<nav class="large-3 medium-4 columns" id="actions-sidebar">
    <?= $this->element('admin_sidebar') ?>
</nav>
<div class="customers form large-9 medium-8 columns content">


    <?= $this->Form->create($fds) ?>
    <fieldset class="fieldset2">

        <legend><?= __('Add ShriRam FD Data') ?></legend>
        <div class="addmenu-col">

        <div class="column-box 18_fd">
            <?php
            echo $this->Form->input('app_fdr_no', ['id'=>'18_app_fdr_no','class' => __('add-column'),'label' => ['text' => __('Certificate No: ')],'type'=>'text']);

            echo $this->Form->input('ar_no', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('SFS TR No: ')],'type'=>'text']);

            echo $this->Form->input('cert_state', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('Cert Status: ')],'type'=>'text']);

            echo $this->Form->input('customer_name', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('Customer Name: ')],'type'=>'text']);

            echo $this->Form->input('add1', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('House No. & Street Name: ')],'type'=>'text']);

            echo $this->Form->input('add2', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('Building / Society Name: ')],'type'=>'text']);

            echo $this->Form->input('add3', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('Area: ')],'type'=>'text']);

            echo $this->Form->input('city', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('	City: ')],'type'=>'text']);
            
            echo $this->Form->input('region', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('State: ')],'type'=>'text']);

            echo $this->Form->input('pincode', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('Pincode: ')],'type'=>'text']);

            echo $this->Form->input('phoneno', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('Phone Number: ')],'type'=>'text']);

            echo $this->Form->input('mobileno', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('Mobile Number: ')],'type'=>'text']);

            echo $this->Form->input('email', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('E-Mail ID: ')],'type'=>'text']);

            echo $this->Form->input('gender', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('Gender: ')],'type'=>'text']);

            echo $this->Form->input('date_of_birth', ['id'=>'','class' => __('datepicker add-column'),'label' => ['text' => __('Date Of Birth: ')],'type'=>'text']);

            echo $this->Form->input('pan_no', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('PAN Number: ')],'type'=>'text']);

            echo $this->Form->input('tran_type', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('Business Name: ')],'type'=>'text']);

            echo $this->Form->input('scheme_type_desc', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('Scheme Type Desc.: ')],'type'=>'text']);

            echo $this->Form->input('txn_type', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('Transaction Type: ')],'type'=>'text']);

            echo $this->Form->input('paid_amt', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('Receipt Amount: ')],'type'=>'text']);

            echo $this->Form->input('period', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('Certificate Term: ')],'type'=>'text']);

            echo $this->Form->input('txn_date', ['id'=>'','class' => __('datepicker add-column'),'label' => ['text' => __('Cert Issue Date: ')],'type'=>'text']);

            echo $this->Form->input('investment_amount', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('Investment Amount: ')],'type'=>'text']);

            echo $this->Form->input('dep_amt', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('SFS APE Amount: ')],'type'=>'text']);

            echo $this->Form->input('maturity_amt', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('Maturity Amount: ')],'type'=>'text']);

            echo $this->Form->input('maturity_date', ['id'=>'','class' => __('datepicker add-column'),'label' => ['text' => __('Maturity Date: ')],'type'=>'text']);

            echo $this->Form->input('broker_code', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('BA/CP Code: ')],'type'=>'text']);

            echo $this->Form->input('broker_name', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('BA/CP Name: ')],'type'=>'text']);

            echo $this->Form->input('broker_mobile_no', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('BA/CP Mobile Number: ')],'type'=>'text']);

            echo $this->Form->input('broker_email_id', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('BA/CP Email ID: ')],'type'=>'text']);

            echo $this->Form->input('broker_reporting_name', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('BA/CP Reporting Name: ')],'type'=>'text']);

            echo $this->Form->input('broker_reporting_email_id', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('BA/CP Reporting Email ID: ')],'type'=>'text']);

            echo $this->Form->input('broker_reporting_mobile_no', ['id'=>'','class' => __('add-column'),'label' => ['text' => __('BA/CP Reporting Mobile No: ')],'type'=>'text']);
        ?></div>

        </div>
    </fieldset>
    <div class="add-button">
        <?= $this->Form->button(__('Submit'),['class' => 'green-btn']) ?>
    </div>
    <div class="btn-link"><input type="button" value="Back" onclick="window.history.back()"
            class="green-btn new_back" /> </div>
    <?= $this->Form->end() ?>
</div>
<script>
$(document).ready(function() {
    $(".datepicker").datepicker({
        dateFormat: 'd/m/yy',
        changeMonth: true,
        changeYear: true,
        yearRange: '-100:+100'
    });
});
</script>