@extends('layouts.admin.app')
@section('content')
<script src="{{asset('admin/js/just-validate.min.js')}}"></script>
<style type="text/css">
    .display{display: none}.td{border-right: 1px solid rgb(82 63 105 / 15%);}
</style>
<div class="modal fade" id="exampleModal" tabindex="-1" role="dialog" aria-labelledby="exampleModalLabel" aria-hidden="true">
  <div class="modal-dialog" role="document">
    <div class="modal-content" style="border:none;background:transparent!important">
      <div class="modal-body">
      <img src="{{asset('admin/gif/Hourglass.gif')}}" alt="processing..." />
      </div>
    </div>
  </div>
</div>
<div class="pd-30">
    <div class="col-sm-12 col-xl-12 " style="display: flex;">
    <h4 class="tx-gray-800 mg-b-5 title" style="width: 100%;">INITIAL DATA FOR SIFF AGREEMENT </h4>
    </div>
</div>
<!-- d-flex -->
    <div class=" br-pagebody mg-t-5 pd-x-30">
        <div class="br-section-wrapper row row-sm">
            <div class="col-sm-12 col-xl-12">
                <form  id="myform" class="form"  method="post" action="/gpclrmainportal/fill-jsf-submit">
                 @csrf @method('post')
                 <h6>Substance Information</h6>
                    <div class="row">
                       
                        <div class="col-md-6">
                            <div class="form-group">
                               Cas Name:<span class="text-danger">*</span>
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group"> 
                               <input type="text" name="cas_name" class="form-control" placeholder="Cas Name" data-validate-field="cas_name" value="{{old('cas_name')}}">
                               @error('cas_name')
                                       <p class="text-danger">{{ $message }}</p>
                                @enderror
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                               Cas No:<span class="text-danger">*</span>
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                               <input type="text" name="cas_no" class="form-control" placeholder="Cas No" data-validate-field="cas_no" value="{{old('cas_no')}}">
                               @error('cas_no')
                                       <p class="text-danger">{{ $message }}</p>
                                @enderror
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                              EC No:<span class="text-danger">*</span>
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                               <input type="text" name="ec_no" class="form-control" placeholder="EC No" data-validate-field="ec_no" value="{{old('ec_no')}}">
                               @error('ec_no')
                                       <p class="text-danger">{{ $message }}</p>
                                @enderror
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                              Region:<span class="text-danger">*</span>
                            </div>
                        </div>
                        <div class="col-md-6">
                            <div class="form-group">
                               <select class="form-control" name="region_id" data-validate-field="region_id">
                                   <option value="">Select</option>
                                   @foreach($regions as $key => $n)
                                   <option value="{{$n->id}}"