44 lines
1.5 KiB
Text
44 lines
1.5 KiB
Text
.col-xs-3.center
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%h3 Mes informations
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%p
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Les informations de bases
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%br
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vous concernant.
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.etape.etapes-informations.col-xs-9
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= form_for @facade.dossier, url: { controller: '/users/dossiers', action: :update } do |f|
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.row
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.col-xs-12.padding-left-30
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= f.hidden_field :id
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= f.fields_for :individual, @facade.individual do |ff|
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.form-group
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%label
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%h4
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Civilité
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= ff.select :gender, ['M.', 'Mme']
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.form-group
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%label
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%h4
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Nom *
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= ff.text_field :nom, { class: 'form-control', required: true }
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.form-group
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%label
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%h4
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Prénom *
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= ff.text_field :prenom, { class: 'form-control', required: true }
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.form-group
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%label
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%h4
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Date de naissance *
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= ff.date_field :birthdate, { value: @facade.individual.birthdate, class: 'form-control', placeholder: 'jj/mm/aaaa', required: true }
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%p
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%label{ style: 'font-weight: normal;' }
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= f.check_box :autorisation_donnees
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J'accepte <a href="https://tps.gitbooks.io/tps-documentation/content/conditions-generales-dutilisation.html" target="_blank">les CGU</a>.
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.row
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.col-xs-5.col-xs-5
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.col-xs-2.col-xs-2
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= f.submit 'Etape suivante', class: "action", id: 'etape_suivante'
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.col-xs-5.col-xs-5
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