au format MM/AAAA
Nature du sinistre
Responsabilité du conducteur
au format MM/AAAA
Nature du sinistre
Responsabilité du conducteur
au format MM/AAAA
Nature du sinistre
Responsabilité du conducteur
HTML
PUG
.form-details-info
.details-info
header
| Sinistre 1
button.chip.-icon.-icon-with-text-md
i.maificon.maificon-trash(aria-hidden="true")
span Supprimer
.content
.form-group-version2
.wrapper-label
.field-label
label(for="details-info") Date
p.help-input au format MM/AAAA
.row
.col-md-4
.field-item.-datebox.-close-date
input#details-info(type='text', placeholder='__/_____')
.form-group-version2(role="radiogroup" aria-labelledby="details-info-label")
.wrapper-label
.field-label
p#details-info-label Nature du sinistre
.field-item.-form-check-version2.-horizontal
.row
.col-md-3.col-6
.item
input(type='radio' name='details-info-radio')#details-info-1
label(for='details-info-1')
span.wrapper-content
span Collision
.col-md-3.col-6
.item
input(type='radio' name='details-info-radio')#details-info-2
label(for='details-info-2')
span.wrapper-content
span Autre
.form-group-version2(role="radiogroup" aria-labelledby="details-info-label-1")
.wrapper-label
.field-label
p#details-info-label-1 Responsabilité du conducteur
.field-item.-form-check-version2.-horizontal
.row
.col-md-3.col-6
.item
input(type='radio' name='details-info-radio-1')#details-info-1-1
label(for='details-info-1-1')
span.wrapper-content
span Entière
.col-md-3.col-6
.item
input(type='radio' name='details-info-radio-1')#details-info-1-2
label(for='details-info-1-2')
span.wrapper-content
span Partielle
.col-md-3.col-6
.item
input(type='radio' name='details-info-radio')#details-info-1-3
label(for='details-info-1-3')
span.wrapper-content
span Aucune
.form-details-info.has-error
.details-info
header
| Sinistre 1
button.chip.-icon.-icon-with-text-md
i.maificon.maificon-trash(aria-hidden="true")
span Supprimer
.content
.form-group-version2.has-error
.wrapper-label
.field-label
label(for="details-info-2") Date
p.help-input au format MM/AAAA
.row
.col-md-4
.field-item.-datebox.-close-date
input#details-info-2(type='text', placeholder='__/_____')
.form-group-version2.has-error(role="radiogroup" aria-labelledby="details-info-label-2")
.wrapper-label
.field-label
p#details-info-label-2 Nature du sinistre
.field-item.-form-check-version2.-horizontal
.row
.col-md-3.col-6
.item
input(type='radio' name='details-info-radio-2')#details-info-2-1
label(for='details-info-2-1')
span.wrapper-content
span Collision
.col-md-3.col-6
.item
input(type='radio' name='details-info-radio-2')#details-info-2-2
label(for='details-info-2-2')
span.wrapper-content
span Autre
.form-group-version2.has-error(role="radiogroup" aria-labelledby="details-info-label-2-1")
.wrapper-label
.field-label
p#details-info-label-2-1 Responsabilité du conducteur
.field-item.-form-check-version2.-horizontal
.row
.col-md-3.col-6
.item
input(type='radio' name='details-info-radio-2-1')#details-info-2-1-1
label(for='details-info-2-1-1')
span.wrapper-content
span Entière
.col-md-3.col-6
.item
input(type='radio' name='details-info-radio-2-1')#details-info-2-1-2
label(for='details-info-2-1-2')
span.wrapper-content
span Partielle
.col-md-3.col-6
.item
input(type='radio' name='details-info-radio-2-1')#details-info-2-1-3
label(for='details-info-2-1-3')
span.wrapper-content
span Aucune