Nature du sinistre
Responsabilité du conducteur
Nature du sinistre
Responsabilité du conducteur
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
.row
.col-md-4.col-8
label Date du sinistre
label.label-sub (au format MM/AAAA)
.form-date.form-date-lointaine
input(type='month')
.form-group(role="radiogroup" aria-labelledby="radio-details-info")
p#radio-details-info.field-label Nature du sinistre
.field-item.form-check.inline
.row
.col-md-3.col-6
.item
input(type='radio' name='name-details-info')#radio-details-info-1
label(for='radio-details-info-1')
span Collision
.col-md-3.col-6
.item
input(type='radio' name='name-details-info')#radio-details-info-2
label(for='radio-details-info-2')
span Autre
.form-group(role="radiogroup" aria-labelledby="radio-details-info-1")
p#radio-details-info-1.field-label Responsabilité du conducteur
.field-item.form-check.inline
.row
.col-md-3.col-6
.item
input(type='radio' name='name-details-info-1')#radio-details-info-1-1
label(for='radio-details-info-1-1')
span Entière
.col-md-3.col-6
.item
input(type='radio' name='name-details-info-1')#radio-details-info-1-2
label(for='radio-details-info-1-2')
span Partielle
.col-md-3.col-6
.item
input(type='radio' name='name-details-info-1')#radio-details-info-1-2
label(for='radio-details-info-1-2')
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
.row
.col-md-4.col-8
label Date du sinistre
label.label-sub (au format MM/AAAA)
.form-date.form-date-lointaine
input(type='month')
.form-group(role="radiogroup" aria-labelledby="radio-details-info-2")
p#radio-details-info-2.field-label Nature du sinistre
.field-item.form-check.inline
.row
.col-md-3.col-6
.item
input(type='radio' name='name-details-info-2')#radio-details-info-2-1
label(for='radio-details-info-2-1')
span Collision
.col-md-3.col-6
.item
input(type='radio' name='name-details-info-2')#radio-details-info-2-2
label(for='radio-details-info-2-2')
span Autre
.form-group(role="radiogroup" aria-labelledby="radio-details-info-1")
p#radio-details-info-1.field-label Responsabilité du conducteur
.field-item.form-check.inline
.row
.col-md-3.col-6
.item
input(type='radio' name='name-details-info-2-1')#radio-details-info-2-1
label(for='radio-details-info-2-1')
span Entière
.col-md-3.col-6
.item
input(type='radio' name='name-details-info-2-1')#radio-details-info-2-2
label(for='radio-details-info-2-2')
span Partielle
.col-md-3.col-6
.item
input(type='radio' name='name-details-info-2-1')#radio-details-info-2-2
label(for='radio-details-info-2-2')
span Aucune