@if(session()->has('success'))

{{ session()->get('success') }}

@endif @if(session()->has('error'))

{{ session()->get('error') }}

@endif

New Log Saved successfuly.

New Log Saved unsuccessfuly.

type == "Supervisor") {{ url('/adminHome') }} @else {{ url('/home') }} @endif">
@csrf
Motor Accident Claim Form
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Insured & Broker Details
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Vehicle Details
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Is the vehilce subject to a Hire Purchase, Credit or Leasing Agreement? HPCLA == "Yes") checked @endif name="HPCLA" class="signCheckbox_yes" id="HPCLA_yes" value="Yes"> HPCLA == "No") checked @endif value="No" name="HPCLA" class="signCheckbox_no" id="HPCLA_no">
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Driver
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Is the vehilce subject to a Hire Purchase, Credit or Leasing Agreement? HirePurchase == "Yes") checked @endif name="HPCLA2" class="signCheckbox_yes" id="HPCLA_yes2" value="Yes"> HirePurchase == "No") checked @endif value="No" name="HPCLA2" class="signCheckbox_no" id="HPCLA_no2">
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Endorsements Endorsements == "Insured") checked @endif name="HPCLA3" class="signCheckbox_insured" id="HPCLAinsured" value="Insured"> Endorsements == "Spouse") checked @endif name="HPCLA3" class="signCheckbox_spouse" id="HPCLAspouse" value="Spouse"> Endorsements == "Other") checked @endif value="Other" name="HPCLA3" class="signCheckbox_other" id="HPCLA_no3">
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Was the driver driving with your permission? Permission == "Not Applicable") checked @endif name="HPCLA4" class="signCheckbox_na" id="HPCLA_yes4_na" value="Not Applicable"> Permission == "No") checked @endif name="HPCLA4" class="signCheckbox_no" id="HPCLA_yes4_yes" value="No"> Permission == "Yes") checked @endif value="Yes" name="HPCLA4" class="signCheckbox_yes" id="HPCLA_no4_no">
Was the driver in your empoly? Employee == "Not Applicable") checked @endif name="HPCLA5" class="signCheckbox_na" id="HPCLA_na5" value="Not Applicable"> Employee == "No") checked @endif name="HPCLA5" class="signCheckbox_no" id="HPCLA_yes5" value="No"> Employee == "Yes") checked @endif value="Yes" name="HPCLA5" class="signCheckbox_yes" id="HPCLA_no5">
Does the driver have any motor vehicle insurance on their own vehicle? Motor_insurance == "Not Applicable") checked @endif name="HPCLA6" class="signCheckbox_na" id="HPCLA_na6" value="Not Applicable"> Motor_insurance == "No") checked @endif name="HPCLA6" class="signCheckbox_no" id="HPCLA_yes6" value="No"> Motor_insurance == "Yes") checked @endif value="Yes" name="HPCLA6" class="signCheckbox_yes" id="HPCLA_no6">
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@if(count($injured_persons) > 0) @for($j = 0; $j < count($injured_persons); $j++)
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@endfor @else
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@endif
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Are they employees? Empolyees == "No") checked @endif name="HPCLA7" class="signCheckbox_no" id="HPCLA_yes7" value="No"> Empolyees == "Yes") checked @endif value="Yes" name="HPCLA7" class="signCheckbox_yes" id="HPCLA_no7">
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Motor Accident Claim Form
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Third-Party Injuries (Persons injured other than in the insured vehicle)
@if(count($injured_third_party) > 0) @for($j = 0; $j < count($injured_third_party); $j++)
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@endfor @else
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@endif
Third-Party information/Vehicle or property damage (This is compulsory for recovery purposes) @for($j = 0; $j < count($third_party_property_damage); $j++)
Vehicle {{$j +1}}
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Insurance Details
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@endfor Damage To Property(Non-Motor)
@if(count($Damage_to_property) > 0) @for($j = 0; $j < count($Damage_to_property); $j++)
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@endfor @else
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@endif
Witnesses(This section is compulsory for recovery purposes)
@if(count($witnesses) > 0) @for($j = 0; $j < count($witnesses); $j++)
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@endfor @else
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@endif
Accident Details
Damage
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Estimate for the repairs or attach qoautation
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Motor Accident Claim Form
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Speed
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Conditions
Weather weather == "Dry") checked @endif name="weather" class="signCheckboxDary" id="weatherDry" value="Dry"> weather == "Wet") checked @endif name="weather" class="signCheckboxWet" id="weatherWet" value="Wet">
Visibility Visibility == "Poor") checked @endif name="Visibility" class="signCheckboxPoor" id="VisibilityPoor" value="Poor"> Visibility == "Good") checked @endif name="Visibility" class="signCheckboxGood" id="VisibilityGood" value="Good">
Road Surface Road_Surface == "Tar") checked @endif name="Road_Surface" class="signCheckboxTar" id="Road_SurfaceTar" value="Tar"> Road_Surface == "Dirt") checked @endif name="Road_Surface" class="signCheckboxDirt" id="Road_SurfaceDirt" value="Dirt">
Street Lighting Street_Lighting == "Yes") checked @endif name="Street_Lighting" class="signCheckboxSLYes" id="Street_LightingYes" value="Yes"> Street_Lighting == "No") checked @endif name="Street_Lighting" class="signCheckboxSLNo" id="Street_LightingNo" value="No">
Width of Road Width_of_Road == "Single") checked @endif name="Width_of_Road" class="signCheckboxSingle" id="Width_of_RoadSingle" value="Single"> Width_of_Road == "Multiple") checked @endif name="Width_of_Road" class="signCheckboxMulitple" id="Width_of_RoadMultiple" value="Multiple">
POLICE DETAILS
Did the police attend the scene? Police_attended_scene == "Yes") checked @endif name="dtpats" class="signCheckbox_yes" id="dtpats_yes" value="Yes"> Police_attended_scene == "No") checked @endif name="dtpats" class="signCheckbox_no" id="dtpats_no" value="No">
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Was the driver tested for drugs Drug_test == "Yes") checked @endif> Drug_test == "No") checked @endif>