@extends('layouts.agent') @section('styles') @endsection @section('content')
@csrf

Your Details

@if($errors->has('name'))
{{ $errors->first('name') }}
@endif
@if($errors->has('ic_number'))
{{ $errors->first('ic_number') }}
@endif
@if($errors->has('address'))
{{ $errors->first('address') }}
@endif
@if($errors->has('state_id'))
{{ $errors->first('state_id') }}
@endif
@if($errors->has('city_id'))
{{ $errors->first('city_id') }}
@endif
@if($errors->has('gender'))
{{ $errors->first('gender') }}
@endif
@if($errors->has('civil_status'))
{{ $errors->first('civil_status') }}
@endif
@if($errors->has('contact_number'))
{{ $errors->first('contact_number') }}
@endif
@if($errors->has('email'))
{{ $errors->first('email') }}
@endif
@if($errors->has('education_level'))
{{ $errors->first('education_level') }}
@endif
@if($errors->has('education_level_answer'))
{{ $errors->first('education_level_answer') }}
@endif
@if($errors->has('password'))
{{ $errors->first('password') }}
@endif
@if($errors->has('area_cities_cover'))
{{ $errors->first('area_cities_cover') }}
@endif
@if($errors->has('answer_question_1'))
{{ $errors->first('answer_question_1') }}
@endif
@if($errors->has('referral'))
{{ $errors->first('referral') }}
@endif

Please choose either IC or SSM to upload for verification purpose.

Accepted files : PDF, JPG, PNG (2MB file size is maximum)
Image preview...
@if($errors->has('upload_ic'))
{{ $errors->first('upload_ic') }}
@endif
Accepted files : PDF, JPG, PNG (2MB file size is maximum)
Image preview...
@if($errors->has('upload_ssm'))
{{ $errors->first('upload_ssm') }}
@endif

Customer Details

Customer Information
@if($errors->has('company_name'))
{{ $errors->first('company_name') }}
@endif
@if($errors->has('brn_ic_no'))
{{ $errors->first('brn_ic_no') }}
@endif
@if($errors->has('sst_reg_no'))
{{ $errors->first('sst_reg_no') }}
@endif
@if($errors->has('reg_address'))
{{ $errors->first('reg_address') }}
@endif
@if($errors->has('bus_address'))
{{ $errors->first('bus_address') }}
@endif
@if($errors->has('tel_no'))
{{ $errors->first('tel_no') }}
@endif
@if($errors->has('fax_no'))
{{ $errors->first('fax_no') }}
@endif
Contact Person Information for Customer Notification Purposes
@if($errors->has('contact_person_name'))
{{ $errors->first('contact_person_name') }}
@endif
@if($errors->has('designation'))
{{ $errors->first('designation') }}
@endif
@if($errors->has('email_address'))
{{ $errors->first('email_address') }}
@endif
@if($errors->has('contact_no'))
{{ $errors->first('contact_no') }}
@endif
Bank Information
@if($errors->has('bank_beneficiary_name'))
{{ $errors->first('bank_beneficiary_name') }}
@endif
@if($errors->has('bank_name'))
{{ $errors->first('bank_name') }}
@endif
@if($errors->has('bank_account_no'))
{{ $errors->first('bank_account_no') }}
@endif
Document for submission

Please enclose the following documents:

  • Photocopy of Certificate of Incorporation (Form 9)/ Business Registration Form.
  • Photocopy of Form 24, Form 44 and Form 49.

Selected files:

@endsection @section('scripts') @endsection