@extends('layouts.user.usercas')
@section('title') REACH JOINT SUBMISSION FORM (JSF) @endsection
@section('meta_description') Register your substances with us and we will help you to fulfill all compliance requirements also you can contact our experts for further details. @endsection
@section('meta_keywords') REACH JOINT SUBMISSION FORM (JSF) @endsection
@section('pageTitle')
REACH JOINT SUBMISSION FORM (JSF)
@endsection
@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%);}.page{display: block !important;}.box-border{border-bottom: 2px solid black;border-top: 2px solid black;}
</style>
@if($companyData != null)
<form id="myform" class=" form"  method="post" action="/jsf"  enctype="multipart/form-data" >
    @csrf @method('post')
    <div class="text-center">
        <h5>KKDIK REACH JOINT SUBMISSION FORM (JSF)</h5>
        <h6>KKDİK ORTAK SUNUM FORMU</h6>
        <h6>{{$companyData->cas_name}}(CAS No: {{$mainsearchData->CAS_Registry_No}}; EC No: {{$mainsearchData->EC_No}})</h6>
        <p>Lead Registrant(LR/Lider Kayıt Ettiren):Global Product Compliance(GPC)</p>
        <input type="hidden" name="cas_no" value="{{old('cas_no', $mainsearchData->CAS_Registry_No)}}">
        <input type="hidden" name="cas_name" value="{{old('cas_name', $companyData->cas_name)}}">
        <input type="hidden" name="companyid" value="{{old('companyid', $companyData->id)}}">
        <input type="hidden" name="ec_no" value="{{old('ec_no', $mainsearchData->EC_No)}}">
        <input type="hidden" name="region_id"  value="{{old('region_id', $companyData->region_id)}}">
        <input type="hidden" name="preregistration_no"  value="{{old('preregistration_no', $companyData->preregistration_no)}}">
    </div>
    <b>Note:<span class="text-danger">*</span>Indicate mandatory field.</b>
    <div>
        <p style="text-align: justify;">By signing this form you indicate an interest to become a joint submission member to the KKDIK Registration of the substance indicated below. Please complete the requested details in this form in clear writing / electronically and return the signed form in softcopy to … at the earliest. Joint Registration Format has no binding on the timing of registration or registration itself, but it is an important information for LR to make various projections and also to cut short time at later date when SIEF member decides to register.</p>
        <p>Bu formu imzalayarak KKDIK çerçevesinde belirtilen madde için ortak kayıt ettirenlerden biri olma niyetinizi belirtmektesiniz. Lütfen bu formda yer alan gerekli bilgileri yazılı ya da elektronik ortamda doldurarak imzalanmış formun çıktısını … e-mail adresine en kısa zamanda gönderiniz. Ortak Kayıt Formatının kayıt veya kayıt zamanlaması üzerinde hiçbir bağlayıcılığı yoktur, ancak Lider Kayıt Ettirenin çeşitli planlar yapması ve ayrıca MBDF üyesinin kayıt olmaya karar verdiği takdirde kısa sürede harekete geçmek için önemli bir bilgidir.</p>
    </div>
    <div  style="border: 3px solid black;">
        <h6 class="text-center mt-2">Substance Information (Madde Bilgisi)</h6>
        <table class="table mb-0" >
            <tbody style="border-top: 2px solid black;">
                <tr>
                    <td style="border-right: 1px solid black;">Name(Ad):</td>
                    <td>{{$companyData->cas_name}}</td>
                </tr>
                <tr>
                    <td style="border-right: 1px solid black;">CAS No:</td>
                    <td>{{$mainsearchData->CAS_Registry_No}}</td>
                </tr>
                <tr>
                    <td style="border-right: 1px solid black;">EC No:</td>
                    <td>{{$mainsearchData->EC_No}}</td>
                </tr>
            </tbody>
        </table>
    </div>
    <div class="text-center">
        <p class="mb-0 mt-1">See Substance Identity Profile (SIP) attached for details about substance identity.</p>
        <p>Lütfen madde kimliğine ilişkin Madde Kimlik Profiline(SIP) ekine bakınız.</p>
    </div>
    <div style="border: 3px solid black;margin-top:1rem">
        <h6 class="text-center mt-2 " style="border-bottom: 2px solid black;">Registrant Company Details: <br>Kayıt Ettiren Şirketin Detayları</h6>
        <div class="row" style="padding:10px">
            <div class="col-md-6">
                <div class="form-group">
                    Registering Legal Entity name:<br>Kayıt Ettiren Tüzel Kişi Adı:<span class="text-danger">*</span>
                </div> 
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input id="address_1" type="text" name="entity_name" readonly  value="{{old('company_name', $companyData->company_name)}}" class="form-control" data-validate-field="entity_name">
                    @error('entity_name')
                        <p class="text-danger">{{ $message }}</p>
                    @enderror
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    Environment Identity No:<br>Çevre Kimlik Numarası/ ÇKN<span class="text-danger">*</span>
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input id="address_6" type="text" name="uuid" readonly value="{{old('uuid', $companyData->uuid)}}" class="form-control" data-validate-field="uuid">
                    @error('uuid')<p class="text-danger">{{ $message }}</p>@enderror
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    Postal Address:<br>Adres<span class="text-danger">*</span>
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <textarea id="address_2" class="form-control @error('address') is-invalid @enderror" name="address" data-validate-field="address" placeholder="Postal Address">{{old('address', $jsfdata->address ?? '')}}</textarea>
                    @error('address')<p class="text-danger">{{ $message }}</p>@enderror
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    Postal Code:<br>Posta Kodu<span class="text-danger">*</span>
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input id="address_3" class="form-control @error('code') is-invalid @enderror" name="code" value="{{old('code', $jsfdata->code ?? '')}}"data-validate-field="code" placeholder="Postal Code">
                    @error('code')<p class="text-danger">{{ $message }}</p>@enderror
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    Postal City:<br>Şehir<span class="text-danger">*</span>
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input id="address_4" class="form-control @error('city') is-invalid @enderror" name="city"  value="{{old('city', $jsfdata->city ?? '')}}"data-validate-field="city" placeholder="Postal city">
                    @error('city')<p class="text-danger">{{ $message }}</p>@enderror
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    Country:<br>Ülke<span class="text-danger">*</span>
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                <input id="address_5" class="form-control @error('country') is-invalid @enderror" name="country" value="{{old('city', $jsfdata->country ?? '')}}"   data-validate-field="country" placeholder="Postal Country">
                @error('country')
                    <p class="text-danger">{{ $message }}</p>
                @enderror
                </div>
            </div>
        </div>
        <h6 class="text-center mt-2 box-border">Additional Affiliate(s) that will also register <br>Kayıt Ettirecek Bağlı Şirket(ler)</h6>
            <div class="row" style="padding: 10px;">
                <div class="col-md-6">
                    <div class="form-group">
                    Legal Entity Name (if applicable):<br>Tüzel Kişilik Adı (geçerli ise)
                    </div>
                </div>
                <div class="col-md-6">
                    <div class="form-group">
                        <input type="text" name="rc_l_entity" class="form-control "  value="{{old('rc_l_entity', $jsfdata->rc_l_entity ?? '')}}" placeholder="Legal Entity name">
                    </div>
                </div>
                <!-- <div class="col-md-6">
                    <div class="form-group">
                        UUID:
                    </div>
                </div>
                    <div class="col-md-6">
                    <div class="form-group">
                        <input type="text" name="rc_uuid"  class="form-control" value="{{old('rc_uuid', $jsfdata->rc_uuid ?? '')}}"  placeholder="UUID">
                        <span><b>(if applicable)</b></span>
                    </div> -->
                    <!-- </div> -->
            </div>
            
            <h6 class="text-center mt-2 box-border">Registrant Contact Details <br>Kayıt Ettirenin İletişim Bilgileri</h6>
            <div class="row" style="padding:10px">
                <div class="col-md-6">
                    <div class="form-group">
                    Contact Person:<br>İletişim Kişisi<span class="text-danger">*</span>
                    </div>
                </div>
                <div class="col-md-6">
                    <div class="form-group">
                        <input type="text" name="contact_person" class="form-control @error('contact_person') is-invalid @enderror" data-validate-field="contact_person" value="{{old('contact_person')}}" placeholder="Contact Person">
                        @error('contact_person')
                            <p class="text-danger">{{ $message }}</p>
                        @enderror
                        
                    </div>
                </div>
                <div class="col-md-6">
                    <div class="form-group">
                    E-mail address:<br>E-posta Adresi<span class="text-danger">*</span>
                    </div>
                </div>
                <div class="col-md-6">
                    <div class="form-group">
                        <input type="text" name="e_mail"  class="form-control @error('e_mail') is-invalid @enderror" data-validate-field="e_mail" placeholder="E-mail address" value="{{old('e_mail')}}">
                        @error('e_mail')
                        <p class="text-danger">{{ $message }}</p>
                        @enderror
                    </div>
                </div>
                <div class="col-md-6">
                    <div class="form-group">
                    Telephone:<br>Telefon<span class="text-danger">*</span>
                    </div>
                </div>
                <div class="col-md-6">
                    <div class="form-group">
                        <input type="text" name="telephone"  class="form-control  @error('telephone') is-invalid @enderror" data-validate-field="telephone" placeholder="Telephone" value="{{old('telephone')}}">
                        @error('telephone')
                        <p class="text-danger">{{ $message }}</p>
                        @enderror
                    </div>
                </div>
        </div>
        <div style="text-align:center;">
            <p class="text-danger"><input id="toshipping_checkbox" type="checkbox" name="check1"  @if(old('check1')) checked @endif style="margin: 3px;">Check this box if Registrant Company Address and billing address are the same.</p>
        </div>
        <h6 class="text-center mt-2 box-border" >Registrant Billing Details<br> (Kayıt Ettirenin Fatura Bilgileri)</h6>
        <div class="row" style="padding:10px">
            <div class="col-md-6">
                <div class="form-group">
                Tax Number<br>Vergi Kimlik No:<span class="text-danger">*</span>
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input type="text" name="vat" class="form-control @error('vat') is-invalid @enderror" data-validate-field="vat" placeholder="VAT number / TAX number" value="{{old('vat')}}">
                    @error('vat')
                        <p class="text-danger">{{ $message }}</p>
                    @enderror
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                Tax Office:<br>Vergi Dairesi:<span class="text-danger">*</span>
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input type="text" name="tax_office" class="form-control @error('tax_office') is-invalid @enderror" data-validate-field="tax_office" placeholder="TAX Office" value="{{old('tax_office')}}">
                    @error('tax_office')
                        <p class="text-danger">{{ $message }}</p>
                    @enderror
                </div>
            </div>
            
            <div class="col-md-6">
                <div class="form-group">
                    Billing Company Name:<br>Fatura Edilen Firma:<span class="text-danger">*</span>
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input id="shipping_address_1" type="text" name="billing_company" class="form-control @error('billing_company') is-invalid @enderror" data-validate-field="billing_company" placeholder="Billing Company Name" value="{{old('billing_company')}}">
                    @error('billing_company')
                        <p class="text-danger">{{ $message }}</p>
                    @enderror
                    <span><b>(if diffrent from above)</b></span>
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                Billing Address:<br>Fatura Adresi:
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input id="shipping_address_2" type="text" name="billing_address" class="form-control @error('billing_address') is-invalid @enderror" placeholder="Billing Address" value="{{old('billing_address')}}">
                    @error('billing_address')
                        <p class="text-danger">{{ $message }}</p>
                    @enderror
                    <span><b>(if diffrent from above)</b></span>
                </div>
            </div>
            <div class="col-md-6">
                    <div class="form-group">
                    Postal Code:<br>Posta Kodu

                    </div>
                </div>
                <div class="col-md-6">
                    <div class="form-group">
                    <input id="shipping_address_3" class="form-control" name="postal_code" placeholder="Postal Code" value="{{old('postal_code')}}">

                    <span><b>(if diffrent from above)</b></span>
                    </div>
                </div>
                <div class="col-md-6">
                    <div class="form-group">
                    Postal City:<br>Şehir
                    </div>
                </div>
                <div class="col-md-6">
                    <div class="form-group">
                    <input id="shipping_address_4" class="form-control" name="rc_city" placeholder="Postal City" value="{{old('rc_city')}}">
                    <span><b>(if diffrent from above)</b></span>
                    </div>
                </div>
                <div class="col-md-6">
                    <div class="form-group">
                    Country:<br>Ülke
                    </div>
                </div>
                <div class="col-md-6">
                    <div class="form-group">
                    <input id="shipping_address_5" class="form-control" name="rc_country" placeholder="Country" value="{{old('rc_country')}}">
                    <span><b>(if diffrent from above)</b></span>
                    </div>
                </div>
                <div class="col-md-6">
                    <div class="form-group">
                    Additional required payment data(e.g. Purchase order if required):<br>İlave gerekli ödeme verisi (gerekliyse satınalma emri)
                    </div>
                </div>
                <div class="col-md-6">
                    <div class="form-group">
                    <input class="form-control" name="additional_data" placeholder="Additional required payment data" value="{{old('additional_data')}}">
                    <span><b>(if diffrent from above)</b></span>
                    </div>
                </div>
                <div class="col-md-6">
                    <div class="form-group">
                        Environmental Identity Number (if different from above)<br>Çevre Kimlik Numarası/ÇKN (eğer yukarıdakinden farklıysa)
                    </div>
                </div>
                <div class="col-md-6">
                    <div class="form-group">
                    <input id="shipping_address_6" class="form-control" name="rb_uuid" placeholder="UUID" value="{{old('rb_uuid')}}">
                    
                    </div>
                </div>

        </div>
        <h6 class="text-center mt-2 box-border" >Registrant Bank Account Details <br> (Kayıt Ettiren Banka Hesap Bilgileri)</h6>
        <div class="row" style="padding:10px">
            <div class="col-md-6">
                <div class="form-group">IBAN:</div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input type="text" name="iban" class="form-control" placeholder="IBAN" value="{{old('iban')}}">
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">Account Number<br>Hesap Numarası</div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input type="text" name="routing_num" class="form-control" placeholder="Account Number" value="{{old('routing_num')}}">
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">Bank Name:<br>Banka Adı</div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input type="text" name="bank_name" class="form-control" placeholder="Bank Name" value="{{old('bank_name')}}">
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">BIC/SWIFT Code:<br>BIC/SWIFT Kodu:</div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input type="text" name="bic" class="form-control" placeholder="BIC/SWIFT Code" value="{{old('bic')}}">
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">Payment Method:<br>Ödeme Yöntemi</div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input type="text" name="payment_method" class="form-control" placeholder="Payment Method" value="{{old('payment_method')}}">
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">Description to be added(if required):<br>Açıklama(Gerekli ise)</div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input type="text" name="description" class="form-control" placeholder="Description" value="{{old('description')}}">
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">Additional Required payment data(if required):<br>
(Gerekli ise) ilave gerekli ödeme verisi
</div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input type="text" name="addtitional_requirement" class="form-control" placeholder="Additional Required  payment data" value="{{old('addtitional_requirement')}}">
                </div>
            </div>
        </div>
      
        <h6 class="text-center mt-2 box-border" >Inputs for preparing the SIEF Agreement:<br> MBDF Sözleşmesi için Girdiler</h6>
        <div class="row" style="padding:10px">
            <div class="col-md-6">
                <div class="form-group">
                    <label>Signing Authority (İmzalayan Makam):</label>
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input type="text" name="signing_person" class="form-control" placeholder="Signing Authority" value="{{old('signing_person')}}">
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <label>Function/Title (Ünvan):</label>
                </div>
            </div>
            <div class="col-md-6">
                <div class="form-group">
                    <input type="text" name="function" class="form-control" placeholder="Function/Title" value="{{old('function')}}">
                </div>
            </div>
        </div>
        
        
        <div class="row" style="padding:10px">
        <p><b>Scope of registration & dossier type (Madde Tonaj Aralığı&Dosya Tipi)<span class="text-danger">*</span>:</b></p>
            @if($mainsearchData->CAS_Registry_No =="79-11-8")
            <div class="col-md-6">
                <div class="form-group">
                    <input type="radio" name="scope" value="Transported Isolated Intermediate 1-1000 t/a" data-validate-field="scope"