72 lines
2.4 KiB
Plaintext
72 lines
2.4 KiB
Plaintext
<div class="verification account row">
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<div class="small-12 column">
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<div class="text-center">
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<div class="small-4 column verification-step active">
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<span class="number">1</span> <%= t("verification.step_1") %>
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</div>
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<div class="small-4 column verification-step">
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<span class="number">2</span> <%= t("verification.step_2") %>
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</div>
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<div class="small-4 column verification-step">
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<span class="number">3</span> <%= t("verification.step_3") %>
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</div>
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</div>
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<div class="progress small-12 success radius">
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<span class="meter" style="width: 33%"></span>
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</div>
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<%= link_to account_path, class: "left back clear" do %>
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<i class="icon-angle-left left"></i>
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<%= t("verification.back") %>
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<% end %>
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<h1><%= t("verification.residence.new.title") %></h1>
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<%= form_for @residence, as: "residence", url: residence_path do |f| %>
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<%= render "errors" %>
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<div class="small-12 medium-8">
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<div class="small-12 medium-4 left">
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<%= f.label t("verification.residence.new.document_type_label") %>
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<%= f.select :document_type, document_types, prompt: "", label: false %>
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</div>
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<div class="small-12 medium-5 left">
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<%= f.label t("verification.residence.new.document_number") %>
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<%= f.text_field :document_number, label: false %>
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</div>
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</div>
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<div class="date small-12 medium-6 clear">
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<%= f.label t("verification.residence.new.date_of_birth") %>
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<%= f.date_select :date_of_birth,
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prompt: true,
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start_year: 1900, end_year: 16.years.ago.year,
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label: false %>
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</div>
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<div class="small-12 medium-4 clear">
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<%= f.label t("verification.residence.new.postal_code") %>
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<%= f.text_field :postal_code, label: false %>
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</div>
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<div class="small-12">
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<%= f.label :terms_of_service do %>
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<%= f.check_box :terms_of_service, label: false %>
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<span class="checkbox">
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<%= t("verification.residence.new.accept_terms_text",
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terms_url: link_to(t("verification.residence.new.terms"), "/census_terms",
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target: "_blank")).html_safe
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%>
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</span>
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<% end %>
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</div>
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<div class="small-12 clear">
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<%= f.submit t("verification.residence.new.verify_residence") %>
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</div>
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<% end %>
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</div>
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</div>
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