Sinistre 1

au format MM/AAAA

Nature du sinistre

Responsabilité du conducteur

Sinistre 1

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