<div class="modal fade bs-modal-lg" id="form-pay" tabindex="-1" role="dialog" aria-hidden="true">
	<div class="modal-dialog modal-lg">
		<div class="modal-content">

			<div class="modal-header">
				<button type="button" class="close" data-dismiss="modal" aria-hidden="true"></button>
				<h4 class="modal-title">Payment</h4>
			</div>
			<div id="_div_paymentPopup" style="display:none;" class="alert alert-block alert-danger fade in">
				<h4 class="alert-heading">Warning!</h4>
				<p id="_msg_paymentPopup"></p>
			</div>

			<form class="form-horizontal" role="form" action="<?php echo e(route('submit_payment_data')); ?>" method="post">
				<?php echo csrf_field(); ?>
				<div class="row">
					<br>
					<div class="col-md-12">
						<input type="hidden" name="pid" id="pid">
						<input type="hidden" name="loan_id" id="loan_id">
						<div class="col-md-5 col-md-offset-1">
							<div class="form-group">
								<label class="col-md-5 required control-label">Principle </label>
								<div class="col-md-7">
									<div class="input-group">
										<span class="input-group-addon"><i class=""></i>$</span>
										<input type="text" name="principle" class="form-control" id="principle" readonly="readonly">
									</div>
								</div>
							</div>
							<div class="form-group">
								<label class="col-md-5 required control-label">Interest </label>
								<div class="col-md-7">
									<div class="input-group">
										<span class="input-group-addon"><i class=""></i>$</span>
										<input type="text" name="interest" class="form-control" id="interest" readonly="readonly">
									</div>
								</div>
							</div>
							<div class="form-group">
								<label class="col-md-5 required control-label">Payment</label>
								<div class="col-md-7">
									<div class="input-group">
										<span class="input-group-addon"><i class=""></i>$</span>
										<input type="text" name="payment" class="form-control allownumericwithdecimal" id="payment">
									</div>
								</div>
							</div>
							<!-- <div class="form-group">
								<label class="col-md-4 control-label">Extra Amount </label>
								<div class="col-md-8">
									<div class="input-group">
										<span class="input-group-addon"><i class=""></i>$</span>
										<input type="text" name="extra_amount" class="form-control" id="extra_amount">
									</div>
								</div>
							</div> -->
							<div class="form-group">
								<label class="col-md-5 control-label">Reference </label>
								<div class="col-md-7">
									<input type="text" name="reference" class="form-control form-control" id="reference">
								</div>
							</div>
							<div class="form-group" style="display: none">
								<label class="col-md-5 required control-label">Pay </label>
								<div class="col-md-7">
									<div class="input-group">
										<span class="input-group-addon"><i class=""></i>$</span>
										<input type="text" name="pay" class="form-control number-only" id="pay" readonly="readonly">
									</div>
								</div>
							</div>
							<div class="form-group" id="deposit-schedule-payment-method-from">
								
							</div>
							<div class="form-group" style="display: none;">
								<label class="col-md-5 required control-label">Condition </label>
								<div class="col-md-7">
									<select name="condition" id="condition" class="form-control select2" data-placeholder="Select..." tabindex="-1" aria-hidden="true" readonly="readonly">
										<option value=""></option>
										<option value="1" selected="">None Payment</option>
										<option value="2">Next Payment</option>
									</select>
								</div>
							</div>
							<div class="form-group">
								<label class="col-md-5  control-label">Remark </label>
								<div class="col-md-7">
									<textarea class="form-control  " rows="3" name="remark" placeholder="" id="remark" value=""></textarea>
								</div>
							</div>
						</div>
						<div class="col-md-5">
							<div class="form-group">
								<label class="col-md-5 control-label">Penalty </label>
								<div class="col-md-7">
									<div class="input-group">
										<span class="input-group-addon"><i class=""></i>$</span>
										<input type="text" name="penalty" class="form-control number-only" id="penalty">
									</div>
								</div>
							</div>
							<div class="form-group">
								<label class="col-md-5  control-label">Option</label>
								<div class="col-md-7">
									<select name="penalty_condition" id="penalty_option" class="select2 form-control">
										<option value=""> Please Select </option>
										<option value="1">Pay Now</option>
										<option value="2">Next Step</option>
										<option value="3">Wave</option>
									</select>
								</div>
							</div>

							<div class="form-group">
								<label class="col-md-5 required control-label">Date </label>
								<div class="col-md-7">
									<input type="text" name="date_pay" class="form-control form-control date_picker" value="<?php echo e(date('d-m-Y')); ?>" id="date">
								</div>
							</div>
							<div class="form-group" id="bank-list-condition">
								<label class="required col-md-5 control-label">Payment Method</label>
								<div class="col-md-7">
									<?php echo Form::select('bank_id',['11001'=>'Cash On Hand','11002'=>'Cash In Bank','11013'=>'Cheque'], null, ['id' => 'bank-list', 'class' => 'form-control payment-schedule-type-payment select2','required']); ?>

								</div>
							</div>
							<div class="form-group" id="deposit-schedule-payment-method-to">
								
                            </div>
							<div class="form-group fee-charge" style="display: none">
								<label for="" class="col-md-5 control-label">Fee Charge</label>
								<div class="col-md-7">
									<div class="input-group">
										<span class="input-group-addon"><i class=""></i>$</span>
										<input type="text" name="fee" class="form-control" id="fee-charge">
									</div>
								</div>
							</div>
						</div>
					</div>
					
				</div>
				<div class="modal-footer">
					<button type="button" class="button_danger" data-dismiss="modal">Close</button>
					<button type="button" class="button_success" id="btn-submit" onclick="save_payment(this)">Payment</button>
				</div>
			</form>
		</div>
		<!-- /.modal-content -->
	</div>
	<!-- /.modal-dialog -->
</div>