
            <div class="row">
                <div class="col-md-12">
                    <div class="portlet box grey-cascade">
                        <div class="portlet-title">
                            <div class="caption">
                                <i class="fa fa-gift"></i>Purchase UNA
                            </div>
                        </div>
                        <div class="portlet-body form">
                            <!-- BEGIN FORM-->
                            <form id="save_add_una" class="form-horizontal" method="POST" enctype="multipart/form-data">
                                <div class="form-body">
                                    <div class="form-group">
                                        <label class="control-label col-md-3">Date</label>
                                        <div class="col-md-3">
                                            <input class="form-control form-control-inline input-medium date-picker" size="16" type="text" data-date-format=dd-mm-yyyy name="invoice_date" value="<?php echo date('d-m-Y') ?>"/>
                                        </div>
                                    </div>
                                    <div class="form-group">
                                        <label class="control-label col-md-3">UNA Creditor</label>
                                        <div class="col-md-3">
                                            <select class="form-control input-medium select2me" data-placeholder="Select..." id="una_add_creditor" name="select_creditor">
                                                <option value="">Select Creditor</option>
                                                <option value="Add New Creditor">Add New Creditor</option>
                                                <?php
                                                    $creditors = $this->admin_db->get_creditors_to_add_una();
                                                    foreach ($creditors as $creditor) {
                                                        $sel = '';
                                                ?>

                                                <option value="<?php echo $creditor['id']; ?>" <?php echo $sel; ?> item_id="<?php echo $creditor['contact_number']; ?>"><?php echo $creditor['creditor_name']; ?></option>

                                                <?php } ?>
                                            </select>
                                        </div>
                                    </div>
                                    <div id="div_creditor_details" class="hidden">
                                        <div class="form-group">
                                            <label class="control-label col-md-3">Mobile Number</label>
                                            <div class="col-md-3">
                                                <input class="form-control" size="16" type="text" id="txt_creditor_contact_num" disabled="disabled"/>
                                            </div>
                                        </div>
                                        <div class="form-group">
                                            <label class="control-label col-md-3">Contact Number</label>
                                            <div class="col-md-3">
                                                <input class="form-control" size="16" type="text" id="txt_creditor_tel_num" disabled="disabled"/>
                                            </div>
                                        </div>
                                    </div>
                                    <div id="add_new_creditor" class="hidden">
                                        <div class="form-group">
                                            <label class="control-label col-md-3">Creditor Name</label>
                                            <div class="col-md-3">
                                                <input type="text" name="creditor_name" id="creditor_name" placeholder="Shafraz & Co." class="form-control"/>
                                            </div>
                                        </div>
                                        <div class="form-group">
                                            <label class="control-label col-md-3">Mobile Number</label>
                                            <div class="col-md-3">
                                                <input type="number" name="contact_num" id="contact_num" placeholder="0777123456" class="form-control"/>
                                            </div>
                                        </div>
                                        <div class="form-group">
                                            <label class="control-label col-md-3">Telephone Number</label>
                                            <div class="col-md-3">
                                                <input type="number" name="tel_number" id="tel_number" placeholder="0342235122" class="form-control"/>
                                            </div>
                                        </div>
                                        <div class="row form-group">
                                            <label class="col-md-3 control-label pull-left">Creditor Type</label>
                                            <div class="col-md-3">
                                                <select class="form-control" name="creditor_type" id="creditor_type">
                                                    <option value="">Select Creditor Type</option>
                                                    <option value="UNA Creditor">UNA Creditor</option>
                                                    <option value="UNA & Normal Creditor">UNA & Normal Creditor</option>
                                                </select>
                                            </div>
                                        </div>
                                    </div>
                                    <div class="form-group">
                                        <label class="control-label col-md-3">UNA Amount (AED)</label>
                                        <div class="col-md-3">
                                            <div class="input-group input-small">
                                                <span class="input-group-addon">
                                                    AED 
                                                </span>
                                                <input class="form-control input-small" type="number" id="una_amount" placeholder="0.00" name="una_amount"/>
                                            </div>
                                        </div>
                                    </div>
                                    <div class="form-group">
                                        <label class="control-label col-md-3">UNA Rate</label>
                                        <div class="col-md-3">
                                            <div class="input-group input-small">
                                                <span class="input-group-addon">
                                                    Rs. 
                                                </span>
                                                <input class="form-control input-small" type="number" id="una_rate" name="una_rate" placeholder="0.00"/>
                                            </div>
                                        </div>
                                    </div>
                                    <div class="form-group">
                                        <label class="control-label col-md-3">LKR Amount</label>
                                        <div class="col-md-3">
                                            <div class="control-label pull-left" id="div_lkr_amount">Rs. 0.00</div>
                                            <input type="hidden" name="lkr_amount" id="lkr_amount" placeholder="0.00" class="form-control"/>
                                        </div>
                                    </div>
                                    <div class="form-group">
                                        <label class="control-label col-md-3">Recipient</label>
                                        <div class="col-md-3">
                                            <input type="text" name="recipient" id="recipient" placeholder="" class="form-control"/>
                                        </div>
                                    </div>
                                    <div class="form-group">
                                        <label class="control-label col-md-3">Remarks</label>
                                        <div class="col-md-3">
                                            <textarea name="remarks" id="remarks" class="form-control"></textarea>
                                        </div>
                                    </div>
                                    <div class="form-actions fluid">
                                        <div class="row">
                                            <div class="col-md-12">
                                                <div class="col-md-offset-3 col-md-9">
                                                    <button type="submit" class="btn green">
                                                        Submit <i class="fa fa-check"></i>
                                                    </button>
                                                    <button type="button" class="btn default">Cancel</button>
                                                </div>
                                            </div>
                                        </div>
                                    </div>
                                </div>
                            </form>
                        </div>
                    </div>
                </div> 
            </div>
            <!-- END DASHBOARD STATS -->
        </div>
    </div>
    <!-- END CONTENT -->
</div>
<!-- END CONTAINER -->
