<link rel="modulepreload" as="script" href="https://carteverde.nldsite.com/laravel/build/assets/bootstrap-l0sNRNKZ.js" /><script type="module" src="https://carteverde.nldsite.com/laravel/build/assets/bootstrap-l0sNRNKZ.js"></script><link rel="preload" as="style" href="https://carteverde.nldsite.com/laravel/build/assets/app-DJkLWsE7.css" /><link rel="stylesheet" href="https://carteverde.nldsite.com/laravel/build/assets/app-DJkLWsE7.css" />

<style type="text/css">
  .input-box > img {
    right:1.25rem;
    bottom:1.125rem;
  }
</style>
<script type="text/javascript">
var alertMessageTranslations={
    'filled':'Значение обязательно.',
    'custom.invalid':'Неверные данные',
    'custom.valid_example':'Пример верных данных: ',
    '.':'.'
};
var csrfToken='bVyw4KvSzuRI1q7AKjyjlgTmb6NKABBdJnIMBPim';
var fetchRequestPrefix='https://carteverde.nldsite.com/laravel';
var fetchRequestLanguageCode='ru_RU';
</script>
<div class="calculator-block household-insurance-calculator">
<div class="calculator-header">
<ul class="nav nav-tabs" id="insuranceTabs" role="tablist">
  <li class="nav-item" role="presentation">
    <a class="nav-link active" id="asigurat-tab" data-bs-toggle="tab" href="#asigurat" role="tab" aria-controls="asigurat" aria-selected="true">1. Страхователь</a>
  </li>
  <li class="nav-item" id="confirmare-tab-top" role="presentation">
    <a class="nav-link" id="confirmare-tab" href="#confirmare" role="tab" aria-controls="confirmare" aria-selected="false">2. Подтверждение</a>
  </li>
</ul>
</div><div class="calculator-body">
  <link rel="modulepreload" as="script" href="https://carteverde.nldsite.com/laravel/build/assets/calculator-household-BKkr-PD5.js" /><link rel="modulepreload" as="script" href="https://carteverde.nldsite.com/laravel/build/assets/policy-submitters-nf9Gpqft2.js?v1" /><link rel="modulepreload" as="script" href="https://carteverde.nldsite.com/laravel/build/assets/set-minimal-date-nEdphS1Z.js" /><script type="module" src="https://carteverde.nldsite.com/laravel/build/assets/calculator-household-BKkr-PD5.js"></script>
<div class="tab-content" id="insuranceTabsContent">

        <!-- Asigurat Tab -->
        <div class="tab-pane fade show active" id="asigurat" role="tabpanel" aria-labelledby="asigurat-tab">
          <div class="d-flex flex-column" style="gap: 20px;">

            <form class="calculation-form submittable-block revalidatable"  data-mode="package_lookup" data-status="pending" data-next-action="calculation">
              <div class="d-flex flex-column" style="gap: 20px;" id="household-package-lookup">
  <input type="hidden" name="shipping_method_id" value="1"/>
  <input type="hidden" name="insurance_policy_type_id" value="8"/>
  <input type="hidden" name="premium" value="0"/>
  <input type="hidden" name="insurance_company_id" value="1"/>  
    <input type="hidden" name="apartment_house_type_id" value="1" />
  <pre style="display: none;">
/home/carte/laravel/storage/framework/views/637234ef02f1db0fe3983e066487e45f.php
Illuminate\View\ComponentAttributeBag Object
(
    [attributes:protected] =&gt; Array
        (
            [required] =&gt; 1
        )

)

</pre>
<div class="d-flex flex-column position-relative input-set ">
    <label class="fs-14 fw-bold" for="house-type-id-uniqid-689afc6a284c5">
  Тип недвижимости 
  
   <span style="color: #E60028">*</span>   </label>
    <div class="form-check-list flex-column flex-sm-row ">
    
            <div class="form-check">
      <input class="form-check-input " required  type="radio" name="house_type_id" id="house-type-id-uniqid-689afc6a283d6-1" value="1" >
      <label class="form-check-label" for="house-type-id-uniqid-689afc6a283d6-1">Квартира</label>
    </div>
            <div class="form-check">
      <input class="form-check-input " required  type="radio" name="house_type_id" id="house-type-id-uniqid-689afc6a283d6-2" value="2" >
      <label class="form-check-label" for="house-type-id-uniqid-689afc6a283d6-2">Дом</label>
    </div>
      </div>
  <p></p>
</div>
  <div class="d-flex flex-column position-relative input-box  p-0 m-0">
  <label class="fs-14 fw-bold" for="area-uniqid-689afc6a2865f">
  Площадь (кв.м.)
  
   <span style="color: #E60028">*</span>   </label>
  <input id="area-uniqid-689afc6a2865f" name="area" required class="border-0" type="number" required="required" min="1" step="1" units="кв.м." max="100000" maxlength="5" pattern="[1-9]\d{1,4}" placeholder="10-100000" />
    <p></p>
</div>
  
  <!--pre>
/home/carte/laravel/storage/framework/views/d13311a362b33df1f4d49140b63c5d6b.php
Illuminate\View\ComponentAttributeBag Object
(
    [attributes:protected] =&gt; Array
        (
            [required] =&gt; 1
        )

)

</pre-->

<div class="d-flex flex-column position-relative input-box  p-0 m-0"  >
  
  <label class="fs-14 fw-bold" for="property-locality-uniqid-689afc6a28815">
  Населённый пункт недвижимости 
  
   <span style="color: #E60028">*</span>   </label>

  <select id="property-locality-uniqid-689afc6a28815" class="calculator-select"   required  name="property_locality"
    >
    <option value="" data-code="placeholder">Выберите</option>
    <!-- data-divider -->
    <option value="chisinau">Кишинёв</option><option value="balti">Бельцы</option><option value="comrat">Комрат</option><option value="cahul">Кагул</option><option value="ceadar-lunga">Чадыр-Лунга</option><option value="edinet">Единцы</option><option value="hincesti">Хынчешты</option><option value="orhei">Орхей</option><option value="soroca">Сороки</option><option value="straseni">Страшены</option><option value="ungheni">Унгены</option><option value="anenii-noi">Анений Ной</option><option value="basarabeasca">Басарабяска</option><option value="briceni">Бричаны</option><option value="cantemir">Кантемир</option><option value="calarasi">Кэлэраши</option><option value="causeni">Каушаны</option><option value="cimislia">Чимишлия</option><option value="criuleni">Криулены</option><option value="donduseni">Дондушены</option><option value="drochia">Дрокия</option><option value="falesti">Фалешты</option><option value="floresti">Флорешты</option><option value="glodeni">Глодяны</option><option value="ialoveni">Яловены</option><option value="leova">Леова</option><option value="nisporeni">Ниспорены</option><option value="ocnita">Окница</option><option value="rezina">Резина</option><option value="riscani">Рышканы</option><option value="singerei">Сынжерей</option><option value="soldanesti">Шолданешты</option><option value="stefan-voda">Штефан Водэ</option><option value="taraclia">Тараклия</option><option value="telenesti">Теленьшты</option><option value="other">Другие населённые пункты</option>
  </select>

  <img class="calculator-select-arrow" src="https://carteverde.nldsite.com/laravel/build/assets/arrowBottom-DpjjrdOL.svg" alt="">
  <p></p>
</div>
  <input type="hidden" name="in_municipality" value="" data-yes="Да" data-no="Нет"/>
</div>
<script type="text/javascript">
document.querySelector('#household-package-lookup select[name="property_locality"]').addEventListener('change',function(e){
  var v='';
  switch(e.target.value){
    case '':
    break;
    case 'other':
      v='no';
    break;
    default:
      v='yes';
    break;
  }
  document.querySelector('#household-package-lookup [name="in_municipality"]').value=v;
});
</script>            
            
            <div class="d-flex flex-column show-for-confirmation d-none" style="gap: 20px;">
              <style type="text/css">
.insurance-packages .form-check-input {
  margin:auto!important;
  position: absolute;
  top:50%;
  transform:translateY(-50%);
  border:1px solid rgb(35,31,33);
}
.insurance-packages .form-check-input:checked {
background-color: rgb(50,147,111);
--bs-form-check-bg: var(--bs-body-bg);
border-color: rgb(50,147,111);
box-shadow:none;
}
.insurance-packages label {
  position: relative;
}
</style>
<pre style="display: none;">
/home/carte/laravel/storage/framework/views/637234ef02f1db0fe3983e066487e45f.php
Illuminate\View\ComponentAttributeBag Object
(
    [attributes:protected] =&gt; Array
        (
            [required] =&gt; 1
            [box-class] =&gt; input-set
        )

)

</pre>
<div class="d-flex flex-column position-relative input-set ">
    <label class="fs-14 fw-bold" for="insurance-package-id-uniqid-689afc6a289d8">
  Страховой пакет 
  
   <span style="color: #E60028">*</span>   </label>
    <table class="d-none">
    <tbody id="insurance-package-row-template">
      <tr onclick="chooseHouseholdInsurancePackage('_ID_','_PREMIUM_');">
        <td>_REAL_ESTATE_COVERAGE_LIMIT_</td>
        <td>_MOVABLE_PROPERTY_COVERAGE_LIMIT_</td>
        <td>_THIRD_PARTY_COVERAGE_LIMIT_</td>
        <td>_ACCIDENT_COVERAGE_LIMIT_</td>
        <td class="text-center"><label for="insurance-package-_ID_" ><input type="radio" name="insurance_package_id" id="insurance-package-_ID_" value="_ID_" class="form-check-input"> <span style="padding-left:24px;">_PREMIUM_</span></label></td>
      </tr>
    </tbody>
  </table>
  <table class="table text-center">
    <thead><tr>
      
      <th colspan="4">Застрахованная сумма (EUR/USD) (MDL)</th>
    </tr><tr>
      <th>Недвижимость (MDL)</th>
      <th>Движимое имущество (MDL)</th>
      <th>Третьим лицам (MDL)</th>
      <th>Несчастный случай (MDL)</th>
      <th rowspan="2">Цена (MDL)</th>
    </tr></thead>
    <tbody class="insurance-packages"></tbody>
  </table>
  <p></p>
</div>

<script type="text/javascript">
var householdInsurancePackageID='0';
function chooseHouseholdInsurancePackage(ID,premium){
  /** /if (householdInsurancePackageID=='0'){
    document.querySelector('#household-package-selector .text-end').classList.remove('d-none');
    householdInsurancePackageID=ID;
  }/**/
  document.getElementById('insurance-package-'+ID).checked=true;
  document.querySelector('.household-insurance-calculator [name="premium"]').value=premium;
}
</script>              <div class="d-flex flex-column" style="gap: 20px;">


  <div class="d-flex flex-column border border-black p-3 py-4" style="gap:22px;">
    <div class="mb-2 fw-bold">Адрес</div>

    <!--pre>
/home/carte/laravel/storage/framework/views/e7af3e5878c4ba90921bfc32a5522a06.php
Illuminate\View\ComponentAttributeBag Object
(
    [attributes:protected] =&gt; Array
        (
            [required] =&gt; 1
            [name] =&gt; address[locality]
            [data-placeholder] =&gt; mun. Chișinău
            [minlength] =&gt; 5
            [maxlength] =&gt; 40
        )

)

</pre--><div class="d-flex flex-column position-relative input-box  p-0 m-0">
  <label class="fs-14 fw-bold" for="address-locality-uniqid-689afc6a28bf0">
  Населённый пункт 
  
   <span style="color: #E60028">*</span>   </label>
  <input id="address-locality-uniqid-689afc6a28bf0" name="address[locality]" required placeholder="mun. Chișinău" class="border-0" type="text" required="required" data-placeholder="mun. Chișinău" minlength="5" maxlength="40"/>
    <p></p>
</div>
    <!--pre>
/home/carte/laravel/storage/framework/views/e7af3e5878c4ba90921bfc32a5522a06.php
Illuminate\View\ComponentAttributeBag Object
(
    [attributes:protected] =&gt; Array
        (
            [required] =&gt; 1
            [name] =&gt; address[street]
            [data-placeholder] =&gt; bd. Ștefan cel Mare și Sfînt
            [minlength] =&gt; 5
            [maxlength] =&gt; 40
        )

)

</pre--><div class="d-flex flex-column position-relative input-box  p-0 m-0">
  <label class="fs-14 fw-bold" for="address-street-uniqid-689afc6a28dbb">
  Улица 
  
   <span style="color: #E60028">*</span>   </label>
  <input id="address-street-uniqid-689afc6a28dbb" name="address[street]" required placeholder="bd. Ștefan cel Mare și Sfînt" class="border-0" type="text" required="required" data-placeholder="bd. Ștefan cel Mare și Sfînt" minlength="5" maxlength="40"/>
    <p></p>
</div>

    <div class="row">
      <div class="col-6"><!--pre>
/home/carte/laravel/storage/framework/views/e7af3e5878c4ba90921bfc32a5522a06.php
Illuminate\View\ComponentAttributeBag Object
(
    [attributes:protected] =&gt; Array
        (
            [required] =&gt; 1
            [name] =&gt; address[house]
            [data-placeholder] =&gt; 1
            [maxlength] =&gt; 7
        )

)

</pre--><div class="d-flex flex-column position-relative input-box  p-0 m-0">
  <label class="fs-14 fw-bold" for="address-house-uniqid-689afc6a28f29">
  Дом 
  
   <span style="color: #E60028">*</span>   </label>
  <input id="address-house-uniqid-689afc6a28f29" name="address[house]" required placeholder="1" class="border-0" type="text" required="required" data-placeholder="1" maxlength="7"/>
    <p></p>
</div>
</div>
      <div class="col-6"><!--pre>
/home/carte/laravel/storage/framework/views/e7af3e5878c4ba90921bfc32a5522a06.php
Illuminate\View\ComponentAttributeBag Object
(
    [attributes:protected] =&gt; Array
        (
            [required] =&gt; 1
            [name] =&gt; address[apartment]
            [data-placeholder] =&gt; 1-999
            [maxlength] =&gt; 3
            [data-valid-example] =&gt; 1
            [pattern] =&gt; [1-9][0-9]{0,2}
            [data-abbreviation] =&gt; кв.
        )

)

</pre--><div class="d-flex flex-column position-relative input-box  p-0 m-0">
  <label class="fs-14 fw-bold" for="address-apartment-uniqid-689afc6a2910b">
  Квартира 
  
   <span style="color: #E60028">*</span>   </label>
  <input id="address-apartment-uniqid-689afc6a2910b" name="address[apartment]" required placeholder="1-999" class="border-0" type="text" required="required" data-placeholder="1-999" maxlength="3" data-valid-example="1" pattern="[1-9][0-9]{0,2}" data-abbreviation="кв."/>
    <p></p>
</div>
</div>
    </div>
  </div>

  <!--pre>
/home/carte/laravel/storage/framework/views/e7af3e5878c4ba90921bfc32a5522a06.php
Illuminate\View\ComponentAttributeBag Object
(
    [attributes:protected] =&gt; Array
        (
            [required] =&gt; 1
            [name] =&gt; cadastral_number
            [data-placeholder] =&gt; XXXXXXX.XXXX
            [pattern] =&gt; [0-9\.,]{10,30}
            [data-valid-example] =&gt; 1234567.8910
            [maxlength] =&gt; 30
        )

)

</pre--><div class="d-flex flex-column position-relative input-box  p-0 m-0">
  <label class="fs-14 fw-bold" for="cadastral-number-uniqid-689afc6a2928c">
  Кадастровый номер 
  
   <span style="color: #E60028">*</span>   </label>
  <input id="cadastral-number-uniqid-689afc6a2928c" name="cadastral_number" required placeholder="XXXXXXX.XXXX" class="border-0" type="text" required="required" data-placeholder="XXXXXXX.XXXX" pattern="[0-9\.,]{10,30}" data-valid-example="1234567.8910" maxlength="30"/>
    <p></p>
</div>

</div>              <div class="d-flex flex-column" style="gap: 20px;">

  <div class="d-flex flex-column border border-black p-3 py-4" style="gap:22px;">
    <div class="mb-2 fw-bold">Страхователь (Контрагент полиса)</div>
    <!--pre>
/home/carte/laravel/storage/framework/views/e7af3e5878c4ba90921bfc32a5522a06.php
Illuminate\View\ComponentAttributeBag Object
(
    [attributes:protected] =&gt; Array
        (
            [required] =&gt; 1
            [name] =&gt; holder[name]
            [data-placeholder] =&gt; Ion Meleca
            [minlength] =&gt; 5
            [maxlength] =&gt; 40
        )

)

</pre--><div class="d-flex flex-column position-relative input-box  p-0 m-0">
  <label class="fs-14 fw-bold" for="holder-name-uniqid-689afc6a294df">
  Имя / Организация 
  
   <span style="color: #E60028">*</span>   </label>
  <input id="holder-name-uniqid-689afc6a294df" name="holder[name]" required placeholder="Ion Meleca" class="border-0" type="text" required="required" data-placeholder="Ion Meleca" minlength="5" maxlength="40"/>
    <p></p>
</div>
    <!--pre>
/home/carte/laravel/storage/framework/views/e7af3e5878c4ba90921bfc32a5522a06.php
Illuminate\View\ComponentAttributeBag Object
(
    [attributes:protected] =&gt; Array
        (
            [required] =&gt; 1
            [name] =&gt; holder[idnx]
            [minlength] =&gt; 11
            [maxlength] =&gt; 13
            [data-placeholder] =&gt; *************
            [data-valid-example] =&gt; 1234567890123
        )

)

</pre--><div class="d-flex flex-column position-relative input-box  p-0 m-0">
  <label class="fs-14 fw-bold" for="holder-idnx-uniqid-689afc6a296c3">
  IDNP для граждан РМ / IDNO 
  
   <span style="color: #E60028">*</span>   </label>
  <input id="holder-idnx-uniqid-689afc6a296c3" name="holder[idnx]" required placeholder="*************" class="border-0" type="text" required="required" minlength="11" maxlength="13" data-placeholder="*************" data-valid-example="1234567890123"/>
    <p></p>
</div>
  </div>

  <div class="d-flex flex-column border border-black p-3 py-4" style="gap:22px;">
    <div class="mb-2 fw-bold">Бенефициар</div>
    <!--pre>
/home/carte/laravel/storage/framework/views/e7af3e5878c4ba90921bfc32a5522a06.php
Illuminate\View\ComponentAttributeBag Object
(
    [attributes:protected] =&gt; Array
        (
            [required] =&gt; 1
            [name] =&gt; beneficiary[name]
            [data-placeholder] =&gt; Ion Meleca
            [minlength] =&gt; 5
            [maxlength] =&gt; 40
        )

)

</pre--><div class="d-flex flex-column position-relative input-box  p-0 m-0">
  <label class="fs-14 fw-bold" for="beneficiary-name-uniqid-689afc6a29851">
  Имя 
  
   <span style="color: #E60028">*</span>   </label>
  <input id="beneficiary-name-uniqid-689afc6a29851" name="beneficiary[name]" required placeholder="Ion Meleca" class="border-0" type="text" required="required" data-placeholder="Ion Meleca" minlength="5" maxlength="40"/>
    <p></p>
</div>
    <!--pre>
/home/carte/laravel/storage/framework/views/e7af3e5878c4ba90921bfc32a5522a06.php
Illuminate\View\ComponentAttributeBag Object
(
    [attributes:protected] =&gt; Array
        (
            [required] =&gt; 1
            [name] =&gt; beneficiary[idnp]
            [minlength] =&gt; 13
            [maxlength] =&gt; 13
            [data-placeholder] =&gt; *************
            [data-valid-example] =&gt; 1234567890123
        )

)

</pre--><div class="d-flex flex-column position-relative input-box  p-0 m-0">
  <label class="fs-14 fw-bold" for="beneficiary-idnp-uniqid-689afc6a299b8">
  IDNP для граждан РМ 
  
   <span style="color: #E60028">*</span>   </label>
  <input id="beneficiary-idnp-uniqid-689afc6a299b8" name="beneficiary[idnp]" required placeholder="*************" class="border-0" type="text" required="required" minlength="13" maxlength="13" data-placeholder="*************" data-valid-example="1234567890123"/>
    <p></p>
</div>
  </div>

  <div class="d-flex flex-column position-relative input-box  p-0 m-0">
  <label class="fs-14 fw-bold" for="other-household-residents-uniqid-689afc6a29b5f">
  Количество других жильцов (родственников 1-го уровня) 
  
   <span style="color: #E60028">*</span>   </label>
  <input id="other-household-residents-uniqid-689afc6a29b5f" name="other_household_residents" required placeholder="0-10" class="border-0" type="number" required="required" min="0" step="1" max="10" maxlength="2" pattern="\d{1,2}" data-placeholder="0-10" data-valid-example="1" />
    <p></p>
</div>

</div>            </div>
              <div class="text-end mt-4">
    <button
  type="button"
  class="btn rounded rounded-5 px-5 py-3 fs-14 fw-bold text-uppercase text-white text-decoration-none block-submitter"
>
  <div class="spinner-border" role="status"></div>
  Следующий шаг
</button>  </div>
            </form>
          </div>          
          
        </div>

        <!-- Confirmare Tab -->
        <div class="tab-pane fade" id="confirmare" role="tabpanel" aria-labelledby="confirmare-tab">
          <div class="card my-4 border-0">
            <form class="confirmation-form submittable-block" data-status="pending">
              
              <input type="hidden" name="insurance_period" value="12m"/>
              <div
                class="card-body p-0 d-flex flex-column"
                style="gap: 5px;"
                >
                <div
  class="p-3 d-flex flex-column"
  style="gap: 10px; background: #F2F2F2; color: #231F21;"
  >
  <div class="d-flex justify-content-between align-items-center ">
  <p class="mb-0 fs-14 fw-bold">Тип недвижимости</p>
  <p class="mb-0 fs-16 text-end "  data-field="house_type_id"  ></p>
</div>  <div class="d-flex justify-content-between align-items-center ">
  <p class="mb-0 fs-14 fw-bold">Площадь</p>
  <p class="mb-0 fs-16 text-end "  ><span data-field="area"></span> кв.м.</p>
</div>  <div class="d-flex justify-content-between align-items-center ">
  <p class="mb-0 fs-14 fw-bold">В муниципалитете</p>
  <p class="mb-0 fs-16 text-end "  data-field="in_municipality"  ></p>
</div>  <div class="d-flex justify-content-between align-items-center ">
  <p class="mb-0 fs-14 fw-bold">Адрес</p>
  <p class="mb-0 fs-16 text-end "  data-field="address"  ></p>
</div>  <div class="d-flex justify-content-between align-items-center ">
  <p class="mb-0 fs-14 fw-bold">Кадастровый номер</p>
  <p class="mb-0 fs-16 text-end "  data-field="cadastral_number"  ></p>
</div>  <div class="d-flex justify-content-between align-items-center ">
  <p class="mb-0 fs-14 fw-bold">Страхователь (Контрагент полиса)</p>
  <p class="mb-0 fs-16 text-end "  data-field="holder"  ></p>
</div>  <div class="d-flex justify-content-between align-items-center ">
  <p class="mb-0 fs-14 fw-bold">Бенефициар</p>
  <p class="mb-0 fs-16 text-end "  data-field="beneficiary"  ></p>
</div>
  <div class="d-flex justify-content-between align-items-center ">
  <p class="mb-0 fs-14 fw-bold">Страховая компания:</p>
  <p class="mb-0 fs-16 text-end "  >MOLDASIG</p>
</div></div>
<div class="p-3 border border-black d-flex justify-content-between align-items-center"
     style="background: #F2F2F2; color: #231F21;"
     >
  <p class="mb-0 fs-14 fw-bold">Общая стоимость:</p>
  <p class="mb-0 fs-26 fw-bold"><span data-field="premium"></span> MDL</p>
</div>

                <!-- Contact Information -->

<!--pre>
/home/carte/laravel/storage/framework/views/e7af3e5878c4ba90921bfc32a5522a06.php
Illuminate\View\ComponentAttributeBag Object
(
    [attributes:protected] =&gt; Array
        (
            [required] =&gt; 1
            [name] =&gt; billing_first_name
            [forcedLabel] =&gt; Имя
            [placeholder] =&gt; Ion
            [minlength] =&gt; 2
            [maxlength] =&gt; 40
        )

)

</pre--><div class="d-flex flex-column position-relative input-box  p-0 m-0">
  <label class="fs-14 fw-bold" for="billing-first-name-uniqid-689afc6a2a371">
  Имя 
  
   <span style="color: #E60028">*</span>   </label>
  <input id="billing-first-name-uniqid-689afc6a2a371" name="billing_first_name" required class="border-0" type="text" required="required" forcedLabel="Имя" placeholder="Ion" minlength="2" maxlength="40"/>
    <p></p>
</div>

<!--pre>
/home/carte/laravel/storage/framework/views/e7af3e5878c4ba90921bfc32a5522a06.php
Illuminate\View\ComponentAttributeBag Object
(
    [attributes:protected] =&gt; Array
        (
            [required] =&gt; 1
            [name] =&gt; billing_last_name
            [forcedLabel] =&gt; Фамилия
            [placeholder] =&gt; Rusu
            [minlength] =&gt; 2
            [maxlength] =&gt; 40
        )

)

</pre--><div class="d-flex flex-column position-relative input-box  p-0 m-0">
  <label class="fs-14 fw-bold" for="billing-last-name-uniqid-689afc6a2a598">
  Фамилия 
  
   <span style="color: #E60028">*</span>   </label>
  <input id="billing-last-name-uniqid-689afc6a2a598" name="billing_last_name" required class="border-0" type="text" required="required" forcedLabel="Фамилия" placeholder="Rusu" minlength="2" maxlength="40"/>
    <p></p>
</div>

<!--pre>
/home/carte/laravel/storage/framework/views/e7af3e5878c4ba90921bfc32a5522a06.php
Illuminate\View\ComponentAttributeBag Object
(
    [attributes:protected] =&gt; Array
        (
            [required] =&gt; 1
            [name] =&gt; billing_phone
            [forcedLabel] =&gt; Номер телефона
            [placeholder] =&gt; 000000000
            [minlength] =&gt; 9
            [maxlength] =&gt; 11
        )

)

</pre--><div class="d-flex flex-column position-relative input-box  p-0 m-0">
  <label class="fs-14 fw-bold" for="billing-phone-uniqid-689afc6a2a75e">
  Номер телефона 
  
   <span style="color: #E60028">*</span>   </label>
  <input id="billing-phone-uniqid-689afc6a2a75e" name="billing_phone" required class="border-0" type="text" required="required" forcedLabel="Номер телефона" placeholder="000000000" minlength="9" maxlength="11"/>
    <p></p>
</div>

<!--pre>
/home/carte/laravel/storage/framework/views/e7af3e5878c4ba90921bfc32a5522a06.php
Illuminate\View\ComponentAttributeBag Object
(
    [attributes:protected] =&gt; Array
        (
            [required] =&gt; 1
            [name] =&gt; billing_email
            [forcedLabel] =&gt; Электронная почта
            [placeholder] =&gt; olivia@carteverde.nldsite.com
            [pattern] =&gt; [a-zA-Z0-9._%+\-]+@[a-z0-9.\-]+\.[a-z]{2,}$
            [maxlength] =&gt; 50
        )

)

</pre--><div class="d-flex flex-column position-relative input-box  p-0 m-0">
  <label class="fs-14 fw-bold" for="billing-email-uniqid-689afc6a2a8be">
  Электронная почта 
  
   <span style="color: #E60028">*</span>   </label>
  <input id="billing-email-uniqid-689afc6a2a8be" name="billing_email" required class="border-0" type="text" required="required" forcedLabel="Электронная почта" placeholder="olivia@carteverde.nldsite.com" pattern="[a-zA-Z0-9._%+\-]+@[a-z0-9.\-]+\.[a-z]{2,}$" maxlength="50"/>
    <p></p>
</div>
                <div class="d-flex flex-column position-relative input-box mt-4 input-box-date p-0 m-0">
  <label class="fs-14 fw-bold" for="effective-date-uniqid-689afc6a2aae7">
  Дата начала действия 
  
   <span style="color: #E60028">*</span>   </label>
  <input id="effective-date-uniqid-689afc6a2aae7" name="effective_date" required
        class="border-0 input-date"
        type="date" required="required" boxClass="mt-4 input-box-date" min="2025-08-13"
    />
    <p></p>
</div>
                <div
  class="mt-4 d-flex flex-column"
  style="gap: 20px;"
  >
  <p class="mb-0 fs-20 fw-bold">Как вы хотите получить страховой полис?</p>
  <div class="form-check ps-0 calculator-delivery-block">
    <input
      class="form-check-input calculator-delivery-input"
      type="radio"
      value="1"
      name="shipping_method_id"
      checked
      id="deliveryOptionsOnline"
      >
    <label class="form-check-label px-4 py-3 calculator-delivery-label"
           for="deliveryOptionsOnline">
      <img src="https://carteverde.nldsite.com/laravel/build/assets/deliveryOnline-C21zHLdR.svg" alt="">
      <p class="mb-0 fs-16">Онлайн (электронная почта)</p>
    </label>
  </div>
</div>                <p class="mb-0 mt-2 fs-26 fw-bold">Оплатить с помощью</p>
<div class="col-12 mb-3 d-flex flex-column align-items-center" style="gap: 10px;">
  <div class="col-12 form-check ps-0 calculator-delivery-block">
    <input
      class="form-check-input calculator-delivery-input"
      type="radio"
      value="1"
      name="payment_method_id"
      checked
      id="payment_method_id"
      >
    <label class="form-check-label px-4 py-3 calculator-delivery-label"
           for="payment_method_id">
      <img src='https://carteverde.nldsite.com/laravel/build/assets/visa-mastercard-C756L9Vo.png'
           style="width: 70px" alt="">
      <p class="mb-0 fs-16">Банковская карта (онлайн)</p>
    </label>
  </div>
</div>
                
                <div class="form-check mb-3 check-black">
  <input class="form-check-input" type="checkbox" id="termsAgreement">
  <label class="form-check-label" for="termsAgreement">
    Я согласен с <a target="_blank" href="https://carteverde.nldsite.com/ru/pravila-i-uslovija/">Условиями и положениями CarteVerde.md</a>, включая условия оплаты, и выражаю свое согласие на обработку персональных данных.  </label>
</div>                <div class="input-box recaptcha-box"  id="field689afc6a2ae0b">
  <div class="g-recaptcha" data-sitekey="6LcdPigrAAAAAEnNzYqjXS2TrQ7ewgoSoqDqQff2" data-callback="field689afc6a2ae0bRecaptchaCallback"></div>
  <input type="hidden" name="recaptcha" id="field689afc6a2ae0b-value" value="" required data-unicode-pattern=".{10,}"/>
  
  <p class="static">Пожалуйста, выполните проверку reCAPTCHA, чтобы продолжить.</p>
</div>
<script type="text/javascript">
function field689afc6a2ae0bRecaptchaCallback(token){
  //console.groupCollapsed('recaptcha field689afc6a2ae0b callback');
  var container=document.getElementById('field689afc6a2ae0b'), 
    div=container.querySelector('.g-recaptcha'), 
    input=container.querySelector('input[name="recaptcha"]');
  container.classList.remove('input-error');
  input.value=token;
  
  setTimeout(function (container,div,input){
    grecaptcha.reset(div);
    container.classList.add('input-error');
    
    input.value='';
    input.dispatchEvent(new Event('change',{'bubbles':true}));
  },50000,container,div,input);

  input.dispatchEvent(new Event('change',{'bubbles':true}));
  //console.groupEnd();
}
</script><div
    class="mt-4 d-flex flex-column flex-sm-row justify-content-between final-button-block"
    style="gap: 15px;"
>
  <button type="button" class="back-step-button btn rounded rounded-5 px-5 py-3 fs-14 fw-bold text-uppercase btn-gray2">
  <span>Назад</span>
</button>  <button
  type="button"
  class="btn rounded rounded-5 px-5 py-3 fs-14 fw-bold text-uppercase text-white text-decoration-none block-submitter"
>
  <div class="spinner-border" role="status"></div>
  Подтвердить
</button></div>
              </div>
            </form>
          </div>
        </div>

      </div>
</div>
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