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