PERSONAL DATA
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Last Name:
@error('last_name')
{{ $message }}
@enderror
First Name:
@error('first_name')
{{ $message }}
@enderror
Middle Name (optional):
@error('middle_name')
{{ $message }}
@enderror
Email:
@error('email')
{{ $message }}
@enderror
Present Address:
@error('present_address')
{{ $message }}
@enderror
Provincial Address:
@error('provincial_address')
{{ $message }}
@enderror
Mobile No:
@error('mobile_number')
{{ $message }}
@enderror
Alternative Number:
@error('alternative_number')
{{ $message }}
@enderror
Date of Birth:
@error('date_of_birth')
{{ $message }}
@enderror
Age:
@error('age')
{{ $message }}
@enderror
Place of Birth:
@error('place_of_birth')
{{ $message }}
@enderror
Civil Status:
civil_status == 'single' ? 'checked' : '' }}>
Single
civil_status == 'married' ? 'checked' : '' }}>
Married
civil_status == 'head_of_family' ? 'checked' : '' }}>
Head of the Family
civil_status == 'widow' ? 'checked' : '' }}>
Widow/er
@error('civil_status')
{{ $message }}
@enderror
Nationality:
@error('nationality')
{{ $message }}
@enderror
Religion:
@error('religion')
{{ $message }}
@enderror
Height:
@error('height')
{{ $message }}
@enderror
Weight:
@error('weight')
{{ $message }}
@enderror
Name of Spouse (if married):
@error('spouse_name')
{{ $message }}
@enderror
Occupation:
@error('spouse_occupation')
{{ $message }}
@enderror
Mother's Maiden Name
@if ($errors->has('mother_maiden_name'))
{{ $errors->first('mother_maiden_name') }}
@endif
Mother's Occupation
@if ($errors->has('mother_occupation'))
{{ $errors->first('mother_occupation') }}
@endif
Father's Name
@if ($errors->has('father_name'))
{{ $errors->first('father_name') }}
@endif
Father's Occupation
@if ($errors->has('father_occupation'))
{{ $errors->first('father_occupation') }}
@endif
Dependents
@if ($errors->has('dependents'))
{{ $errors->first('dependents') }}
@endif
PhilHealth No.
@if ($errors->has('philhealth_no'))
{{ $errors->first('philhealth_no') }}
@endif
Blood Type
@if ($errors->has('blood_type'))
{{ $errors->first('blood_type') }}
@endif
`