries. The information contained in this diff is provided for informational purposes only and reflects changes between package versions as they appear in their respective public registries.
- package/dist/libs/pdf-form/templates/receipt.template.d.ts +1 -1
- package/dist/libs/pdf-form/templates/receipt.template.js +2 -2
- package/dist/libs/pdf-form/templates/sio-form-en.template.d.ts +1 -1
- package/dist/libs/pdf-form/templates/sio-form-en.template.js +45 -37
- package/dist/libs/pdf-form/templates/sio-form-kh.template.d.ts +1 -1
- package/dist/libs/pdf-form/templates/sio-form-kh.template.js +79 -33
- package/dist/models/application/application.entity.d.ts +2 -1
- package/dist/models/application/application.entity.js +9 -0
- package/dist/types/application.type.d.ts +5 -0
- package/dist/types/application.type.js +7 -1
- package/dist/utils/frontend/data.util.d.ts +4 -3
- package/dist/utils/frontend/data.util.js +13 -0
- package/package.json +1 -1
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export declare const RECEIPT_TEMPLATE = "\n<!doctype html>\n<html lang=\"en\">\n\n<head>\n <meta charset=\"UTF-8\" />\n <meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\" />\n <title>\u1794\u1784\u17D2\u1780\u17B6\u1793\u17CB\u178A\u17C3\u1791\u1791\u17BD\u179B\u1794\u17D2\u179A\u17B6\u1780\u17CB - OFFICIAL RECEIPT</title>\n\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\"\n rel=\"stylesheet\" />\n <script src=\"https://cdn.tailwindcss.com\"></script>\n\n <style>\n * {\n box-sizing: border-box;\n }\n\n .font-moul {\n font-family: \"Moul\", serif;\n }\n\n .font-hanuman {\n font-family: \"Hanuman\", serif;\n }\n\n body {\n font-family: \"Hanuman\", serif;\n margin: 0;\n padding: 0;\n font-size: 12px;\n line-height: 1.5;\n color: #000;\n background: #fff;\n }\n\n\n @page {\n size: A4 portrait;\n margin: 20mm 10mm 20mm 10mm;\n }\n </style>\n\n</head>\n\n<body>\n <div class=\"space-y-5\">\n <div class=\"text-md space-y-2\">\n <div>\n <h2 class=\"font-bold\">\u17A0\u17D2\u179C\u17B8\u179B\u17B8\u1796 \u17A1\u17B6\u1799\u17A0\u17D2\u179C\u17CD \u17A2\u17B6\u179F\u17BD\u179A\u17C1\u1793 (\u1781\u17C1\u1798\u1794\u17BC\u178C\u17B6)\u200B \u1798.\u1780</h2>\n <h2 class=\"font-bold\">Phillip Life Assurance (Cambodia) PLC.</h2>\n </div>\n\n <div>\n <p>\u17A2\u17B6\u1782\u17B6\u179A\u179B\u17C1\u1781 27AB \u1798\u17A0\u17B6\u179C\u17B7\u1790\u17B8\u1796\u17D2\u179A\u17C7\u1798\u17BB\u1793\u17B8\u179C\u1784\u17D2\u179F \u179F\u1784\u17D2\u1780\u17B6\u178F\u17CB\u179F\u17D2\u179A\u17C7\u1785\u1780 \u1781\u178E\u17D2\u178C\u178A\u17BC\u1793\u1796\u17C1\u1789 </p>\n <p>\u179A\u17B6\u1787\u1792\u17B6\u1793\u17B8\u1797\u17D2\u1793\u17C6\u1796\u17C1\u1789 \u1794\u17D2\u179A\u1791\u17C1\u179F\u1780\u1798\u17D2\u1796\u17BB\u1787\u17B6</p>\n <p>#27AB, Preah Monivong Blvd, Sangkat Srah Chork, Khan Daun Penh</p>\n <p>Phnom Penh, Kingdom of Cambodia</p>\n </div>\n\n <p>\u1791\u17BC\u179A\u179F\u17D0\u1796\u17D2\u1791/Tel: (855) 23 426 888</p>\n </div>\n\n <div class=\"w-full text-right\">\n <p class=\"text-lg font-moul\">\n \u1794\u1784\u17D2\u1780\u17B6\u1793\u17CB\u178A\u17C3\u1791\u1791\u17BD\u179B\u1794\u17D2\u179A\u17B6\u1780\u17CB\n <span class=\"font-hanuman\">/ Official Receipt</span>\n </p>\n\n <table class=\"mt-2 table w-full table-fixed border-collapse\">\n <colgroup>\n <col style=\"width: 75%\">\n <col style=\"width: 2%\">\n <col style=\"width: 23%\">\n </colgroup>\n\n <tr>\n <td class=\"text-right\">\n \u1794\u1784\u17D2\u1780\u17B6\u1793\u17CB\u178A\u17C3\u179B\u17C1\u1781/Official Receipt\n </td>\n <td class=\"text-right\">:</td>\n <td class=\"text-right\">\n <%= data.receipt_no %>\n </td>\n </tr>\n\n <tr>\n <td class=\"text-right\">\n \u1780\u17B6\u179B\u1794\u179A\u17B7\u1785\u17D2\u1786\u17C1\u1791/Date\n </td>\n <td class=\"text-right\">:</td>\n <td class=\"text-right\">\n <%= data.receipt_date %>\n </td>\n </tr>\n\n <tr>\n <td class=\"text-right\">\n \u1798\u17C9\u17C4\u1784/Time\n </td>\n <td class=\"text-right\">:</td>\n <td class=\"text-right\">\n <%= data.receipt_time %>\n </td>\n </tr>\n\n <tr>\n <td class=\"text-right\">\n \u1786\u17D2\u1793\u17B6\u17C6\u1793\u17C3\u1794\u178E\u17D2\u178E\u179F\u1793\u17D2\u1799\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784/Policy Year:\n </td>\n <td class=\"text-right\">:</td>\n <td class=\"text-right\">\n Year 1\n </td>\n </tr>\n\n <tr>\n <td class=\"text-right\">\n \u17A2\u17D2\u1793\u1780\u1791\u1791\u17BD\u179B\u1794\u17D2\u179A\u17B6\u1780\u17CB/Receipt by\n </td>\n <td class=\"text-right\">:</td>\n <td class=\"text-right\">\n <%= data.receipt_by %>\n </td>\n </tr>\n\n\n </table>\n </div>\n\n <table class=\"w-full border-collapse\">\n <colgroup>\n <col style=\"width: 30%\">\n <col style=\"width: 2%\">\n <col style=\"width: 20%\">\n <col style=\"width: 20%\">\n <col style=\"width: 12.5%\">\n <col style=\"width: 30%\">\n <col style=\"width: 2%\">\n <col style=\"width: 20%\">\n </colgroup>\n <tr>\n <td class=\"text-left align-top pb-2\">\n <p>\u1788\u17D2\u1798\u17C4\u17C7\u17A2\u178F\u17B7\u1790\u17B7\u1787\u1793 </p>\n <p>Customer's Name</p>\n </td>\n <td class=\"align-top text-center pb-2\">:</td>\n <td class=\"align-top text-left pb-2\">\n <%= data.customer_name %>\n </td>\n </tr>\n <tr>\n <td class=\"text-left align-top pb-2\">\n <p>\u1796\u17B6\u1780\u17D2\u1799\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784 \u17AC\u1794\u178E\u17D2\u178E\u179F\u1793\u17D2\u1799\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784 </p>\n <p>Applicat\u200Bion or Policy Number</p>\n </td>\n <td class=\"align-top text-center pb-2\">:</td>\n <td class=\"align-top text-left pb-2\">\n <%= data.application_no %>\n </td>\n </tr>\n\n <tr>\n <td class=\"text-left align-top pb-2\">\n <p>\u1785\u17C6\u1793\u17BD\u1793\u1791\u17B9\u1780\u1794\u17D2\u179A\u17B6\u1780\u17CB (\u178A\u17BB\u179B\u17D2\u179B\u17B6\u17A2\u17B6\u1798\u17C1\u179A\u17B7\u1780) </p>\n <p>Amount (USD)</p>\n </td>\n <td class=\"align-top text-center pb-2\">:</td>\n <td class=\"align-top text-left pb-2\">\n <%= data.amount %>\n </td>\n </tr>\n\n <tr>\n <td class=\"text-left align-top pb-2\">\n <p>\u179A\u17BC\u1794\u17B7\u1799\u1794\u17D0\u178E\u17D2\u178E\u1794\u1784\u17CB\u1794\u17D2\u179A\u17B6\u1780\u17CB </p>\n <p>Payment Currency</p>\n </td>\n <td class=\"align-top text-center pb-2\">:</td>\n <td class=\"align-top text-left pb-2\">\n <%= data.currency %>\n </td>\n <td></td>\n <td class=\"text-left align-top pb-2\">\n <p>\u17A2\u178F\u17D2\u179A\u17B6\u1794\u17D2\u178F\u17BC\u179A\u1794\u17D2\u179A\u17B6\u1780\u17CB </p>\n <p>Exchange Rate</p>\n </td>\n <td class=\"align-top text-center pb-2\">:</td>\n <td class=\"align-top text-left pb-2\">\n <%= data.exchange_rate %>\n </td
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export declare const RECEIPT_TEMPLATE = "\n<!doctype html>\n<html lang=\"en\">\n\n<head>\n <meta charset=\"UTF-8\" />\n <meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\" />\n <title>\u1794\u1784\u17D2\u1780\u17B6\u1793\u17CB\u178A\u17C3\u1791\u1791\u17BD\u179B\u1794\u17D2\u179A\u17B6\u1780\u17CB - OFFICIAL RECEIPT</title>\n\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\"\n rel=\"stylesheet\" />\n <script src=\"https://cdn.tailwindcss.com\"></script>\n\n <style>\n * {\n box-sizing: border-box;\n }\n\n .font-moul {\n font-family: \"Moul\", serif;\n }\n\n .font-hanuman {\n font-family: \"Hanuman\", serif;\n }\n\n body {\n font-family: \"Hanuman\", serif;\n margin: 0;\n padding: 0;\n font-size: 12px;\n line-height: 1.5;\n color: #000;\n background: #fff;\n }\n\n\n @page {\n size: A4 portrait;\n margin: 20mm 10mm 20mm 10mm;\n }\n </style>\n\n</head>\n\n<body>\n <div class=\"space-y-5\">\n <div class=\"text-md space-y-2\">\n <div>\n <h2 class=\"font-bold\">\u17A0\u17D2\u179C\u17B8\u179B\u17B8\u1796 \u17A1\u17B6\u1799\u17A0\u17D2\u179C\u17CD \u17A2\u17B6\u179F\u17BD\u179A\u17C1\u1793 (\u1781\u17C1\u1798\u1794\u17BC\u178C\u17B6)\u200B \u1798.\u1780</h2>\n <h2 class=\"font-bold\">Phillip Life Assurance (Cambodia) PLC.</h2>\n </div>\n\n <div>\n <p>\u17A2\u17B6\u1782\u17B6\u179A\u179B\u17C1\u1781 27AB \u1798\u17A0\u17B6\u179C\u17B7\u1790\u17B8\u1796\u17D2\u179A\u17C7\u1798\u17BB\u1793\u17B8\u179C\u1784\u17D2\u179F \u179F\u1784\u17D2\u1780\u17B6\u178F\u17CB\u179F\u17D2\u179A\u17C7\u1785\u1780 \u1781\u178E\u17D2\u178C\u178A\u17BC\u1793\u1796\u17C1\u1789 </p>\n <p>\u179A\u17B6\u1787\u1792\u17B6\u1793\u17B8\u1797\u17D2\u1793\u17C6\u1796\u17C1\u1789 \u1794\u17D2\u179A\u1791\u17C1\u179F\u1780\u1798\u17D2\u1796\u17BB\u1787\u17B6</p>\n <p>#27AB, Preah Monivong Blvd, Sangkat Srah Chork, Khan Daun Penh</p>\n <p>Phnom Penh, Kingdom of Cambodia</p>\n </div>\n\n <p>\u1791\u17BC\u179A\u179F\u17D0\u1796\u17D2\u1791/Tel: (855) 23 426 888</p>\n </div>\n\n <div class=\"w-full text-right\">\n <p class=\"text-lg font-moul\">\n \u1794\u1784\u17D2\u1780\u17B6\u1793\u17CB\u178A\u17C3\u1791\u1791\u17BD\u179B\u1794\u17D2\u179A\u17B6\u1780\u17CB\n <span class=\"font-hanuman\">/ Official Receipt</span>\n </p>\n\n <table class=\"mt-2 table w-full table-fixed border-collapse\">\n <colgroup>\n <col style=\"width: 75%\">\n <col style=\"width: 2%\">\n <col style=\"width: 23%\">\n </colgroup>\n\n <tr>\n <td class=\"text-right\">\n \u1794\u1784\u17D2\u1780\u17B6\u1793\u17CB\u178A\u17C3\u179B\u17C1\u1781/Official Receipt\n </td>\n <td class=\"text-right\">:</td>\n <td class=\"text-right\">\n <%= data.receipt_no %>\n </td>\n </tr>\n\n <tr>\n <td class=\"text-right\">\n \u1780\u17B6\u179B\u1794\u179A\u17B7\u1785\u17D2\u1786\u17C1\u1791/Date\n </td>\n <td class=\"text-right\">:</td>\n <td class=\"text-right\">\n <%= data.receipt_date %>\n </td>\n </tr>\n\n <tr>\n <td class=\"text-right\">\n \u1798\u17C9\u17C4\u1784/Time\n </td>\n <td class=\"text-right\">:</td>\n <td class=\"text-right\">\n <%= data.receipt_time %>\n </td>\n </tr>\n\n <tr>\n <td class=\"text-right\">\n \u1786\u17D2\u1793\u17B6\u17C6\u1793\u17C3\u1794\u178E\u17D2\u178E\u179F\u1793\u17D2\u1799\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784/Policy Year:\n </td>\n <td class=\"text-right\">:</td>\n <td class=\"text-right\">\n Year 1\n </td>\n </tr>\n\n <tr>\n <td class=\"text-right\">\n \u17A2\u17D2\u1793\u1780\u1791\u1791\u17BD\u179B\u1794\u17D2\u179A\u17B6\u1780\u17CB/Receipt by\n </td>\n <td class=\"text-right\">:</td>\n <td class=\"text-right\">\n <%= data.receipt_by %>\n </td>\n </tr>\n\n\n </table>\n </div>\n\n <table class=\"w-full border-collapse\">\n <colgroup>\n <col style=\"width: 30%\">\n <col style=\"width: 2%\">\n <col style=\"width: 20%\">\n <col style=\"width: 20%\">\n <col style=\"width: 12.5%\">\n <col style=\"width: 30%\">\n <col style=\"width: 2%\">\n <col style=\"width: 20%\">\n </colgroup>\n <tr>\n <td class=\"text-left align-top pb-2\">\n <p>\u1788\u17D2\u1798\u17C4\u17C7\u17A2\u178F\u17B7\u1790\u17B7\u1787\u1793 </p>\n <p>Customer's Name</p>\n </td>\n <td class=\"align-top text-center pb-2\">:</td>\n <td class=\"align-top text-left pb-2\">\n <%= data.customer_name %>\n </td>\n </tr>\n <tr>\n <td class=\"text-left align-top pb-2\">\n <p>\u1796\u17B6\u1780\u17D2\u1799\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784 \u17AC\u1794\u178E\u17D2\u178E\u179F\u1793\u17D2\u1799\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784 </p>\n <p>Applicat\u200Bion or Policy Number</p>\n </td>\n <td class=\"align-top text-center pb-2\">:</td>\n <td class=\"align-top text-left pb-2\">\n <%= data.application_no %>\n </td>\n </tr>\n\n <tr>\n <td class=\"text-left align-top pb-2\">\n <p>\u1785\u17C6\u1793\u17BD\u1793\u1791\u17B9\u1780\u1794\u17D2\u179A\u17B6\u1780\u17CB (\u178A\u17BB\u179B\u17D2\u179B\u17B6\u17A2\u17B6\u1798\u17C1\u179A\u17B7\u1780) </p>\n <p>Amount (USD)</p>\n </td>\n <td class=\"align-top text-center pb-2\">:</td>\n <td class=\"align-top text-left pb-2\">\n <%= data.amount %>\n </td>\n </tr>\n\n <tr>\n <td class=\"text-left align-top pb-2\">\n <p>\u179A\u17BC\u1794\u17B7\u1799\u1794\u17D0\u178E\u17D2\u178E\u1794\u1784\u17CB\u1794\u17D2\u179A\u17B6\u1780\u17CB </p>\n <p>Payment Currency</p>\n </td>\n <td class=\"align-top text-center pb-2\">:</td>\n <td class=\"align-top text-left pb-2\">\n <%= data.currency %>\n </td>\n <td></td>\n <!-- <td class=\"text-left align-top pb-2\">\n <p>\u17A2\u178F\u17D2\u179A\u17B6\u1794\u17D2\u178F\u17BC\u179A\u1794\u17D2\u179A\u17B6\u1780\u17CB </p>\n <p>Exchange Rate</p>\n </td>\n <td class=\"align-top text-center pb-2\">:</td>\n <td class=\"align-top text-left pb-2\">\n <%= data.exchange_rate %>\n </td> -->\n </tr>\n\n <tr>\n <td class=\"text-left align-top pb-2\">\n <p>\u1785\u17C6\u1793\u17BD\u1793\u1791\u17B9\u1780\u1794\u17D2\u179A\u17B6\u1780\u17CB\u1794\u17B6\u1793\u1794\u1784\u17CB </p>\n <p>Paid Amount</p>\n </td>\n <td class=\"align-top text-center pb-2\">:</td>\n\n <% if (data.currency===\"USD / KHR\" ) { %>\n <td class=\"align-top text-left pb-2\">\n <%= data.paid_amount_in_usd %>\n </td>\n <td class=\"align-top text-left pb-2\">\n <%= data.paid_amount_in_khr %>\n </td>\n <% } else if (data.currency===\"KHR\" ) { %>\n <td class=\"align-top text-left pb-2\">\n <%= data.paid_amount_in_khr %>\n </td>\n <% } else { %>\n <td class=\"align-top text-left pb-2\">\n <%= data.paid_amount_in_usd %>\n </td>\n <% } %>\n </tr>\n </table>\n\n <div class=\"mt-7 space-y-3\">\n <p class=\"underline font-bold text-md\">\u179F\u1798\u17D2\u1782\u17B6\u179B\u17CB / Remark</p>\n <div>\n <p>\u1794\u1784\u17D2\u1780\u17B6\u1793\u17CB\u178A\u17C3\u1791\u1791\u17BD\u179B\u1794\u17D2\u179A\u17B6\u1780\u17CB\u1793\u17C1\u17C7\u178F\u17D2\u179A\u17BC\u179C\u1794\u17B6\u1793\u1794\u1784\u17D2\u1780\u17BE\u178F\u17A1\u17BE\u1784\u178A\u17C4\u1799\u1794\u17D2\u179A\u1796\u17D0\u1793\u17D2\u1792\u179F\u17D2\u179C\u17D0\u1799\u1794\u17D2\u179A\u179C\u178F\u17D2\u178F\u17B7 \u1793\u17B7\u1784\u1798\u17B7\u1793\u178F\u1798\u17D2\u179A\u17BC\u179C\u17A2\u17C4\u1799\u1798\u17B6\u1793\u1780\u17B6\u179A\u1785\u17BB\u17C7\u17A0\u178F\u17D2\u1790\u179B\u17C1\u1781\u17B6 \u17AC \u178F\u17D2\u179A\u17B6\u1791\u17C1\u200B\u17D4\n </p>\n <p>This official Receipt is auto-generated by the system, no signature or stamp is required.</p>\n </div>\n\n </div>\n </div>\n</body>\n";
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<!-- <td class="text-left align-top pb-2">
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<p>អត្រាប្តូរប្រាក់ </p>
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<p>Exchange Rate</p>
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</td>
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<td class="align-top text-center pb-2">:</td>
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</td> -->
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export declare const SIO_FORM_EN_TEMPLATE = "\n<!doctype html>\n<html lang=\"en\">\n\n<head>\n <meta charset=\"UTF-8\" />\n <meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\" />\n <title>SIO Insurance Application Form</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: Arial, Helvetica, system-ui, sans-serif;\n font-size: 12px;\n line-height: 1.4;\n margin: 1rem;\n /* Reduced from 2rem */\n background: #fff;\n color: #000;\n }\n\n .font-kh {\n font-family: 'Hanuman', sans-serif !important;\n }\n\n .space {\n width: 8px;\n }\n\n /* margin */\n .ml-4 {\n margin-left: 1rem;\n }\n\n .ml-8 {\n margin-left: 2rem;\n }\n\n .mr-4 {\n margin-right: 1rem;\n }\n\n .mr-8 {\n margin-right: 2rem;\n }\n\n .mt-4 {\n margin-top: 1rem;\n }\n\n .mt-8 {\n margin-top: 2rem;\n }\n\n .mb-4 {\n margin-bottom: 1rem;\n }\n\n .mb-8 {\n margin-bottom: 2rem;\n }\n\n /* alignment */\n .align-left {\n justify-content: flex-start !important;\n text-align: left;\n padding-left: 16px;\n }\n\n .align-right {\n justify-content: flex-end !important;\n text-align: right;\n padding-right: 16px;\n }\n\n .align-center {\n justify-content: center !important;\n text-align: center;\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 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: 14px;\n line-height: 1;\n }\n\n .title-container {\n text-align: center;\n font-weight: 700;\n font-size: 14px;\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: 13px;\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 {\n flex: none;\n width: 30px;\n min-width: unset;\n }\n\n .underline.sm {\n flex: none;\n width: 80px;\n min-width: unset;\n }\n\n .underline.md {\n flex: none;\n width: 180px;\n min-width: unset;\n }\n\n .underline.lg {\n flex: 2;\n }\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 margin-right: 0.5rem;\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: \"\";\n position: absolute;\n top: 45%;\n left: calc(0.2rem + 7px);\n width: 6px;\n height: 12px;\n border: solid #0d6efd;\n border-width: 0 2px 2px 0;\n box-sizing: border-box;\n transform: translateY(-50%) rotate(45deg);\n pointer-events: none;\n }\n\n .page-break {\n page-break-before: always;\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 }\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: \"Page \" counter(page) \" of \" counter(pages);\n font-size: 11px;\n color: #555;\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\">LIFE ASSURANCE APPLICATION FORM</h1>\n <h1 class=\"title\">\n SIMPLIFY FORM FOR CHOKCHEY FINANCE PLC (SIO)\n </h1>\n </div>\n </div>\n\n <div class=\"form-container\">\n <div class=\"form-item\">\n <span class=\"label\">Branch Name and Code:</span>\n <span class=\"underline\">\n <%= branch_staff_app_info.branch_name %> / <%= branch_staff_app_info.branch_code %>\n </span>\n <span class=\"label\">Advisor's Name and Code:</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\">Bank staff's name and code:</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\">Application Number:</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\">INFORMATION ABOUT THE APPLICANT</div>\n\n <div class=\"form-container\">\n <div class=\"form-item\">\n <span class=\"label\">Full Name as shown in identity documents: in KH Language:</span>\n <span class=\"underline font-kh\">\n <%= applicant_info.full_name_kh %>\n </span>\n <span class=\"label\">EN Language:</span>\n <span class=\"underline\">\n <%= applicant_info.full_name %>\n </span>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">Gender:</span>\n <label class=\"checkbox-label <%= applicant_info.gender === 'M' ? 'checked' : '' %>\">M</label>\n <label class=\"checkbox-label <%= applicant_info.gender === 'F' ? 'checked' : '' %>\">F</label>\n\n <div class=\"ml-8\"></div>\n\n <div>\n <span class=\"label\">Marital Status:</span>\n <label class=\"checkbox-label <%= applicant_info.marital_status === 'single' ? 'checked' : '' %>\">\n Single\n </label>\n <label class=\"checkbox-label <%= applicant_info.marital_status === 'married' ? 'checked' : '' %>\">\n Married\n </label>\n <label class=\"checkbox-label <%= applicant_info.marital_status === 'divorced' ? 'checked' : '' %>\">\n Divorced\n </label>\n <label class=\"checkbox-label <%= applicant_info.marital_status === 'widowed' ? 'checked' : '' %>\">\n Widowed\n </label>\n </div>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">Job Title and Nature of Work:</span>\n <span class=\"underline align-left\">\n <%= applicant_info.occupation %>\n </span>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">Identity documents:</span>\n <label class=\"checkbox-label <%= applicant_info.identity_type === 'nid' ? 'checked' : '' %>\">\n National ID Card\n </label>\n <label class=\"checkbox-label <%= applicant_info.identity_type === 'passport' ? 'checked' : '' %>\">\n Passport\n </label>\n <label class=\"checkbox-label <%= applicant_info.identity_type === 'birth' ? 'checked' : '' %>\">\n Birth Certificate\n </label>\n <label class=\"checkbox-label <%= applicant_info.identity_type === 'other' ? 'checked' : '' %>\">\n Others :\n </label>\n\n\n <!-- other field stays separate since it has extra input -->\n <label class=\"underline\">\n <%= applicant_info.identity_other_description %>\n </label>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">Identity #</span>\n <span class=\"underline\">\n <%= applicant_info.identity_no %>\n </span>\n <span class=\"label\">DOB:</span>\n <span class=\"underline\">\n <%= applicant_info.date_of_birth %>\n </span>\n <span class=\"label\">Age:</span>\n <span class=\"underline xs\">\n <%= applicant_info.age %>\n </span>\n <span class=\"label\">Nationality:</span>\n <span class=\"underline\">\n <%= applicant_info.nationality %>\n </span>\n <span class=\"label\">Phone #:</span>\n <span class=\"underline\">\n <%= applicant_info.phone_number %>\n </span>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">Current Address:</span>\n <span class=\"underline align-left\">\n <%= applicant_info.current_address %>\n </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\">Declaration on FATCA implementation</span>\n </div>\n <div class=\"form-item\">\n <span class=\"label\">\n The Policyholder is USA citizen / USA resident for tax purpose or holding Green Card.\n </span>\n </div>\n <div class=\"form-item\">\n <label class=\"checkbox-label <%= fatca_info.is_fatca === false ? 'checked' : '' %>\">No</label>\n <label class=\"checkbox-label <%= fatca_info.is_fatca === true ? 'checked' : '' %>\">Yes</label>\n <span class=\"label\">US TIN #:</span>\n <span class=\"underline\">\n <%= fatca_info.us_tin_no %>\n </span>\n <span class=\"label\">FATCA Exemption Code (If have):</span>\n <span class=\"underline\">\n <%= fatca_info.fatca_exempt_code %>\n </span>\n </div>\n <div class=\"form-item\">\n <span class=\"label\">\n If any of the certifications I have provided are incorrect, I will submit a new document within 30 days, and I\n certify that I am not subject to U.S. withholding tax.\n </span>\n </div>\n </div>\n\n\n\n <!-- Section 2 -->\n <div class=\"card-header mt-4\">INFORMATION ABOUT THE PRODUCT\n </div>\n <div class=\"table-container\">\n <table>\n <thead>\n <tr>\n <th>\n <div class=\"cell\">NAME OF PRODUCT AND TERMS</div>\n </th>\n <th>\n <div class=\"cell\">SUM ASSURED (USD)</div>\n </th>\n <th>\n <div class=\"cell\">MODE OF PAYMENT</div>\n </th>\n <th>\n <div class=\"cell\">PREMIUM (USD)</div>\n </th>\n </tr>\n </thead>\n <tbody>\n <% product_payment_info?.products?.forEach(function(product) { %>\n <tr>\n <td>\n <div class=\"cell\">\n <%= product.name %>\n <%= product.term %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= product.sum_assured %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= product.payment_mode %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= product.premium %>\n </div>\n </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\">Method of payment:</span>\n <label class=\"checkbox-label <%= product_payment_info.payment_method === 'transfer_to_plac' ? 'checked' : '' %>\">\n Credit to Phillip Life Account\n </label>\n <label class=\"checkbox-label <%= product_payment_info.payment_method === 'other' ? 'checked' : '' %>\">\n Through Phillip Life's partner\n </label>\n </div>\n </div>\n\n <% if (loan_info) { %>\n <div class=\"card-header mt-4\">LOAN INFORMATION</div>\n <div class=\"table-container\">\n <table>\n <thead>\n <tr>\n <th>\n <div class=\"cell\">LOAN AMOUNT</div>\n </th>\n <th>\n <div class=\"cell\">LOAN TERM</div>\n </th>\n <th>\n <div class=\"cell\">LOAN TYPE</div>\n </th>\n </tr>\n </thead>\n <tbody>\n <tr>\n <td>\n <div class=\"cell\">\n <%= loan_info.loan_amount %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= loan_info.loan_duration %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= loan_info.loan_type %>\n </div>\n </td>\n </tr>\n </tbody>\n </table>\n </div>\n \n <% } %>\n\n <!-- Section 3 -->\n <div class=\"card-header mt-4\">INFORMATION ABOUT THE BENEFICIARY(IES)</div>\n <div class=\"table-container\">\n <table>\n <thead>\n <tr>\n <th>\n <div class=\"cell\">FULL NAME OF BENEFICIARY</div>\n </th>\n <th>\n <div class=\"cell\">AGE</div>\n </th>\n <th>\n <div class=\"cell\">RELATIONSHIP</div>\n </th>\n <th>\n <div class=\"cell\">IDENTITY NUMBER</div>\n </th>\n <th>\n <div class=\"cell\">SHARE</div>\n </th>\n </tr>\n </thead>\n <tbody>\n <% beneficiary_info?.forEach(function(beneficiary) { %>\n <tr>\n <td>\n <div class=\"align-left\">\n <%= beneficiary.full_name %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= beneficiary.age %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= beneficiary.relationship %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= beneficiary.id_number %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= beneficiary.percentage %>\n </div>\n </td>\n </tr>\n <% }) %>\n <tr>\n <td colspan=\"5\">\n <div class=\"cell align-left\"\n style=\"text-align: start !important; padding-top: 5px; padding-bottom: 5px;\">\n The company will pay benefits to the primary beneficiary first before paying any remaining benefits to\n the secondary beneficiary designated by the applicant or to the heirs of the insured if no beneficiary\n is appointed.\n </div>\n </td>\n </tr>\n </tbody>\n </table>\n </div>\n\n <!-- Section 4 -->\n <div class=\"page-break\"></div>\n <div class=\"card-header\">\n HEALTH RELATED QUESTIONS\n </div>\n\n <!-- Question 1 -->\n <div class=\"form-container\">\n <div class=\"form-item\">\n <span class=\"label\">1) Height:</span>\n <span class=\"underline sm\">\n <%= health_info.height %>\n </span>\n <span class=\"label\">cm</span>\n <div class=\"space\"></div>\n <span class=\"label\">Weight:</span>\n <span class=\"underline sm\">\n <%= health_info.weight %>\n </span>\n <span class=\"label\">Kg</span>\n <div class=\"space\"></div>\n <span class=\"question-label\">A) Do you smoke?</span>\n <label class=\"checkbox-label <%= health_info.is_smoke === false ? 'checked' : '' %>\">\n No\n </label>\n <label class=\"checkbox-label <%= health_info.is_smoke === true ? 'checked' : '' %>\">\n Yes\n </label>\n </div>\n\n <div class=\"form-item mb-4\">\n <span class=\"label\">How many</span>\n <% if (health_info.smoke_detail) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= health_info.smoke_detail %>\n </span>\n <span class=\"unit\">per day</span>\n </span>\n <% } else { %>\n <span class=\"underline\"></span>\n <% } %>\n </div>\n </div>\n\n <!-- Question 2 -->\n <div class=\"form-container\">\n <div class=\"form-item\">\n <span class=\"question-label\">2) Do you drink alcohol?</span>\n <label class=\"checkbox-label <%= health_info.is_drink_alcohol === false ? 'checked' : '' %>\">\n No\n </label>\n <label class=\"checkbox-label <%= health_info.is_drink_alcohol === true ? 'checked' : '' %>\">\n Yes\n </label>\n </div>\n <div class=\"form-item mb-4\">\n <span class=\"label\">Please specify amount of drink per week</span>\n <% if (health_info.drink_alcohol_detail) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= health_info.drink_alcohol_detail %>\n </span>\n </span>\n <% } else { %>\n <span class=\"underline\"></span>\n <% } %>\n </div>\n </div>\n\n <!-- Question 3 -->\n <div class=\"form-container\">\n <span class=\"question-label\">\n 3) In the past 2 years, have you ever been hospitalized, undergone any surgical operation, or had abnormal results\n such as: Blood test, Urine test, X-ray, ECG, Ultrasound, Scan, Biopsy or any other test results.\n </span>\n <div class=\"form-item\">\n <label class=\"checkbox-label <%= health_info.is_hospitalized === false ? 'checked' : '' %>\">\n No\n </label>\n <label class=\"checkbox-label <%= health_info.is_hospitalized === true ? 'checked' : '' %>\">\n Yes\n </label>\n </div>\n\n <div class=\"form-item mb-4\">\n <span class=\"label\">provided more details:</span>\n <% if (health_info.hospitalized_detail) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= health_info.hospitalized_detail %>\n </span>\n </span>\n <% } else { %>\n <span class=\"underline\"></span>\n <% } %>\n </div>\n </div>\n\n <!-- Question 4 -->\n <div class=\"form-container\">\n <span class=\"question-label\">\n 4) Have you ever been diagnosed with, consulted a medical practitioner or been given treatment for any of the\n following conditions: Hypertension, Diabetes, Heart diseases, Chest pain, Lung diseases, Liver disease, Renal\n diseases, Cancer, Stroke, AIDS, Mental illness, Disability or Deformity, Drug or Alcohol Abuse or Any other\n diseases are not mentioned above.\n </span>\n <div class=\"form-item\">\n <label class=\"checkbox-label <%= health_info.is_diagnosed === false ? 'checked' : '' %>\">\n No\n </label>\n <label class=\"checkbox-label <%= health_info.is_diagnosed === true ? 'checked' : '' %>\">\n Yes\n </label>\n\n </div>\n <div class=\"form-item mb-4\">\n <span class=\"label\">if yes, please provided more details:</span>\n <% if (health_info.diagnosed_detail) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= health_info.diagnosed_detail %>\n </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-4\">DECLARATION BY THE APPLICANT</div>\n <div class=\"form-container\" style=\"margin: 15px 0px 15px 0px;\">\n <div class=\"form-item\">\n <ol style=\"padding-left: 1.2rem; margin: 0;\">\n <li class=\"label\" style=\"margin-bottom: 5px;\">\n I authorize and consent the Company to use all of my information provided in my application form for legal\n purposes such as marketing, market survey and customer service by company, affiliate, or business partner\n without my prior consent or notification. The Company shall not allow to disclose any information of any other\n purpose not related to the above-mentioned purpose without prior consent in writing.\n </li>\n <li class=\"label\">\n I hereby confirm that I have read and understood all the information in this document. I declare that all the\n information provided in this application form is complete, accurate, and true.\n </li>\n </ol>\n </div>\n </div>\n\n\n <div class=\"table-container mt-4\">\n <table>\n <thead>\n <tr>\n <th style=\"width: 50%\">\n <div class=\"cell\">\n Signature or Thumb print of the Applicant\n </div>\n <div class=\"signature-space\"></div>\n </th>\n <th style=\"width: 50%\">\n <div class=\"cell\">Signature or Thumb print of the witness</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\">Name</span>\n <% if (signature_info.applicant_name) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= signature_info.applicant_name %>\n </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\">Name</span>\n <% if (signature_info.witness_name) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= signature_info.witness_name %>\n </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\">Date</span>\n <% if (signature_info.applicant_signature_date) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= signature_info.applicant_signature_date %>\n </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\">Date</span>\n <% if (signature_info.witness_signature_date) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= signature_info.witness_signature_date %>\n </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\n</html>\n";
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export declare const SIO_FORM_EN_TEMPLATE = "\n<!doctype html>\n<html lang=\"en\">\n\n<head>\n <meta charset=\"UTF-8\" />\n <meta name=\"viewport\" content=\"width=device-width, initial-scale=1.0\" />\n <title>SIO Insurance Application Form</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: Arial, Helvetica, system-ui, sans-serif;\n font-size: 12px;\n line-height: 1.4;\n margin: 1rem;\n /* Reduced from 2rem */\n background: #fff;\n color: #000;\n }\n\n .font-kh {\n font-family: 'Hanuman', sans-serif !important;\n }\n\n .space {\n width: 8px;\n }\n\n /* margin */\n .ml-4 {\n margin-left: 1rem;\n }\n\n .ml-8 {\n margin-left: 2rem;\n }\n\n .mr-4 {\n margin-right: 1rem;\n }\n\n .mr-8 {\n margin-right: 2rem;\n }\n\n .mt-4 {\n margin-top: 1rem;\n }\n\n .mt-8 {\n margin-top: 2rem;\n }\n\n .mb-4 {\n margin-bottom: 1rem;\n }\n\n .mb-8 {\n margin-bottom: 2rem;\n }\n\n /* alignment */\n .align-left {\n justify-content: flex-start !important;\n text-align: left;\n padding-left: 16px;\n }\n\n .align-right {\n justify-content: flex-end !important;\n text-align: right;\n padding-right: 16px;\n }\n\n .align-center {\n justify-content: center !important;\n text-align: center;\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 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: 14px;\n line-height: 1;\n }\n\n .title-container {\n text-align: center;\n font-weight: 700;\n font-size: 14px;\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: 13px;\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 {\n flex: none;\n width: 30px;\n min-width: unset;\n }\n\n .underline.sm {\n flex: none;\n width: 80px;\n min-width: unset;\n }\n\n .underline.md {\n flex: none;\n width: 180px;\n min-width: unset;\n }\n\n .underline.lg {\n flex: 2;\n }\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 margin-right: 0.5rem;\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: \"\";\n position: absolute;\n top: 45%;\n left: calc(0.2rem + 7px);\n width: 6px;\n height: 12px;\n border: solid #0d6efd;\n border-width: 0 2px 2px 0;\n box-sizing: border-box;\n transform: translateY(-50%) rotate(45deg);\n pointer-events: none;\n }\n\n .page-break {\n page-break-before: always;\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 }\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: \"Page \" counter(page) \" of \" counter(pages);\n font-size: 11px;\n color: #555;\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\">LIFE ASSURANCE APPLICATION FORM</h1>\n <h1 class=\"title\">\n SIMPLIFY FORM FOR CHOKCHEY FINANCE PLC (SIO)\n </h1>\n </div>\n </div>\n\n <div class=\"form-container\">\n <div class=\"form-item\">\n <span class=\"label\">Branch Name and Code:</span>\n <span class=\"underline\">\n <%= branch_staff_app_info.branch_name %> / <%= branch_staff_app_info.branch_code %>\n </span>\n <span class=\"label\">Advisor's Name and Code:</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\">Bank staff's name and code:</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\">Application Number:</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\">INFORMATION ABOUT THE APPLICANT</div>\n\n <div class=\"form-container\">\n <div class=\"form-item\">\n <span class=\"label\">Full Name as shown in identity documents: in KH Language:</span>\n <span class=\"underline font-kh\">\n <%= applicant_info.full_name_kh %>\n </span>\n <span class=\"label\">EN Language:</span>\n <span class=\"underline\">\n <%= applicant_info.full_name %>\n </span>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">Gender:</span>\n <label class=\"checkbox-label <%= applicant_info.gender === 'M' ? 'checked' : '' %>\">M</label>\n <label class=\"checkbox-label <%= applicant_info.gender === 'F' ? 'checked' : '' %>\">F</label>\n\n <div class=\"ml-8\"></div>\n\n <div>\n <span class=\"label\">Marital Status:</span>\n <label class=\"checkbox-label <%= applicant_info.marital_status === 'single' ? 'checked' : '' %>\">\n Single\n </label>\n <label class=\"checkbox-label <%= applicant_info.marital_status === 'married' ? 'checked' : '' %>\">\n Married\n </label>\n <label class=\"checkbox-label <%= applicant_info.marital_status === 'divorced' ? 'checked' : '' %>\">\n Divorced\n </label>\n <label class=\"checkbox-label <%= applicant_info.marital_status === 'widowed' ? 'checked' : '' %>\">\n Widowed\n </label>\n </div>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">Job Title and Nature of Work:</span>\n <span class=\"underline align-left\">\n <%= applicant_info.occupation %>\n </span>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">Identity documents:</span>\n <label class=\"checkbox-label <%= applicant_info.identity_type === 'nid' ? 'checked' : '' %>\">\n National ID Card\n </label>\n <label class=\"checkbox-label <%= applicant_info.identity_type === 'passport' ? 'checked' : '' %>\">\n Passport\n </label>\n <label class=\"checkbox-label <%= applicant_info.identity_type === 'birth' ? 'checked' : '' %>\">\n Birth Certificate\n </label>\n <label class=\"checkbox-label <%= applicant_info.identity_type === 'other' ? 'checked' : '' %>\">\n Others :\n </label>\n\n\n <!-- other field stays separate since it has extra input -->\n <label class=\"underline\">\n <%= applicant_info.identity_other_description %>\n </label>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">Identity #</span>\n <span class=\"underline\">\n <%= applicant_info.identity_no %>\n </span>\n <span class=\"label\">DOB:</span>\n <span class=\"underline\">\n <%= applicant_info.date_of_birth %>\n </span>\n <span class=\"label\">Age:</span>\n <span class=\"underline xs\">\n <%= applicant_info.age %>\n </span>\n <span class=\"label\">Nationality:</span>\n <span class=\"underline\">\n <%= applicant_info.nationality %>\n </span>\n <span class=\"label\">Phone #:</span>\n <span class=\"underline\">\n <%= applicant_info.phone_number %>\n </span>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">Current Address:</span>\n <span class=\"underline align-left\">\n <%= applicant_info.current_address %>\n </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\">Declaration on FATCA implementation:</span>\n </div>\n <div class=\"form-item\">\n <span class=\"label\">\n Are you a USA citizen / USA resident for tax purpose or holding Green Card?\n </span>\n </div>\n <div class=\"form-item\">\n <label class=\"checkbox-label <%= fatca_info.is_fatca === false ? 'checked' : '' %>\">No</label>\n <label class=\"checkbox-label <%= fatca_info.is_fatca === true ? 'checked' : '' %>\">Yes</label>\n <span class=\"label\">US TIN #:</span>\n <span class=\"underline\">\n <%= fatca_info.us_tin_no %>\n </span>\n <span class=\"label\">FATCA Exemption Code (If have):</span>\n <span class=\"underline\">\n <%= fatca_info.fatca_exempt_code %>\n </span>\n </div>\n <div class=\"form-item\">\n <span class=\"label\">\n If any of the certifications I have provided are incorrect, I will submit a new document within 30 days, and I\n certify that I am not subject to U.S. withholding tax.\n </span>\n </div>\n </div>\n\n\n\n <!-- Section 2 -->\n <div class=\"card-header mt-4\">INFORMATION ABOUT THE PRODUCT\n </div>\n <div class=\"table-container\">\n <table>\n <thead>\n <tr>\n <th>\n <div class=\"cell\">NAME OF PRODUCT AND TERMS</div>\n </th>\n <th>\n <div class=\"cell\">SUM ASSURED (USD)</div>\n </th>\n <th>\n <div class=\"cell\">MODE OF PAYMENT</div>\n </th>\n <th>\n <div class=\"cell\">PREMIUM (USD)</div>\n </th>\n </tr>\n </thead>\n <tbody>\n <% product_payment_info?.products?.forEach(function(product) { %>\n <tr>\n <td>\n <div class=\"cell\">\n <%= product.name %>\n <%= product.term %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= product.sum_assured %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= product.payment_mode %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= product.premium %>\n </div>\n </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\">Method of payment:</span>\n <label class=\"checkbox-label <%= product_payment_info.payment_method === 'transfer_to_plac' ? 'checked' : '' %>\">\n Transfer to Phillip Life Account\n </label>\n <label class=\"checkbox-label <%= product_payment_info.payment_method === 'other' ? 'checked' : '' %>\">\n Through Phillip Life's partner\n </label>\n </div>\n </div>\n\n <% if (loan_info) { %>\n <div class=\"card-header mt-4\">LOAN INFORMATION</div>\n <div class=\"table-container\">\n <table>\n <thead>\n <tr>\n <th>\n <div class=\"cell\">LOAN AMOUNT</div>\n </th>\n <th>\n <div class=\"cell\">LOAN TERM</div>\n </th>\n <th>\n <div class=\"cell\">LOAN TYPE</div>\n </th>\n </tr>\n </thead>\n <tbody>\n <tr>\n <td>\n <div class=\"cell\">\n <%= loan_info.loan_amount %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= loan_info.loan_duration %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= loan_info.loan_type %>\n </div>\n </td>\n </tr>\n </tbody>\n </table>\n </div>\n \n <% } %>\n\n <!-- Section 3 -->\n <div class=\"card-header mt-4\">INFORMATION ABOUT THE BENEFICIARY(IES)</div>\n <div class=\"table-container\">\n <table>\n <thead>\n <tr>\n <th>\n <div class=\"cell\">FULL NAME OF BENEFICIARY</div>\n </th>\n <th>\n <div class=\"cell\">AGE</div>\n </th>\n <th>\n <div class=\"cell\">RELATIONSHIP</div>\n </th>\n <th>\n <div class=\"cell\">IDENTITY NUMBER</div>\n </th>\n <th>\n <div class=\"cell\">SHARE</div>\n </th>\n </tr>\n </thead>\n <tbody>\n <% beneficiary_info?.forEach(function(beneficiary) { %>\n <tr>\n <td>\n <div class=\"align-left\">\n <%= beneficiary.full_name %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= beneficiary.age %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= beneficiary.relationship %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= beneficiary.id_number %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= beneficiary.percentage %>\n </div>\n </td>\n </tr>\n <% }) %>\n <tr>\n <td colspan=\"5\">\n <div class=\"cell align-left\"\n style=\"text-align: start !important; padding-top: 5px; padding-bottom: 5px;\">\n The company will pay benefits to the primary beneficiary first before paying any remaining benefits to\n the secondary beneficiary designated by the applicant or to the heirs of the insured if no beneficiary\n is appointed.\n </div>\n </td>\n </tr>\n </tbody>\n </table>\n </div>\n\n <!-- Section 4 -->\n <div class=\"page-break\"></div>\n <div class=\"card-header\">\n HEALTH RELATED QUESTIONS\n </div>\n\n <!-- Question 1 -->\n <div class=\"form-container\">\n <!-- Row 1: Height + Weight -->\n <div class=\"form-item\">\n <span class=\"label\">1) Height:</span>\n <span class=\"underline sm\">\n <%= health_info.height %>\n </span>\n <span class=\"label\">cm</span>\n <div class=\"space\"></div>\n <span class=\"label\">Weight:</span>\n <span class=\"underline sm\">\n <%= health_info.weight %>\n </span>\n <span class=\"label\">Kg</span>\n </div>\n \n <!-- Row 2: Smoking question + checkboxes + how many -->\n <div class=\"form-item mb-4\" style=\"display: flex; align-items: center; flex-wrap: nowrap; width: 100%;\">\n <span class=\"question-label\">A) Do you smoke?</span>\n <label class=\"checkbox-label <%= health_info.is_smoke === false ? 'checked' : '' %>\">\n No\n </label>\n <label class=\"checkbox-label <%= health_info.is_smoke === true ? 'checked' : '' %>\">\n Yes\n </label>\n <div class=\"space\"></div>\n <span class=\"label\">How many</span>\n <% if (health_info.smoke_detail) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= health_info.smoke_detail %>\n </span>\n <span class=\"unit\">per day</span>\n </span>\n <% } else { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= health_info.smoke_detail %>\n </span>\n <span class=\"underline\"></span>\n <span class=\"unit\">per day</span>\n </span>\n <% } %>\n </div>\n </div>\n\n <!-- Question 2 -->\n <div class=\"form-container\">\n <div class=\"form-item\">\n <span class=\"question-label\">2) Do you drink alcohol?</span>\n <label class=\"checkbox-label <%= health_info.is_drink_alcohol === false ? 'checked' : '' %>\">\n No\n </label>\n <label class=\"checkbox-label <%= health_info.is_drink_alcohol === true ? 'checked' : '' %>\">\n Yes\n </label>\n </div>\n <div class=\"form-item mb-4\">\n <span class=\"label\">Please specify amount of drink per week</span>\n <% if (health_info.drink_alcohol_detail) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= health_info.drink_alcohol_detail %>\n </span>\n </span>\n <% } else { %>\n <span class=\"underline\"></span>\n <% } %>\n </div>\n </div>\n\n <!-- Question 3 -->\n <div class=\"form-container\">\n <span class=\"question-label\">\n 3) In the past 2 years, have you ever been hospitalized, undergone any surgical operation, or had abnormal results\n such as: Blood test, Urine test, X-ray, ECG, Ultrasound, Scan, Biopsy or any other test results.\n </span>\n <div class=\"form-item\">\n <label class=\"checkbox-label <%= health_info.is_hospitalized === false ? 'checked' : '' %>\">\n No\n </label>\n <label class=\"checkbox-label <%= health_info.is_hospitalized === true ? 'checked' : '' %>\">\n Yes\n </label>\n </div>\n\n <div class=\"form-item mb-4\">\n <span class=\"label\">provided more details:</span>\n <% if (health_info.hospitalized_detail) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= health_info.hospitalized_detail %>\n </span>\n </span>\n <% } else { %>\n <span class=\"underline\"></span>\n <% } %>\n </div>\n </div>\n\n <!-- Question 4 -->\n <div class=\"form-container\">\n <span class=\"question-label\">\n 4) Have you ever been diagnosed with, consulted a medical practitioner or been given treatment for any of the\n following conditions: Hypertension, Diabetes, Heart diseases, Chest pain, Lung diseases, Liver disease, Renal\n diseases, Cancer, Stroke, AIDS, Mental illness, Disability or Deformity, Drug or Alcohol Abuse or Any other\n diseases are not mentioned above.\n </span>\n <div class=\"form-item\">\n <label class=\"checkbox-label <%= health_info.is_diagnosed === false ? 'checked' : '' %>\">\n No\n </label>\n <label class=\"checkbox-label <%= health_info.is_diagnosed === true ? 'checked' : '' %>\">\n Yes\n </label>\n\n </div>\n <div class=\"form-item mb-4\">\n <span class=\"label\">if yes, please provided more details:</span>\n <% if (health_info.diagnosed_detail) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= health_info.diagnosed_detail %>\n </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-4\">DECLARATION BY THE APPLICANT</div>\n <div class=\"form-container\" style=\"margin: 15px 0px 15px 0px;\">\n <div class=\"form-item\">\n <ol style=\"padding-left: 1.2rem; margin: 0;\">\n <li class=\"label\" style=\"margin-bottom: 5px;\">\n I authorize and consent the Company to use all of my information provided in my application form for legal\n purposes such as marketing, market survey and customer service by company, affiliate, or business partner\n without my prior consent or notification. The Company shall not allow to disclose any information of any other\n purpose not related to the above-mentioned purpose without prior consent in writing.\n </li>\n <li class=\"label\">\n I hereby confirm that I have read and understood all the information in this document. I declare that all the\n information provided in this application form is complete, accurate, and true.\n </li>\n </ol>\n </div>\n </div>\n\n\n <div class=\"table-container mt-4\">\n <table>\n <thead>\n <tr>\n <th style=\"width: 50%\">\n <div class=\"cell\">\n Signature or Thumb print of the Applicant\n </div>\n <div class=\"signature-space\"></div>\n </th>\n <th style=\"width: 50%\">\n <div class=\"cell\">Signature or Thumb print of the witness</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\">Name</span>\n <% if (signature_info.applicant_name) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= signature_info.applicant_name %>\n </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\">Name</span>\n <% if (signature_info.witness_name) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= signature_info.witness_name %>\n </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\">Date</span>\n <% if (signature_info.applicant_signature_date) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= signature_info.applicant_signature_date %>\n </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\">Date</span>\n <% if (signature_info.witness_signature_date) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= signature_info.witness_signature_date %>\n </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\n</html>\n";
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@@ -484,11 +484,11 @@ exports.SIO_FORM_EN_TEMPLATE = `
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<div class="form-container">
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<div class="form-item mt-4">
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<span class="label">Declaration on FATCA implementation
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<span class="label">Declaration on FATCA implementation:</span>
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</div>
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<div class="form-item">
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<span class="label">
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Are you a USA citizen / USA resident for tax purpose or holding Green Card?
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</span>
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</div>
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<div class="form-item">
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@@ -567,7 +567,7 @@ exports.SIO_FORM_EN_TEMPLATE = `
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<div class="form-item">
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<span class="question-label">Method of payment:</span>
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<label class="checkbox-label <%= product_payment_info.payment_method === 'transfer_to_plac' ? 'checked' : '' %>">
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Transfer to Phillip Life Account
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</label>
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<label class="checkbox-label <%= product_payment_info.payment_method === 'other' ? 'checked' : '' %>">
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Through Phillip Life's partner
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@@ -691,42 +691,50 @@ exports.SIO_FORM_EN_TEMPLATE = `
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|
691
691
|
|
|
692
692
|
<!-- Question 1 -->
|
|
693
693
|
<div class="form-container">
|
|
694
|
-
|
|
695
|
-
|
|
696
|
-
|
|
697
|
-
|
|
698
|
-
|
|
699
|
-
|
|
700
|
-
|
|
701
|
-
|
|
702
|
-
|
|
703
|
-
|
|
694
|
+
<!-- Row 1: Height + Weight -->
|
|
695
|
+
<div class="form-item">
|
|
696
|
+
<span class="label">1) Height:</span>
|
|
697
|
+
<span class="underline sm">
|
|
698
|
+
<%= health_info.height %>
|
|
699
|
+
</span>
|
|
700
|
+
<span class="label">cm</span>
|
|
701
|
+
<div class="space"></div>
|
|
702
|
+
<span class="label">Weight:</span>
|
|
703
|
+
<span class="underline sm">
|
|
704
|
+
<%= health_info.weight %>
|
|
705
|
+
</span>
|
|
706
|
+
<span class="label">Kg</span>
|
|
707
|
+
</div>
|
|
708
|
+
|
|
709
|
+
<!-- Row 2: Smoking question + checkboxes + how many -->
|
|
710
|
+
<div class="form-item mb-4" style="display: flex; align-items: center; flex-wrap: nowrap; width: 100%;">
|
|
711
|
+
<span class="question-label">A) Do you smoke?</span>
|
|
712
|
+
<label class="checkbox-label <%= health_info.is_smoke === false ? 'checked' : '' %>">
|
|
713
|
+
No
|
|
714
|
+
</label>
|
|
715
|
+
<label class="checkbox-label <%= health_info.is_smoke === true ? 'checked' : '' %>">
|
|
716
|
+
Yes
|
|
717
|
+
</label>
|
|
718
|
+
<div class="space"></div>
|
|
719
|
+
<span class="label">How many</span>
|
|
720
|
+
<% if (health_info.smoke_detail) { %>
|
|
721
|
+
<span class="underline with-unit">
|
|
722
|
+
<span class="value">
|
|
723
|
+
<%= health_info.smoke_detail %>
|
|
724
|
+
</span>
|
|
725
|
+
<span class="unit">per day</span>
|
|
704
726
|
</span>
|
|
705
|
-
|
|
706
|
-
<
|
|
707
|
-
|
|
708
|
-
|
|
709
|
-
No
|
|
710
|
-
</label>
|
|
711
|
-
<label class="checkbox-label <%= health_info.is_smoke === true ? 'checked' : '' %>">
|
|
712
|
-
Yes
|
|
713
|
-
</label>
|
|
714
|
-
</div>
|
|
715
|
-
|
|
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 %>
|
|
722
|
-
</span>
|
|
723
|
-
<span class="unit">per day</span>
|
|
727
|
+
<% } else { %>
|
|
728
|
+
<span class="underline with-unit">
|
|
729
|
+
<span class="value">
|
|
730
|
+
<%= health_info.smoke_detail %>
|
|
724
731
|
</span>
|
|
725
|
-
|
|
726
|
-
|
|
727
|
-
|
|
728
|
-
|
|
729
|
-
|
|
732
|
+
<span class="underline"></span>
|
|
733
|
+
<span class="unit">per day</span>
|
|
734
|
+
</span>
|
|
735
|
+
<% } %>
|
|
736
|
+
</div>
|
|
737
|
+
</div>
|
|
730
738
|
|
|
731
739
|
<!-- Question 2 -->
|
|
732
740
|
<div class="form-container">
|
|
@@ -1 +1 @@
|
|
|
1
|
-
export declare const SIO_FORM_KH_TEMPLATE = "\n<!doctype html>\n<html lang=\"km\">\n\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: 12px;\n line-height: 1.4;\n margin: 1rem;\n background: #fff;\n color: #000;\n }\n\n .space {\n width: 8px;\n }\n\n .ml-4 {\n margin-left: 1rem;\n }\n\n .ml-8 {\n margin-left: 2rem;\n }\n\n .mr-4 {\n margin-right: 1rem;\n }\n\n .mr-8 {\n margin-right: 2rem;\n }\n\n .mt-4 {\n margin-top: 1rem;\n }\n\n .mt-8 {\n margin-top: 2rem;\n }\n\n .mb-4 {\n margin-bottom: 1rem;\n }\n\n .mb-8 {\n margin-bottom: 2rem;\n }\n\n .align-left {\n justify-content: flex-start !important;\n text-align: left;\n padding-left: 16px;\n }\n\n .align-right {\n justify-content: flex-end !important;\n text-align: right;\n padding-right: 16px;\n }\n\n .align-center {\n justify-content: center !important;\n text-align: center;\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 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: 14px;\n line-height: 1;\n }\n\n .title-container {\n text-align: center;\n font-weight: 700;\n font-size: 14px;\n line-height: 1.4;\n margin: 0;\n }\n\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-weight: bold;\n margin-bottom: 0.5rem;\n -webkit-print-color-adjust: exact;\n print-color-adjust: exact;\n }\n\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 {\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 .underline.xs {\n flex: none;\n width: 30px;\n min-width: unset;\n }\n\n .underline.sm {\n flex: none;\n width: 80px;\n min-width: unset;\n }\n\n .underline.md {\n flex: none;\n width: 180px;\n min-width: unset;\n }\n\n .underline.lg {\n flex: 2;\n }\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-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: \"\";\n position: absolute;\n top: 45%;\n left: calc(0.2rem + 7px);\n width: 6px;\n height: 12px;\n border: solid #0d6efd;\n border-width: 0 2px 2px 0;\n box-sizing: border-box;\n transform: translateY(-50%) rotate(45deg);\n pointer-events: none;\n }\n\n .page-break {\n page-break-before: always;\n }\n\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 }\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 @media print {\n body {\n margin: 0;\n padding-top: 10mm;\n }\n\n @page {\n size: A4 portrait;\n margin: 15mm 15mm 20mm 10mm;\n\n /* @bottom-right {\n content: \"Page \" counter(page) \" of \" counter(pages);\n font-size: 11px;\n color: #555;\n } */\n }\n\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\">\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)</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 <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\">\n <%= applicant_info.full_name_kh %>\n </span>\n <span class=\"label\">\u1787\u17B6\u1797\u17B6\u179F\u17B6\u17A2\u1784\u17CB\u1782\u17D2\u179B\u17C1\u179F</span>\n <span class=\"underline\">\n <%= applicant_info.full_name %>\n </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' : '' %>\">\u1793\u17C5\u179B\u17B8\u179C</label>\n <label\n class=\"checkbox-label <%= applicant_info.marital_status === 'married' ? 'checked' : '' %>\">\u179A\u17C0\u1794\u1780\u17B6\u179A\u17A0\u17BE\u1799</label>\n <label class=\"checkbox-label <%= applicant_info.marital_status === 'divorced' ? 'checked' : '' %>\">\u179B\u17C2\u1784\u179B\u17C7</label>\n <label\n class=\"checkbox-label <%= applicant_info.marital_status === 'widowed' ? 'checked' : '' %>\">\u1798\u17C1\u1798\u17C9\u17B6\u1799/\u1796\u17C4\u17C7\u1798\u17C9\u17B6\u1799</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\">\n <%= applicant_info.occupation %>\n </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\n class=\"checkbox-label <%= applicant_info.identity_type === 'nid' ? 'checked' : '' %>\">\u17A2\u178F\u17D2\u178F\u179F\u1789\u17D2\u1789\u17B6\u178E\u1794\u178E\u17D2\u178E</label>\n <label\n class=\"checkbox-label <%= applicant_info.identity_type === 'passport' ? 'checked' : '' %>\">\u179B\u17B7\u1781\u17B7\u178F\u1786\u17D2\u179B\u1784\u178A\u17C2\u1793</label>\n <label\n class=\"checkbox-label <%= applicant_info.identity_type === 'birth' ? 'checked' : '' %>\">\u179F\u17C6\u1794\u17BB\u178F\u17D2\u179A\u1780\u17C6\u178E\u17BE\u178F</label>\n <label class=\"checkbox-label <%= applicant_info.identity_type === 'other' ? 'checked' : '' %>\">\u1795\u17D2\u179F\u17C1\u1784\u1791\u17C0\u178F:</label>\n <label class=\"underline\">\n <%= applicant_info.identity_other_description %>\n </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\">\n <%= applicant_info.identity_no %>\n </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\">\n <%= applicant_info.date_of_birth %>\n </span>\n <span class=\"label\">\u17A2\u17B6\u1799\u17BB:</span>\n <span class=\"underline xs\">\n <%= applicant_info.age %>\n </span>\n <span class=\"label\">\u179F\u1789\u17D2\u1785\u17B6\u178F\u17B7:</span>\n <span class=\"underline\">\n <%= applicant_info.nationality %>\n </span>\n <span class=\"label\">\u179B\u17C1\u1781\u1791\u17BC\u179A\u179F\u17D0\u1796\u17D2\u1791:</span>\n <span class=\"underline\">\n <%= applicant_info.phone_number %>\n </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\">\n <%= applicant_info.current_address %>\n </span>\n </div>\n </div>\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\">\n \u1798\u17D2\u1785\u17B6\u179F\u17CB\u1794\u178E\u17D2\u178E\u179F\u1793\u17D2\u1799\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u1787\u17B6\u1796\u179B\u179A\u178A\u17D2\u178B\u17A2\u17B6\u1798\u17C1\u179A\u17B7\u1780 \u17AC\u1787\u17B6\u1794\u17CB\u1796\u1793\u17D2\u1792\u179F\u17D2\u1793\u17B6\u1780\u17CB\u1793\u17C5\u17A2\u17B6\u1798\u17C1\u179A\u17B7\u1780 \u17AC\u1798\u17B6\u1793\u179F\u17B7\u1791\u17D2\u1792\u17B7\u1780\u17B6\u1793\u17CB Green Card\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 <div class=\"ml-4\">\n <span class=\"label\">US TIN:</span>\n <span class=\"underline\">\n <%= fatca_info.us_tin_no %>\n </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\">\n <%= fatca_info.fatca_exempt_code %>\n </span>\n </div>\n </div>\n <div class=\"form-item mt-4\">\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 <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>\n <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>\n </th>\n <th>\n <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>\n </th>\n <th>\n <div class=\"cell\">\u179A\u1794\u17C0\u1794\u1794\u1784\u17CB\u1794\u17BB\u1796\u17D2\u179C\u179B\u17B6\u1797</div>\n </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>\n <div class=\"cell\">\n <%= product.name %>\n <%= product.term %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= product.sum_assured %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= product.payment_mode %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= product.premium %>\n </div>\n </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\n class=\"checkbox-label <%= product_payment_info.payment_method === 'transfer_to_plac' ? 'checked' : '' %>\">\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</label>\n <label\n class=\"checkbox-label <%= product_payment_info.payment_method === 'other' ? 'checked' : '' %>\">\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</label>\n </div>\n </div>\n\n<% if (loan_info) { %>\n <div class=\"card-header mt-4\">\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u17A2\u17C6\u1796\u17B8\u1780\u1798\u17D2\u1785\u17B8</div>\n <div class=\"table-container\">\n <table>\n <thead>\n <tr>\n <th>\n <div class=\"cell\">\u1785\u17C6\u1793\u17BD\u1793\u1791\u17B9\u1780\u1794\u17D2\u179A\u17B6\u1780\u17CB\u1780\u1798\u17D2\u1785\u17B8</div>\n </th>\n <th>\n <div class=\"cell\">\u179A\u1799\u17C8\u1796\u17C1\u179B\u1780\u1798\u17D2\u1785\u17B8</div>\n </th>\n <th>\n <div class=\"cell\">\u1794\u17D2\u179A\u1797\u17C1\u1791\u1780\u1798\u17D2\u1785\u17B8</div>\n </th>\n </tr>\n </thead>\n <tbody>\n <tr>\n <td>\n <div class=\"cell\">\n <%= loan_info.loan_amount %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= loan_info.loan_duration %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= loan_info.loan_type %>\n </div>\n </td>\n </tr>\n </tbody>\n </table>\n </div>\n\n<% } %>\n\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 class=\"align-left\">\n <div>\u1788\u17D2\u1798\u17C4\u17C7\u1796\u17C1\u1789\u179A\u1794\u179F\u17CB\u17A2\u17D2\u1793\u1780\u1791\u1791\u17BD\u179B\u1795\u179B</div>\n </th>\n <th>\n <div class=\"cell\">\u17A2\u17B6\u1799\u17BB</div>\n </th>\n <th>\n <div class=\"cell\">\u1791\u17C6\u1793\u17B6\u1780\u17CB\u1791\u17C6\u1793\u1784</div>\n </th>\n <th>\n <div class=\"cell\">\u179B\u17C1\u1781\u17A2\u178F\u17D2\u178F\u179F\u1789\u17D2\u1789\u17B6\u178E</div>\n </th>\n <th>\n <div class=\"cell\">\u1780\u17B6\u179A\u1794\u17C2\u1784\u1785\u17C2\u1780\u179F\u17C6\u178E\u1784</div>\n </th>\n </tr>\n </thead>\n <tbody>\n <% beneficiary_info?.forEach(function(beneficiary) { %>\n <tr>\n <td class=\"align-left\">\n <div>\n <%= beneficiary.full_name %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= beneficiary.age %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= beneficiary.relationship %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= beneficiary.id_number %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= beneficiary.percentage %>\n </div>\n </td>\n </tr>\n <% }) %>\n <tr>\n <td colspan=\"5\">\n <div class=\"cell align-left\"\n style=\"text-align: start !important; padding-top: 5px; padding-bottom: 5px;\">\n \u1780\u17D2\u179A\u17BB\u1798\u17A0\u17CA\u17BB\u1793 \u1793\u17B9\u1784\u1791\u17BC\u179A\u1791\u17B6\u178F\u17CB\u179F\u17C6\u178E\u1784\u1791\u17C5\u1780\u17B6\u1793\u17CB\u17A2\u17D2\u1793\u1780\u1791\u1791\u17BD\u179B\u1795\u179B\u1785\u1798\u17D2\u1794\u1784\u1787\u17B6\u1798\u17BB\u1793\u179F\u17B7\u1793\n \u1798\u17BB\u1793\u1793\u17B9\u1784\u1791\u17BC\u1791\u17B6\u178F\u17CB\u179F\u17C6\u178E\u1784\u178A\u17C2\u179B\u1793\u17C5\u179F\u179B\u17CB\u1791\u17C5\u1780\u17B6\u1793\u17CB\u17A2\u17D2\u1793\u1780\u1791\u1791\u17BD\u179B\u1795\u179B\u1794\u1793\u17D2\u1791\u17B6\u1794\u17CB\u178A\u17C2\u179B\u1794\u17B6\u1793\u1780\u17C6\u178E\u178F\u17CB\u178A\u17C4\u1799\u17A2\u17D2\u1793\u1780\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\n \u17AC\u1791\u17B6\u1799\u17B6\u1791\u179A\u1794\u179F\u17CB\u17A2\u17D2\u1793\u1780\u178F\u17D2\u179A\u17BC\u179C\u1794\u17B6\u1793\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u1780\u17D2\u1793\u17BB\u1784\u1780\u179A\u178E\u17B7\u1798\u17B7\u1793\u1798\u17B6\u1793\u1780\u17B6\u179A\u178F\u17C2\u1784\u178F\u17B6\u17C6\u1784\u17A2\u17D2\u1793\u1780\u1791\u1791\u17BD\u179B\u1795\u179B\u17D4\n </div>\n </td>\n </tr>\n </tbody>\n </table>\n </div>\n\n <div class=\"page-break\"></div>\n <div class=\"card-header\">\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u1796\u17B6\u1780\u17CB\u1796\u17D0\u1793\u17D2\u1791\u1793\u17B9\u1784\u179F\u17BB\u1781\u1797\u17B6\u1796\u179A\u1794\u179F\u17CB \u17A2\u17D2\u1793\u1780\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1794\u178E\u17D2\u178E\u179F\u1793\u17D2\u1799\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17CB</div>\n\n <div class=\"form-container\">\n <div class=\"form-item\">\n <span class=\"label\">1) \u1780\u1798\u17D2\u1796\u179F\u17CB:</span>\n <span class=\"underline sm\">\n <%= health_info.height %>\n </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\">\n <%= health_info.weight %>\n </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' : '' %>\">\u1798\u17B7\u1793\u1798\u17B6\u1793</label>\n <label class=\"checkbox-label <%= health_info.is_smoke === true ? 'checked' : '' %>\">\u1798\u17B6\u1793</label>\n </div>\n\n <div class=\"form-item mb-4\">\n <span class=\"label\">\u1785\u17C6\u1793\u17BD\u1793:</span>\n <% if (health_info.smoke_detail) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= health_info.smoke_detail %>\n </span>\n <span class=\"unit\">\u178A\u17BE\u1798\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 <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' : '' %>\">\u1798\u17B7\u1793\u1798\u17B6\u1793</label>\n <label class=\"checkbox-label <%= health_info.is_drink_alcohol === true ? 'checked' : '' %>\">\u1798\u17B6\u1793</label>\n </div>\n <div class=\"form-item mb-4\">\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\">\n <%= health_info.drink_alcohol_detail %>\n </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 <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' : '' %>\">\u1798\u17B7\u1793\u1798\u17B6\u1793</label>\n <label class=\"checkbox-label <%= health_info.is_hospitalized === true ? 'checked' : '' %>\">\u1798\u17B6\u1793</label>\n </div>\n\n <div class=\"form-item mb-4\">\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:</span>\n <% if (health_info.hospitalized_detail) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= health_info.hospitalized_detail %>\n </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 <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' : '' %>\">\u1798\u17B7\u1793\u1798\u17B6\u1793</label>\n <label class=\"checkbox-label <%= health_info.is_diagnosed === true ? 'checked' : '' %>\">\u1798\u17B6\u1793</label>\n </div>\n <div class=\"form-item mb-4\">\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:</span>\n <% if (health_info.diagnosed_detail) { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= health_info.diagnosed_detail %>\n </span>\n </span>\n <% } else { %>\n <span class=\"underline\"></span>\n <% } %>\n </div>\n </div>\n\n <div class=\"card-header mt-4\">\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\" style=\"margin: 15px 0px 15px 0px;\">\n <div class=\"form-item\">\n <ol style=\"padding-left: 1.2rem; margin: 0;\">\n <li class=\"label\" style=\"margin-bottom: 5px;\">\n \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\n </li>\n <li class=\"label\">\n \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 </li>\n </ol>\n </div>\n </div>\n\n <div class=\"table-container mt-4\">\n <table>\n <thead>\n <tr>\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\u17A2\u17D2\u1793\u1780\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784</div>\n <div class=\"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\">\n <%= signature_info.applicant_name %>\n </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\">\n <%= signature_info.witness_name %>\n </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\">\n <%= signature_info.applicant_signature_date %>\n </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\">\n <%= signature_info.witness_signature_date %>\n </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\n</html>\n";
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export declare const SIO_FORM_KH_TEMPLATE = "\n<!doctype html>\n<html lang=\"km\">\n\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: 12px;\n line-height: 1.4;\n margin: 1rem;\n background: #fff;\n color: #000;\n }\n\n .space {\n width: 8px;\n }\n\n .ml-4 {\n margin-left: 1rem;\n }\n\n .ml-8 {\n margin-left: 2rem;\n }\n\n .mr-4 {\n margin-right: 1rem;\n }\n\n .mr-8 {\n margin-right: 2rem;\n }\n\n .mt-4 {\n margin-top: 1rem;\n }\n\n .mt-8 {\n margin-top: 2rem;\n }\n\n .mb-4 {\n margin-bottom: 1rem;\n }\n\n .mb-8 {\n margin-bottom: 2rem;\n }\n\n .align-left {\n justify-content: flex-start !important;\n text-align: left;\n padding-left: 16px;\n }\n\n .align-right {\n justify-content: flex-end !important;\n text-align: right;\n padding-right: 16px;\n }\n\n .align-center {\n justify-content: center !important;\n text-align: center;\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 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: 14px;\n line-height: 1;\n }\n\n .title-container {\n text-align: center;\n font-weight: 700;\n font-size: 14px;\n line-height: 1.4;\n margin: 0;\n }\n\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-weight: bold;\n margin-bottom: 0.5rem;\n -webkit-print-color-adjust: exact;\n print-color-adjust: exact;\n }\n\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 {\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 .underline.xs {\n flex: none;\n width: 30px;\n min-width: unset;\n }\n\n .underline.sm {\n flex: none;\n width: 80px;\n min-width: unset;\n }\n\n .underline.md {\n flex: none;\n width: 180px;\n min-width: unset;\n }\n\n .underline.lg {\n flex: 2;\n }\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-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: \"\";\n position: absolute;\n top: 45%;\n left: calc(0.2rem + 7px);\n width: 6px;\n height: 12px;\n border: solid #0d6efd;\n border-width: 0 2px 2px 0;\n box-sizing: border-box;\n transform: translateY(-50%) rotate(45deg);\n pointer-events: none;\n }\n\n .page-break {\n page-break-before: always;\n }\n\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 }\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 @media print {\n body {\n margin: 0;\n padding-top: 10mm;\n }\n\n @page {\n size: A4 portrait;\n margin: 15mm 15mm 20mm 10mm;\n\n @bottom-right {\n content: \"\u1791\u17C6\u1796\u17D0\u179A \" counter(page) \" of \" counter(pages);\n font-size: 11px;\n color: #555;\n }\n }\n\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\">\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)</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\u17D6</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\u17D6</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\u17D6</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\u17D6</span>\n <span class=\"underline\">\n <%= branch_staff_app_info.application_no %>\n </span>\n </div>\n </div>\n\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\u17D6 \u1787\u17B6\u1797\u17B6\u179F\u17B6\u1781\u17D2\u1798\u17C2\u179A</span>\n <span class=\"underline\">\n <%= applicant_info.full_name_kh %>\n </span>\n <span class=\"label\">\u1787\u17B6\u1797\u17B6\u179F\u17B6\u17A2\u1784\u17CB\u1782\u17D2\u179B\u17C1\u179F</span>\n <span class=\"underline\">\n <%= applicant_info.full_name %>\n </span>\n </div>\n\n <div class=\"form-item\">\n <span class=\"label\">\u1797\u17C1\u1791\u17D6</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\u17D6</span>\n <label class=\"checkbox-label <%= applicant_info.marital_status === 'single' ? 'checked' : '' %>\">\u1793\u17C5\u179B\u17B8\u179C</label>\n <label\n class=\"checkbox-label <%= applicant_info.marital_status === 'married' ? 'checked' : '' %>\">\u179A\u17C0\u1794\u1780\u17B6\u179A\u17A0\u17BE\u1799</label>\n <label class=\"checkbox-label <%= applicant_info.marital_status === 'divorced' ? 'checked' : '' %>\">\u179B\u17C2\u1784\u179B\u17C7</label>\n <label\n class=\"checkbox-label <%= applicant_info.marital_status === 'widowed' ? 'checked' : '' %>\">\u1798\u17C1\u1798\u17C9\u17B6\u1799/\u1796\u17C4\u17C7\u1798\u17C9\u17B6\u1799</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\u17D6</span>\n <span class=\"underline align-left\">\n <%= applicant_info.occupation %>\n </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\u17D6</span>\n <label\n class=\"checkbox-label <%= applicant_info.identity_type === 'nid' ? 'checked' : '' %>\">\u17A2\u178F\u17D2\u178F\u179F\u1789\u17D2\u1789\u17B6\u178E\u1794\u178E\u17D2\u178E</label>\n <label\n class=\"checkbox-label <%= applicant_info.identity_type === 'passport' ? 'checked' : '' %>\">\u179B\u17B7\u1781\u17B7\u178F\u1786\u17D2\u179B\u1784\u178A\u17C2\u1793</label>\n <label\n class=\"checkbox-label <%= applicant_info.identity_type === 'birth' ? 'checked' : '' %>\">\u179F\u17C6\u1794\u17BB\u178F\u17D2\u179A\u1780\u17C6\u178E\u17BE\u178F</label>\n <label class=\"checkbox-label <%= applicant_info.identity_type === 'other' ? 'checked' : '' %>\">\u1795\u17D2\u179F\u17C1\u1784\u1791\u17C0\u178F\u17D6</label>\n <label class=\"underline\">\n <%= applicant_info.identity_other_description %>\n </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\u17D6</span>\n <span class=\"underline\">\n <%= applicant_info.identity_no %>\n </span>\n <span class=\"label\">\u1790\u17D2\u1784\u17C3\u1781\u17C2\u1786\u17D2\u1793\u17B6\u17C6\u1780\u17C6\u178E\u17BE\u178F\u17D6</span>\n <span class=\"underline\">\n <%= applicant_info.date_of_birth %>\n </span>\n <span class=\"label\">\u17A2\u17B6\u1799\u17BB\u17D6</span>\n <span class=\"underline xs\">\n <%= applicant_info.age %>\n </span>\n <span class=\"label\">\u179F\u1789\u17D2\u1785\u17B6\u178F\u17B7\u17D6</span>\n <span class=\"underline\">\n <%= applicant_info.nationality %>\n </span>\n <span class=\"label\">\u179B\u17C1\u1781\u1791\u17BC\u179A\u179F\u17D0\u1796\u17D2\u1791\u17D6</span>\n <span class=\"underline\">\n <%= applicant_info.phone_number %>\n </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\u17D6</span>\n <span class=\"underline align-left\">\n <%= applicant_info.current_address %>\n </span>\n </div>\n </div>\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\u17D6</span>\n </div>\n <div class=\"form-item\">\n <span class=\"label\">\n \u178F\u17BE\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\u1787\u17B6\u1796\u179B\u179A\u178A\u17D2\u178B\u17A2\u17B6\u1798\u17C1\u179A\u17B7\u1780 \u17AC \u1787\u17B6\u1794\u17CB\u1796\u1793\u17D2\u1792\u179F\u17D2\u1793\u17B6\u1780\u17CB\u1793\u17C5\u17A2\u17B6\u1798\u17C1\u179A\u17B7\u1780 \u17AC \u1798\u17B6\u1793\u179F\u17B7\u1791\u17D2\u1792\u17B7\u1780\u17B6\u1793\u17CB Green Card \u1798\u17C2\u1793\u17AC\u1791\u17C1?\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 <div class=\"ml-4\">\n <span class=\"label\">US TIN\u17D6</span>\n <span class=\"underline\">\n <%= fatca_info.us_tin_no %>\n </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)\u17D6</span>\n <span class=\"underline\">\n <%= fatca_info.fatca_exempt_code %>\n </span>\n </div>\n </div>\n <div class=\"form-item mt-4\">\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 <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>\n <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>\n </th>\n <th>\n <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>\n </th>\n <th>\n <div class=\"cell\">\u179A\u1794\u17C0\u1794\u1794\u1784\u17CB\u1794\u17BB\u1796\u17D2\u179C\u179B\u17B6\u1797</div>\n </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>\n <div class=\"cell\">\n <%= product.name %>\n <%= product.term %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= product.sum_assured %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= product.payment_mode %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= product.premium %>\n </div>\n </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\u17D6</span>\n <label\n class=\"checkbox-label <%= product_payment_info.payment_method === 'transfer_to_plac' ? 'checked' : '' %>\">\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</label>\n <label\n class=\"checkbox-label <%= product_payment_info.payment_method === 'other' ? 'checked' : '' %>\">\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</label>\n </div>\n </div>\n\n<% if (loan_info) { %>\n <div class=\"card-header mt-4\">\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u17A2\u17C6\u1796\u17B8\u1780\u1798\u17D2\u1785\u17B8</div>\n <div class=\"table-container\">\n <table>\n <thead>\n <tr>\n <th>\n <div class=\"cell\">\u1785\u17C6\u1793\u17BD\u1793\u1791\u17B9\u1780\u1794\u17D2\u179A\u17B6\u1780\u17CB\u1780\u1798\u17D2\u1785\u17B8</div>\n </th>\n <th>\n <div class=\"cell\">\u179A\u1799\u17C8\u1796\u17C1\u179B\u1780\u1798\u17D2\u1785\u17B8</div>\n </th>\n <th>\n <div class=\"cell\">\u1794\u17D2\u179A\u1797\u17C1\u1791\u1780\u1798\u17D2\u1785\u17B8</div>\n </th>\n </tr>\n </thead>\n <tbody>\n <tr>\n <td>\n <div class=\"cell\">\n <%= loan_info.loan_amount %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= loan_info.loan_duration %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= loan_info.loan_type %>\n </div>\n </td>\n </tr>\n </tbody>\n </table>\n </div>\n\n<% } %>\n\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 class=\"align-left\">\n <div>\u1788\u17D2\u1798\u17C4\u17C7\u1796\u17C1\u1789\u179A\u1794\u179F\u17CB\u17A2\u17D2\u1793\u1780\u1791\u1791\u17BD\u179B\u1795\u179B</div>\n </th>\n <th>\n <div class=\"cell\">\u17A2\u17B6\u1799\u17BB</div>\n </th>\n <th>\n <div class=\"cell\">\u1791\u17C6\u1793\u17B6\u1780\u17CB\u1791\u17C6\u1793\u1784</div>\n </th>\n <th>\n <div class=\"cell\">\u179B\u17C1\u1781\u17A2\u178F\u17D2\u178F\u179F\u1789\u17D2\u1789\u17B6\u178E</div>\n </th>\n <th>\n <div class=\"cell\">\u1780\u17B6\u179A\u1794\u17C2\u1784\u1785\u17C2\u1780\u179F\u17C6\u178E\u1784</div>\n </th>\n </tr>\n </thead>\n <tbody>\n <% beneficiary_info?.forEach(function(beneficiary) { %>\n <tr>\n <td class=\"align-left\">\n <div>\n <%= beneficiary.full_name %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= beneficiary.age %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= beneficiary.relationship %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= beneficiary.id_number %>\n </div>\n </td>\n <td>\n <div class=\"cell\">\n <%= beneficiary.percentage %>\n </div>\n </td>\n </tr>\n <% }) %>\n <tr>\n <td colspan=\"5\">\n <div class=\"cell align-left\"\n style=\"text-align: start !important; padding-top: 5px; padding-bottom: 5px;\">\n \u1780\u17D2\u179A\u17BB\u1798\u17A0\u17CA\u17BB\u1793 \u1793\u17B9\u1784\u1791\u17BC\u179A\u1791\u17B6\u178F\u17CB\u179F\u17C6\u178E\u1784\u1791\u17C5\u1780\u17B6\u1793\u17CB\u17A2\u17D2\u1793\u1780\u1791\u1791\u17BD\u179B\u1795\u179B\u1785\u1798\u17D2\u1794\u1784\u1787\u17B6\u1798\u17BB\u1793\u179F\u17B7\u1793\n \u1798\u17BB\u1793\u1793\u17B9\u1784\u1791\u17BC\u1791\u17B6\u178F\u17CB\u179F\u17C6\u178E\u1784\u178A\u17C2\u179B\u1793\u17C5\u179F\u179B\u17CB\u1791\u17C5\u1780\u17B6\u1793\u17CB\u17A2\u17D2\u1793\u1780\u1791\u1791\u17BD\u179B\u1795\u179B\u1794\u1793\u17D2\u1791\u17B6\u1794\u17CB\u178A\u17C2\u179B\u1794\u17B6\u1793\u1780\u17C6\u178E\u178F\u17CB\u178A\u17C4\u1799\u17A2\u17D2\u1793\u1780\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\n \u17AC\u1791\u17B6\u1799\u17B6\u1791\u179A\u1794\u179F\u17CB\u17A2\u17D2\u1793\u1780\u178F\u17D2\u179A\u17BC\u179C\u1794\u17B6\u1793\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u1780\u17D2\u1793\u17BB\u1784\u1780\u179A\u178E\u17B7\u1798\u17B7\u1793\u1798\u17B6\u1793\u1780\u17B6\u179A\u178F\u17C2\u1784\u178F\u17B6\u17C6\u1784\u17A2\u17D2\u1793\u1780\u1791\u1791\u17BD\u179B\u1795\u179B\u17D4\n </div>\n </td>\n </tr>\n </tbody>\n </table>\n </div>\n\n <div class=\"page-break\"></div>\n <div class=\"card-header\">\u1796\u17D0\u178F\u17CC\u1798\u17B6\u1793\u1796\u17B6\u1780\u17CB\u1796\u17D0\u1793\u17D2\u1791\u1793\u17B9\u1784\u179F\u17BB\u1781\u1797\u17B6\u1796\u179A\u1794\u179F\u17CB \u17A2\u17D2\u1793\u1780\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1794\u178E\u17D2\u178E\u179F\u1793\u17D2\u1799\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784\u17CB</div>\n\n <!-- <div class=\"form-container\">\n <div class=\"form-item\">\n <span class=\"label\">1) \u1780\u1798\u17D2\u1796\u179F\u17CB\u17D6</span>\n <span class=\"underline sm\">\n <%= health_info.height %>\n </span>\n <span class=\"label\">\u179F.\u1798</span>\n <div class=\"space\"></div>\n <span class=\"label\">\u1791\u1798\u17D2\u1784\u1793\u17CB\u17D6</span>\n <span class=\"underline sm\">\n <%= health_info.weight %>\n </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?\u17D6</span>\n <label class=\"checkbox-label <%= health_info.is_smoke === false ? 'checked' : '' %>\">\u1798\u17B7\u1793\u1798\u17B6\u1793</label>\n <label class=\"checkbox-label <%= health_info.is_smoke === true ? 'checked' : '' %>\">\u1798\u17B6\u1793</label>\n </div>\n\n <div class=\"form-item mb-4\">\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\">\n <%= health_info.smoke_detail %>\n </span>\n <span class=\"unit\">\u178A\u17BE\u1798\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 <!-- Row 1: Height + Weight -->\n <div class=\"form-item\">\n <span class=\"label\">1) \u1780\u1798\u17D2\u1796\u179F\u17CB\u17D6</span>\n <span class=\"underline sm\">\n <%= health_info.height %>\n </span>\n <span class=\"label\">\u179F.\u1798</span>\n <div class=\"space\"></div>\n <span class=\"label\">\u1791\u1798\u17D2\u1784\u1793\u17CB\u17D6</span>\n <span class=\"underline sm\">\n <%= health_info.weight %>\n </span>\n <span class=\"label\">\u1782.\u1780</span>\n </div>\n \n <!-- Row 2: Smoking question + checkboxes + how many -->\n <div class=\"form-item mb-4\" style=\"display: flex; align-items: center; flex-wrap: nowrap; width: 100%;\">\n <span class=\"question-label\">A) \u178F\u17BE\u179B\u17C4\u1780\u17A2\u17D2\u1793\u1780\u1796\u17B7\u179F\u17B6\u179A\u1794\u17B6\u179A\u17B8\u178A\u17C2\u179A\u17AC\u1791\u17C1?\u17D6</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 class=\"space\"></div>\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\">\n <%= health_info.smoke_detail %>\n </span>\n <span class=\"unit\">\u178A\u17BE\u1798\u1780\u17D2\u1793\u17BB\u1784\u1798\u17BD\u1799\u1790\u17D2\u1784\u17C3</span>\n </span>\n <% } else { %>\n <span class=\"underline with-unit\">\n <span class=\"value\">\n <%= health_info.smoke_detail %>\n </span>\n <span class=\"underline\"></span>\n <span class=\"unit\">\u178A\u17BE\u1798\u1780\u17D2\u1793\u17BB\u1784\u1798\u17BD\u1799\u1790\u17D2\u1784\u17C3</span>\n </span>\n <% } %>\n </div>\n </div>\n\n <div class=\"form-container\">\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?\u17D6</span>\n <label class=\"checkbox-label <%= health_info.is_drink_alcohol === false ? 'checked' : '' %>\">\u1798\u17B7\u1793\u1798\u17B6\u1793</label>\n <label class=\"checkbox-label <%= health_info.is_drink_alcohol === true ? 'checked' : '' %>\">\u1798\u17B6\u1793</label>\n </div>\n <div class=\"form-item mb-4\">\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\">\n <%= health_info.drink_alcohol_detail %>\n </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 <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?\u17D6\n </span>\n <div class=\"form-item\">\n <label class=\"checkbox-label <%= health_info.is_hospitalized === false ? 'checked' : '' %>\">\u1798\u17B7\u1793\u1798\u17B6\u1793</label>\n <label class=\"checkbox-label <%= health_info.is_hospitalized === true ? 'checked' : '' %>\">\u1798\u17B6\u1793</label>\n </div>\n\n <div class=\"form-item mb-4\">\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\">\n <%= health_info.hospitalized_detail %>\n </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 <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' : '' %>\">\u1798\u17B7\u1793\u1798\u17B6\u1793</label>\n <label class=\"checkbox-label <%= health_info.is_diagnosed === true ? 'checked' : '' %>\">\u1798\u17B6\u1793</label>\n </div>\n <div class=\"form-item mb-4\">\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\">\n <%= health_info.diagnosed_detail %>\n </span>\n </span>\n <% } else { %>\n <span class=\"underline\"></span>\n <% } %>\n </div>\n </div>\n\n <div class=\"card-header mt-4\">\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\" style=\"margin: 15px 0px 15px 0px;\">\n <div class=\"form-item\">\n <ol style=\"padding-left: 1.2rem; margin: 0;\">\n <li class=\"label\" style=\"margin-bottom: 5px;\">\n \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\n </li>\n <li class=\"label\">\n \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 </li>\n </ol>\n </div>\n </div>\n\n <div class=\"table-container mt-4\">\n <table>\n <thead>\n <tr>\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\u17A2\u17D2\u1793\u1780\u179F\u17D2\u1793\u17BE\u179F\u17BB\u17C6\u1792\u17B6\u1793\u17B6\u179A\u17C9\u17B6\u1794\u17CB\u179A\u1784</div>\n <div class=\"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\">\n <%= signature_info.applicant_name %>\n </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\">\n <%= signature_info.witness_name %>\n </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\">\n <%= signature_info.applicant_signature_date %>\n </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\">\n <%= signature_info.witness_signature_date %>\n </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\n</html>\n";
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size: A4 portrait;
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margin: 15mm 15mm 20mm 10mm;
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content: "
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@bottom-right {
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content: "ទំព័រ " counter(page) " of " counter(pages);
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font-size: 11px;
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color: #555;
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}
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}
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}
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body {
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<div class="form-container">
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<div class="form-item">
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<span class="label"
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<span class="label">ឈ្មោះនិងលេខកូដសាខា៖</span>
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<span class="underline">
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<%= branch_staff_app_info.branch_name %> / <%= branch_staff_app_info.branch_code %>
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</span>
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<span class="label"
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<span class="label">ឈ្មោះនិងលេខកូដបុគ្គលិកធានារ៉ាប់រង់៖</span>
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<span class="underline">
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<%= branch_staff_app_info.advisor_name %> / <%= branch_staff_app_info.advisor_code %>
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</span>
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</div>
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<div class="form-item">
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<span class="label"
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<span class="label">ឈ្មោះនិងលេខកូដបុគ្គលិកធនាគារ៖</span>
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<span class="underline">
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<%= branch_staff_app_info.bank_staff_name %> / <%= branch_staff_app_info.bank_staff_code %>
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</span>
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<span class="label">លេខពាក្យស្នើសុំ៖</span>
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<span class="underline">
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<%= branch_staff_app_info.application_no %>
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</span>
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<div class="form-container">
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<div class="form-item">
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<span class="label"
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<span class="label">ឈ្មោះពេញដូចបង្ហាញនៅក្នុងឯកសារអត្តសញ្ញាណ៖ ជាភាសាខ្មែរ</span>
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<span class="underline">
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<%= applicant_info.full_name_kh %>
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</span>
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@@ -371,14 +371,14 @@ exports.SIO_FORM_KH_TEMPLATE = `
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</div>
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<div class="form-item">
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<span class="label"
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<span class="label">ភេទ៖</span>
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<label class="checkbox-label <%= applicant_info.gender === 'M' ? 'checked' : '' %>">ប្រុស</label>
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<label class="checkbox-label <%= applicant_info.gender === 'F' ? 'checked' : '' %>">ស្រី</label>
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<div class="ml-8"></div>
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<div>
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<span class="label"
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<span class="label">ស្ថានភាពគ្រួសារ៖</span>
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<label class="checkbox-label <%= applicant_info.marital_status === 'single' ? 'checked' : '' %>">នៅលីវ</label>
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<label
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class="checkbox-label <%= applicant_info.marital_status === 'married' ? 'checked' : '' %>">រៀបការហើយ</label>
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@@ -389,51 +389,51 @@ exports.SIO_FORM_KH_TEMPLATE = `
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</div>
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<div class="form-item">
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<span class="label">តួនាទី
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<span class="label">តួនាទី និងប្រភេទការងារ៖</span>
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<span class="underline align-left">
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<%= applicant_info.occupation %>
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</span>
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</div>
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<div class="form-item">
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<span class="label"
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+
<span class="label">ឯកសារបញ្ចាក់អត្តសញ្ញាណ៖</span>
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<label
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class="checkbox-label <%= applicant_info.identity_type === 'nid' ? 'checked' : '' %>">អត្តសញ្ញាណបណ្ណ</label>
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<label
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class="checkbox-label <%= applicant_info.identity_type === 'passport' ? 'checked' : '' %>">លិខិតឆ្លងដែន</label>
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<label
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class="checkbox-label <%= applicant_info.identity_type === 'birth' ? 'checked' : '' %>">សំបុត្រកំណើត</label>
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-
<label class="checkbox-label <%= applicant_info.identity_type === 'other' ? 'checked' : '' %>"
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+
<label class="checkbox-label <%= applicant_info.identity_type === 'other' ? 'checked' : '' %>">ផ្សេងទៀត៖</label>
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<label class="underline">
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<%= applicant_info.identity_other_description %>
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</label>
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</div>
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<div class="form-item">
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<span class="label"
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+
<span class="label">លេខអត្តសញ្ញាណ៖</span>
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<span class="underline">
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<%= applicant_info.identity_no %>
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</span>
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<span class="label"
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+
<span class="label">ថ្ងៃខែឆ្នាំកំណើត៖</span>
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<span class="underline">
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<%= applicant_info.date_of_birth %>
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</span>
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<span class="label"
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+
<span class="label">អាយុ៖</span>
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<span class="underline xs">
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<%= applicant_info.age %>
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</span>
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-
<span class="label"
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+
<span class="label">សញ្ចាតិ៖</span>
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<span class="underline">
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<%= applicant_info.nationality %>
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</span>
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-
<span class="label"
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+
<span class="label">លេខទូរស័ព្ទ៖</span>
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<span class="underline">
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<%= applicant_info.phone_number %>
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</span>
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</div>
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<div class="form-item">
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-
<span class="label"
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+
<span class="label">អាសយដ្ឋានបច្ចុប្បន្ន៖</span>
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<span class="underline align-left">
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<%= applicant_info.current_address %>
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</span>
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@@ -442,22 +442,22 @@ exports.SIO_FORM_KH_TEMPLATE = `
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<div class="form-container">
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<div class="form-item mt-4">
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-
<span class="label">សេចក្ដីប្រកាសសម្រាប់ការអនុវត្ដ FATCA
|
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+
<span class="label">សេចក្ដីប្រកាសសម្រាប់ការអនុវត្ដ FATCA៖</span>
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</div>
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<div class="form-item">
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<span class="label">
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-
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+
តើអ្នកស្នើសុំបណ្ណសន្យារ៉ាប់រងជាពលរដ្ឋអាមេរិក ឬ ជាប់ពន្ធស្នាក់នៅអាមេរិក ឬ មានសិទ្ធិកាន់ Green Card មែនឬទេ?
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</span>
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</div>
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<div class="form-item">
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<label class="checkbox-label <%= fatca_info.is_fatca === false ? 'checked' : '' %>">មិនមែន</label>
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<label class="checkbox-label <%= fatca_info.is_fatca === true ? 'checked' : '' %>">មែន</label>
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|
<div class="ml-4">
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|
-
<span class="label">US TIN
|
|
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|
+
<span class="label">US TIN៖</span>
|
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|
<span class="underline">
|
|
458
458
|
<%= fatca_info.us_tin_no %>
|
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|
</span>
|
|
460
|
-
<span class="label">លេខកូដលើកលែង FATCA (ប្រសិនមាន)
|
|
460
|
+
<span class="label">លេខកូដលើកលែង FATCA (ប្រសិនមាន)៖</span>
|
|
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|
<span class="underline">
|
|
462
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|
<%= fatca_info.fatca_exempt_code %>
|
|
463
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|
</span>
|
|
@@ -522,7 +522,7 @@ exports.SIO_FORM_KH_TEMPLATE = `
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|
</div>
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|
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523
|
<div class="form-container">
|
|
524
524
|
<div class="form-item">
|
|
525
|
-
<span class="question-label"
|
|
525
|
+
<span class="question-label">វិធីសាស្រ្ដបង់បុព្វលាភធានារ៉ាប់រង់៖</span>
|
|
526
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|
<label
|
|
527
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|
class="checkbox-label <%= product_payment_info.payment_method === 'transfer_to_plac' ? 'checked' : '' %>">ការផ្ទេរប្រាក់ចូលទៅក្នុងគណនីរបស់ហ្វីលីឡាយហ្វ៍</label>
|
|
528
528
|
<label
|
|
@@ -640,27 +640,27 @@ exports.SIO_FORM_KH_TEMPLATE = `
|
|
|
640
640
|
<div class="page-break"></div>
|
|
641
641
|
<div class="card-header">ព័ត៌មានពាក់ព័ន្ទនឹងសុខភាពរបស់ អ្នកស្នើសុំបណ្ណសន្យារ៉ាប់រង់</div>
|
|
642
642
|
|
|
643
|
-
<div class="form-container">
|
|
643
|
+
<!-- <div class="form-container">
|
|
644
644
|
<div class="form-item">
|
|
645
|
-
<span class="label">1)
|
|
645
|
+
<span class="label">1) កម្ពស់៖</span>
|
|
646
646
|
<span class="underline sm">
|
|
647
647
|
<%= health_info.height %>
|
|
648
648
|
</span>
|
|
649
649
|
<span class="label">ស.ម</span>
|
|
650
650
|
<div class="space"></div>
|
|
651
|
-
<span class="label"
|
|
651
|
+
<span class="label">ទម្ងន់៖</span>
|
|
652
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|
<span class="underline sm">
|
|
653
653
|
<%= health_info.weight %>
|
|
654
654
|
</span>
|
|
655
655
|
<span class="label">គ.ក</span>
|
|
656
656
|
<div class="space"></div>
|
|
657
|
-
<span class="question-label"
|
|
657
|
+
<span class="question-label">តើលោកអ្នកពិសារបារីដែរឬទេ?៖</span>
|
|
658
658
|
<label class="checkbox-label <%= health_info.is_smoke === false ? 'checked' : '' %>">មិនមាន</label>
|
|
659
659
|
<label class="checkbox-label <%= health_info.is_smoke === true ? 'checked' : '' %>">មាន</label>
|
|
660
660
|
</div>
|
|
661
661
|
|
|
662
662
|
<div class="form-item mb-4">
|
|
663
|
-
<span class="label"
|
|
663
|
+
<span class="label">ចំនួន៖</span>
|
|
664
664
|
<% if (health_info.smoke_detail) { %>
|
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665
665
|
<span class="underline with-unit">
|
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666
666
|
<span class="value">
|
|
@@ -671,12 +671,58 @@ exports.SIO_FORM_KH_TEMPLATE = `
|
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671
671
|
<% } else { %>
|
|
672
672
|
<span class="underline"></span>
|
|
673
673
|
<% } %>
|
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674
|
+
</div>
|
|
675
|
+
</div> -->
|
|
676
|
+
|
|
677
|
+
<div class="form-container">
|
|
678
|
+
<!-- Row 1: Height + Weight -->
|
|
679
|
+
<div class="form-item">
|
|
680
|
+
<span class="label">1) កម្ពស់៖</span>
|
|
681
|
+
<span class="underline sm">
|
|
682
|
+
<%= health_info.height %>
|
|
683
|
+
</span>
|
|
684
|
+
<span class="label">ស.ម</span>
|
|
685
|
+
<div class="space"></div>
|
|
686
|
+
<span class="label">ទម្ងន់៖</span>
|
|
687
|
+
<span class="underline sm">
|
|
688
|
+
<%= health_info.weight %>
|
|
689
|
+
</span>
|
|
690
|
+
<span class="label">គ.ក</span>
|
|
691
|
+
</div>
|
|
692
|
+
|
|
693
|
+
<!-- Row 2: Smoking question + checkboxes + how many -->
|
|
694
|
+
<div class="form-item mb-4" style="display: flex; align-items: center; flex-wrap: nowrap; width: 100%;">
|
|
695
|
+
<span class="question-label">A) តើលោកអ្នកពិសារបារីដែរឬទេ?៖</span>
|
|
696
|
+
<label class="checkbox-label <%= health_info.is_smoke === false ? 'checked' : '' %>">
|
|
697
|
+
មិនមាន
|
|
698
|
+
</label>
|
|
699
|
+
<label class="checkbox-label <%= health_info.is_smoke === true ? 'checked' : '' %>">
|
|
700
|
+
មាន
|
|
701
|
+
</label>
|
|
702
|
+
<div class="space"></div>
|
|
703
|
+
<span class="label">ចំនួន៖</span>
|
|
704
|
+
<% if (health_info.smoke_detail) { %>
|
|
705
|
+
<span class="underline with-unit">
|
|
706
|
+
<span class="value">
|
|
707
|
+
<%= health_info.smoke_detail %>
|
|
708
|
+
</span>
|
|
709
|
+
<span class="unit">ដើមក្នុងមួយថ្ងៃ</span>
|
|
710
|
+
</span>
|
|
711
|
+
<% } else { %>
|
|
712
|
+
<span class="underline with-unit">
|
|
713
|
+
<span class="value">
|
|
714
|
+
<%= health_info.smoke_detail %>
|
|
715
|
+
</span>
|
|
716
|
+
<span class="underline"></span>
|
|
717
|
+
<span class="unit">ដើមក្នុងមួយថ្ងៃ</span>
|
|
718
|
+
</span>
|
|
719
|
+
<% } %>
|
|
674
720
|
</div>
|
|
675
721
|
</div>
|
|
676
722
|
|
|
677
723
|
<div class="form-container">
|
|
678
724
|
<div class="form-item">
|
|
679
|
-
<span class="question-label">2)
|
|
725
|
+
<span class="question-label">2) តើលោកអ្នកពិសារគ្រឿងស្រវឹងដែរឬទេ?៖</span>
|
|
680
726
|
<label class="checkbox-label <%= health_info.is_drink_alcohol === false ? 'checked' : '' %>">មិនមាន</label>
|
|
681
727
|
<label class="checkbox-label <%= health_info.is_drink_alcohol === true ? 'checked' : '' %>">មាន</label>
|
|
682
728
|
</div>
|
|
@@ -702,7 +748,7 @@ exports.SIO_FORM_KH_TEMPLATE = `
|
|
|
702
748
|
ឬធ្លាប់ទទួលបានលទ្ធផលខុសប្រក្រតីអំពី ការវិភាគឈាម ការវិភាគទឹកនោម
|
|
703
749
|
ការថតកាំរស្មីអុិច (X-ray) ម៉ាសុិនវាស់ចង្វាក់បេះដូង អេកូសាស្រ្ដ
|
|
704
750
|
ស្កេនការច្រឹបសាច់យកពិនិត្យ
|
|
705
|
-
|
|
751
|
+
ឬលទ្ធផលវិភាគផ្សេងៗទៀតដែលមិនបានរៀបរាប់ខាងដើមពីគ្រូពេទ្យដែរឬទេ?៖
|
|
706
752
|
</span>
|
|
707
753
|
<div class="form-item">
|
|
708
754
|
<label class="checkbox-label <%= health_info.is_hospitalized === false ? 'checked' : '' %>">មិនមាន</label>
|
|
@@ -710,7 +756,7 @@ exports.SIO_FORM_KH_TEMPLATE = `
|
|
|
710
756
|
</div>
|
|
711
757
|
|
|
712
758
|
<div class="form-item mb-4">
|
|
713
|
-
<span class="label"
|
|
759
|
+
<span class="label">បើមានសូមផ្ដល់ព័ត៍មានលម្អិត៖</span>
|
|
714
760
|
<% if (health_info.hospitalized_detail) { %>
|
|
715
761
|
<span class="underline with-unit">
|
|
716
762
|
<span class="value">
|
|
@@ -737,7 +783,7 @@ exports.SIO_FORM_KH_TEMPLATE = `
|
|
|
737
783
|
<label class="checkbox-label <%= health_info.is_diagnosed === true ? 'checked' : '' %>">មាន</label>
|
|
738
784
|
</div>
|
|
739
785
|
<div class="form-item mb-4">
|
|
740
|
-
<span class="label"
|
|
786
|
+
<span class="label">បើមានសូមបញ្ជាក់លម្អិតខាងក្រោម៖</span>
|
|
741
787
|
<% if (health_info.diagnosed_detail) { %>
|
|
742
788
|
<span class="underline with-unit">
|
|
743
789
|
<span class="value">
|
|
@@ -1,5 +1,5 @@
|
|
|
1
1
|
import { _BaseEntity } from "../_base_entity";
|
|
2
|
-
import { AppFormType, ApplicationStatus, AppPhLaRelation, UWDecisionMetadata, UWDecisionType } from "../../types";
|
|
2
|
+
import { AppFormType, ApplicationStatus, AppPhLaRelation, AppSourceType, UWDecisionMetadata, UWDecisionType } from "../../types";
|
|
3
3
|
import { OrganizationBranchEntity, OrganizationEntity, OrganizationStaffEntity, OrgReferralEntity } from "../core";
|
|
4
4
|
import { AppCoverageEntity } from "./app_coverage.entity";
|
|
5
5
|
import { AppPersonEntity } from "./app_person.entity";
|
|
@@ -12,6 +12,7 @@ import { CustomerLoanInfoEntity } from "../customer";
|
|
|
12
12
|
export declare class ApplicationEntity extends _BaseEntity {
|
|
13
13
|
id: string;
|
|
14
14
|
form_type: AppFormType;
|
|
15
|
+
source_type: AppSourceType;
|
|
15
16
|
application_no: string;
|
|
16
17
|
cover_note_no?: string | null;
|
|
17
18
|
policy_no?: string | null;
|
|
@@ -39,6 +39,15 @@ __decorate([
|
|
|
39
39
|
}),
|
|
40
40
|
__metadata("design:type", String)
|
|
41
41
|
], ApplicationEntity.prototype, "form_type", void 0);
|
|
42
|
+
__decorate([
|
|
43
|
+
(0, typeorm_1.Column)({
|
|
44
|
+
type: "varchar",
|
|
45
|
+
length: 25,
|
|
46
|
+
default: types_1.AppSourceType.Banca,
|
|
47
|
+
comment: (0, utils_1.enumToCommentString)(types_1.AppSourceType),
|
|
48
|
+
}),
|
|
49
|
+
__metadata("design:type", String)
|
|
50
|
+
], ApplicationEntity.prototype, "source_type", void 0);
|
|
42
51
|
__decorate([
|
|
43
52
|
(0, typeorm_1.Column)({ type: "varchar", length: 25, unique: true }),
|
|
44
53
|
__metadata("design:type", String)
|
|
@@ -2,6 +2,11 @@ export declare enum AppFormType {
|
|
|
2
2
|
Base = "base",
|
|
3
3
|
Simplified = "sio"
|
|
4
4
|
}
|
|
5
|
+
export declare enum AppSourceType {
|
|
6
|
+
Banca = "banca",
|
|
7
|
+
PersonalSales = "personal",
|
|
8
|
+
Agency = "agency"
|
|
9
|
+
}
|
|
5
10
|
export declare enum ApplicationStatus {
|
|
6
11
|
New = "new",// Agent drafting
|
|
7
12
|
Completed = "completed",// Agent completed but not yet submitted
|
|
@@ -1,11 +1,17 @@
|
|
|
1
1
|
"use strict";
|
|
2
2
|
Object.defineProperty(exports, "__esModule", { value: true });
|
|
3
|
-
exports.PaymentMode = exports.CreditCardType = exports.PaymentMethod = exports.AppPaymentStatus = exports.AppPaymentType = exports.AppDocumentType = exports.UwAnswerValueType = exports.AppCoverageType = exports.AppPhLaRelation = exports.AppPersonRole = exports.ApplicationActionType = exports.ApplicationStatus = exports.AppFormType = void 0;
|
|
3
|
+
exports.PaymentMode = exports.CreditCardType = exports.PaymentMethod = exports.AppPaymentStatus = exports.AppPaymentType = exports.AppDocumentType = exports.UwAnswerValueType = exports.AppCoverageType = exports.AppPhLaRelation = exports.AppPersonRole = exports.ApplicationActionType = exports.ApplicationStatus = exports.AppSourceType = exports.AppFormType = void 0;
|
|
4
4
|
var AppFormType;
|
|
5
5
|
(function (AppFormType) {
|
|
6
6
|
AppFormType["Base"] = "base";
|
|
7
7
|
AppFormType["Simplified"] = "sio";
|
|
8
8
|
})(AppFormType || (exports.AppFormType = AppFormType = {}));
|
|
9
|
+
var AppSourceType;
|
|
10
|
+
(function (AppSourceType) {
|
|
11
|
+
AppSourceType["Banca"] = "banca";
|
|
12
|
+
AppSourceType["PersonalSales"] = "personal";
|
|
13
|
+
AppSourceType["Agency"] = "agency";
|
|
14
|
+
})(AppSourceType || (exports.AppSourceType = AppSourceType = {}));
|
|
9
15
|
var ApplicationStatus;
|
|
10
16
|
(function (ApplicationStatus) {
|
|
11
17
|
ApplicationStatus["New"] = "new";
|
|
@@ -1,12 +1,13 @@
|
|
|
1
|
-
import { AddressType, AppDocumentType, ApplicationActionType, AppPhLaRelation, ChannelType, ContactType, Gender, IdentifierType, OrgType, StaffStatus, StaffType } from "../../types";
|
|
1
|
+
import { AddressType, AppDocumentType, ApplicationActionType, AppPhLaRelation, AppSourceType, ChannelType, ContactType, Gender, IdentifierType, OrgType, StaffStatus, StaffType } from "../../types";
|
|
2
2
|
export declare function getGenderDesc(val: Gender): "Male" | "Female";
|
|
3
|
+
export declare function getAppSourceTypeDesc(val: AppSourceType): "Banca" | "Personal Sales" | "Agency";
|
|
3
4
|
export declare function getAppPhLaRelationDesc(val: AppPhLaRelation): "PH = LA" | "PH != LA";
|
|
4
5
|
export declare function getIdentifierTypeDesc(val: IdentifierType): "Other" | "National ID" | "Passport" | "Birth Certificate" | "Tax ID" | "Company Registration";
|
|
5
6
|
export declare function getContactTypeDesc(val: ContactType): "Other" | "Phone Number" | "Email" | "Website" | "Social Media";
|
|
6
7
|
export declare function getAddressTypeDesc(val: AddressType): "Other" | AddressType.PlaceOfBirth | "Home" | "Work" | "Billing";
|
|
7
8
|
export declare function getAppDocumentTypeDesc(val: AppDocumentType): "Other" | "National ID" | "Passport" | "Application Form" | "Quotation Form" | "Claim Form";
|
|
8
9
|
export declare function getAppActionTypeDesc(val: ApplicationActionType): ApplicationActionType.Created | ApplicationActionType.DraftSaved | ApplicationActionType.Completed | ApplicationActionType.EditCompleted | ApplicationActionType.TakenForReview | ApplicationActionType.Assigned | ApplicationActionType.Unassigned | ApplicationActionType.DocumentRemoved | ApplicationActionType.DataUpdated | "Submit" | "Re-Submit" | "Approve" | "Reject" | "Request Edit" | "Request More Documents" | "Cancel" | "Transfer" | "Add Note" | "Upload Document";
|
|
9
|
-
export declare function getOrgTypeDesc(val: OrgType): "Internal" | "Bank" | "Micro Finance" | "
|
|
10
|
-
export declare function getChannelTypeDesc(val: ChannelType): "Other" | "
|
|
10
|
+
export declare function getOrgTypeDesc(val: OrgType): "Agency" | "Internal" | "Bank" | "Micro Finance" | "Broker";
|
|
11
|
+
export declare function getChannelTypeDesc(val: ChannelType): "Other" | "Agency" | "Bank" | "Broker" | "Direct" | "Online" | "Partner" | "Telesales";
|
|
11
12
|
export declare function getStaffTypeDesc(val: StaffType): "Other" | "Employee" | "Contractor" | "Intern";
|
|
12
13
|
export declare function getStaffStatusDesc(val: StaffStatus): "Active" | "Suspended" | "Resigned" | "Terminated";
|
|
@@ -1,6 +1,7 @@
|
|
|
1
1
|
"use strict";
|
|
2
2
|
Object.defineProperty(exports, "__esModule", { value: true });
|
|
3
3
|
exports.getGenderDesc = getGenderDesc;
|
|
4
|
+
exports.getAppSourceTypeDesc = getAppSourceTypeDesc;
|
|
4
5
|
exports.getAppPhLaRelationDesc = getAppPhLaRelationDesc;
|
|
5
6
|
exports.getIdentifierTypeDesc = getIdentifierTypeDesc;
|
|
6
7
|
exports.getContactTypeDesc = getContactTypeDesc;
|
|
@@ -22,6 +23,18 @@ function getGenderDesc(val) {
|
|
|
22
23
|
return val;
|
|
23
24
|
}
|
|
24
25
|
}
|
|
26
|
+
function getAppSourceTypeDesc(val) {
|
|
27
|
+
switch (val) {
|
|
28
|
+
case types_1.AppSourceType.Banca:
|
|
29
|
+
return "Banca";
|
|
30
|
+
case types_1.AppSourceType.PersonalSales:
|
|
31
|
+
return "Personal Sales";
|
|
32
|
+
case types_1.AppSourceType.Agency:
|
|
33
|
+
return "Agency";
|
|
34
|
+
default:
|
|
35
|
+
return val;
|
|
36
|
+
}
|
|
37
|
+
}
|
|
25
38
|
function getAppPhLaRelationDesc(val) {
|
|
26
39
|
switch (val) {
|
|
27
40
|
case types_1.AppPhLaRelation.SamePerson:
|