<div class="box box-success b-t-non" id='panel-add'>
	<h4 class="labelYellow">
		<i class="fa fa-pencil m-r-15"></i> Form Edit
	</h4>
	<hr class="m-t-0">
	<form method='post' action="<?php echo e(route('editDtPernikahan')); ?>" enctype='multipart/form-data'>
		<?php echo e(csrf_field()); ?>

		<div class="box-body">
			<div class='col-lg-12 col-md-12 col-sm-12 col-xs-12 p-0'>
				<div class='col-lg-6 col-md-6 col-sm-12 col-xs-12 p-b-5'>
					<div class="form-group" id='gr_reg'>
						<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>No Registrasi</label>
						<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
							<input type="hidden" name="id_identitas_pasangan" value="<?php echo e($idenPas->id_identitas_pasangan); ?>" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12" readonly>
							<input type="text" name="no_registrasi" value="<?php echo e($idenPas->no_registrasi); ?>" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12" readonly>
						</div>
					</div>
				</div>
				<!-- <div class='clearfix p-b-5'></div> -->
				<div class='col-lg-6 col-md-6 col-sm-12 col-xs-12 p-b-5'>
					<div class="form-group m-b-0">
						<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Tgl Registrasi</label>
						<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12 input-group p-t-0 p-b-0 p-l-15 p-r-15">
							<div class="input-group-addon">
								<i class="fa fa-calendar"></i>
							</div>
							<input type="text" name='tgl_registrasi' value='<?php echo e(date("d-m-Y", strtotime($idenPas->tgl_registrasi))); ?>' autocomplete='off' placeholder='dd-mm-yyyy' class="form-control pull-right"  id='form_datetime_today_reg' data-date-format="dd-mm-yyyy" required='required' disabled>
						</div>
					</div>
				</div>
			</div>
			<div class="clearfix"></div>
			<h4 class="labelYellow m-0 m-b-5"><i class="fa fa-puzzle-piece m-r-15"></i> 1. IDENTITAS PASANGAN</h4>
			<div class='col-lg-6 col-md-6 col-sm-12 col-xs-12 p-0'>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>NIK Calon Suami</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="nik_suami" value="<?php echo e($idenPas->nik_suami); ?>" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Nama Calon Suami</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="nama_suami" value="<?php echo e($idenPas->nama_suami); ?>" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Tempat Lahir</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="tmp_lahir_suami" value="<?php echo e($idenPas->tmp_lahir_suami); ?>" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group m-b-0">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Tanggal Lahir</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12 input-group p-t-0 p-b-0 p-l-15 p-r-15">
						<div class="input-group-addon">
							<i class="fa fa-calendar"></i>
						</div>
						<input type="text" name='tgl_lahir_suami' value='<?php echo e(date("d-m-Y", strtotime($idenPas->tgl_lahir_suami))); ?>' autocomplete='off' placeholder='dd-mm-yyyy' class="form-control pull-right"  id='form_datetime_today_husban' data-date-format="dd-mm-yyyy" required='required'>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Agama</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<select name="agama_suami" id='agamaSuami' required="required" class="form-control input-sm customInput col-md-7 col-xs-12">
							<option value='' disabled selected> .:: Pilih Agama ::. </option>
							<option value='Aliran Kepercayaan' <?php if($idenPas->agama_suami == 'Aliran Kepercayaan'){echo "selected";} ?>>Aliran Kepercayaan</option>
							<option value='Buddha' <?php if($idenPas->agama_suami == 'Buddha'){echo "selected";} ?>>Buddha</option>
							<option value='Hindu' <?php if($idenPas->agama_suami == 'Hindu'){echo "selected";} ?>>Hindu</option>
							<option value='Islam' <?php if($idenPas->agama_suami == 'Islam'){echo "selected";} ?>>Islam</option>
							<option value='Konghucu' <?php if($idenPas->agama_suami == 'Konghucu'){echo "selected";} ?>>Konghucu</option>
							<option value='Kristen Protestan' <?php if($idenPas->agama_suami == 'Kristen Protestan'){echo "selected";} ?>>Kristen Protestan</option>
							<option value='Katholik' <?php if($idenPas->agama_suami == 'Katholik'){echo "selected";} ?>>Katholik</option>
						</select>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Suku</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="suku_suami" value="<?php echo e($idenPas->suku_suami); ?>" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Pendidikan</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="pendidikan_suami" value="<?php echo e($idenPas->pendidikan_suami); ?>" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Pekerjaan</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="pekerjaan_suami" value="<?php echo e($idenPas->pekerjaan_suami); ?>" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Alamat</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="alamat_suami" value="<?php echo e($idenPas->alamat_suami); ?>" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Pilih Provinsi</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<select name="provinsi_suami_id" id='provinsiSuami' required="required" class="form-control input-sm customInput col-md-7 col-xs-12">
							<option value='' disabled selected> .:: Pilih Provinsi ::. </option>
							<?php foreach($provinsis as $provinsi): ?>
								<option value='<?php echo $provinsi->id_provinsi; ?>' <?php if($idenPas->provinsi_suami_id == $provinsi->id_provinsi){echo "selected";} ?>><?php echo $provinsi->nama_provinsi; ?></option>
							<?php endforeach; ?>
						</select>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Pilih Kabupaten</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<select name="kabupaten_suami_id" id='kabupatenSuami' required="required" class="form-control input-sm customInput col-md-7 col-xs-12">
							<option value='' disabled selected> .:: Pilih Kabupaten ::. </option>
							<?php foreach($kabupatens as $kabupaten): ?>
								<option value='<?php echo $kabupaten->id_kabupaten; ?>' <?php if($idenPas->kabupaten_suami_id == $kabupaten->id_kabupaten){echo "selected";} ?>><?php echo $kabupaten->nama_kabupaten; ?></option>
							<?php endforeach; ?>
						</select>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Pilih Kecamatan</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<select name="kecamatan_suami_id" id='kecamatanSuami' required="required" class="form-control input-sm customInput col-md-7 col-xs-12">
							<option value='' disabled selected> .:: Pilih Kecamatan ::. </option>
							<?php foreach($kecamatans as $kecamatan): ?>
								<option value='<?php echo $kecamatan->id_kecamatan; ?>' <?php if($idenPas->kecamatan_suami_id == $kecamatan->id_kecamatan){echo "selected";} ?>><?php echo $kecamatan->nama_kecamatan; ?></option>
							<?php endforeach; ?>
						</select>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Pilih Desa</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<select name="desa_suami_id" id='desaSuami' required="required" class="form-control input-sm customInput col-md-7 col-xs-12">
							<option value='' disabled selected> .:: Pilih Desa ::. </option>
							<?php foreach($desas as $desa): ?>
								<option value='<?php echo $desa->id_desa; ?>' <?php if($idenPas->desa_suami_id == $desa->id_desa){echo "selected";} ?>><?php echo $desa->nama_desa; ?></option>
							<?php endforeach; ?>
						</select>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Pernah Menikah Sebelumnya</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="radio" class="customCheck" id="nikahSuami1" value='1' name="pernah_menikah_suami" <?php if($idenPas->pernah_menikah_suami == '1'){echo "checked";} ?>>
						<label class="labelRadio" for="nikahSuami1">Ya</label>
						<input type="radio" class="customCheck" id="nikahSuami2" value='2' name="pernah_menikah_suami" <?php if($idenPas->pernah_menikah_suami == '2'){echo "checked";} ?>>
						<label class="labelRadio" for="nikahSuami2">Tidak</label>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
			</div>
			<div class='col-lg-6 col-md-6 col-sm-12 col-xs-12 p-0'>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>NIK Calon Istri</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="nik" value="<?php echo e($idenPas->bumil->nik); ?>" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12" readonly>
						<div class='iconStatus' id='icon_nik'></div>
					</div>
					<span class='col-lg-9 col-md-9 col-sm-12 col-xs-12 col-lg-offset-3 col-md-offset-3' id="cek_no_induk"></span>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Nama Calon Istri</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="nama_bumil" value="<?php echo e($idenPas->bumil->nama_bumil); ?>" id="namaBumil" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12" readonly>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Tempat Lahir</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="tmp_lahir" value="<?php echo e($idenPas->bumil->tmp_lahir); ?>" id="tmpLahir" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12" readonly>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group m-b-0">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Tanggal Lahir</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12 input-group p-t-0 p-b-0 p-l-15 p-r-15">
						<div class="input-group-addon">
							<i class="fa fa-calendar"></i>
						</div>
						<input type="text" name='tgl_lahir' value='<?php echo e(date("d-m-Y", strtotime($idenPas->bumil->tgl_lahir))); ?>' autocomplete='off' placeholder='dd-mm-yyyy' class="form-control pull-right"  id='form_datetime_todayWife' data-date-format="dd-mm-yyyy" required='required' disabled>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Agama</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<select name="agama" id='agamaIstri' required="required" class="form-control input-sm customInput col-md-7 col-xs-12" disabled>
							<option value='' disabled selected> .:: Pilih Agama ::. </option>
							<option value='Aliran Kepercayaan' <?php if($idenPas->bumil->agama == 'Aliran Kepercayaan'){echo "selected";} ?>>Aliran Kepercayaan</option>
							<option value='Buddha' <?php if($idenPas->bumil->agama == 'Buddha'){echo "selected";} ?>>Buddha</option>
							<option value='Hindu' <?php if($idenPas->bumil->agama == 'Hindu'){echo "selected";} ?>>Hindu</option>
							<option value='Islam' <?php if($idenPas->bumil->agama == 'Islam'){echo "selected";} ?>>Islam</option>
							<option value='Konghucu' <?php if($idenPas->bumil->agama == 'Konghucu'){echo "selected";} ?>>Konghucu</option>
							<option value='Kristen Protestan' <?php if($idenPas->bumil->agama == 'Kristen Protestan'){echo "selected";} ?>>Kristen Protestan</option>
							<option value='Katholik' <?php if($idenPas->bumil->agama == 'Katholik'){echo "selected";} ?>>Katholik</option>
						</select>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Suku</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="suku_istri" value="<?php echo e($idenPas->suku_istri); ?>" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12" readonly>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Pendidikan</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="pendidikan" value="<?php echo e($idenPas->bumil->pendidikan); ?>" id="pendidikanIstri" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12" readonly>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Pekerjaan</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="pekerjaan" value="<?php echo e($idenPas->bumil->pekerjaan); ?>" id="pekerjaanIstri" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12" readonly>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Alamat</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="text" name="alamat_ktp" value="<?php echo e($idenPas->bumil->alamat_ktp); ?>" id="alamatIstri" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12" readonly>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Pilih Provinsi</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<select name="provinsi_ktp_id" id='provinsiIstri' required="required" class="form-control input-sm customInput col-md-7 col-xs-12" disabled>
							<option value='<?php echo e($idenPas->bumil->provinsi_ktp_id); ?>'><?php echo e($idenPas->bumil->provinsi->nama_provinsi); ?></option>
						</select>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Pilih Kabupaten</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<select name="kabupaten_ktp_id" id='kabupatenIstri' required="required" class="form-control input-sm customInput col-md-7 col-xs-12" disabled>
							<option value='<?php echo e($idenPas->bumil->kabupaten_ktp_id); ?>'><?php echo e($idenPas->bumil->kabupaten->nama_kabupaten); ?></option>
						</select>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Pilih Kecamatan</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<select name="kecamatan_ktp_id" id='kecamatanIstri' required="required" class="form-control input-sm customInput col-md-7 col-xs-12" disabled>
							<option value='<?php echo e($idenPas->bumil->kecamatan_ktp_id); ?>'><?php echo e($idenPas->bumil->kecamatan->nama_kecamatan); ?></option>
						</select>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Pilih Desa</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<select name="desa_ktp_id" id='desaIstri' required="required" class="form-control input-sm customInput col-md-7 col-xs-12" disabled>
							<option value='<?php echo e($idenPas->bumil->desa_ktp_id); ?>'><?php echo e($idenPas->bumil->desa->nama_desa); ?></option>
						</select>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
				<div class="form-group">
					<label class="control-label col-lg-3 col-md-3 col-sm-12 col-xs-12" id='label-input'>Pernah Menikah Sebelumnya</label>
					<div class="col-lg-9 col-md-9 col-sm-12 col-xs-12">
						<input type="radio" class="customCheck" id="nikahIstri1" value='1' name="pernah_menikah_istri" <?php if($idenPas->pernah_menikah_suami == "1"){echo "checked";} ?> disabled>
						<label class="labelRadio" for="nikahIstri1">Ya</label>
						<input type="radio" class="customCheck" id="nikahIstri2" value='2' name="pernah_menikah_istri" <?php if($idenPas->pernah_menikah_suami == "2"){echo "checked";} ?> disabled>
						<label class="labelRadio" for="nikahIstri2">Tidak</label>
					</div>
				</div>
				<div class='clearfix p-b-5'></div>
			</div>
			<div class="clearfix"></div>
			<h4 class="labelYellow m-0 m-b-5"><i class="fa fa-puzzle-piece m-r-15"></i> 2. DATA PERNIKAHAN</h4>
			<input type="hidden" name="id_pernikahan_pasangan" value="<?php echo e($perPas->id_pernikahan_pasangan); ?>" required="required" autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
			<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-5 col-md-5 col-sm-12 col-xs-12" id='label-input'>Persyaratan administrasi</label>
				<div class="col-lg-5 col-md-5 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="adminis1" value='1' name="syarat_administrasi" required="required" <?php if($perPas->syarat_administrasi == '1'){echo "checked";} ?>><label class="labelRadio" for="adminis1">Lengkap</label>
					<input type="radio" class="customCheck" id="adminis2" value='2' name="syarat_administrasi" required="required" <?php if($perPas->syarat_administrasi == '2'){echo "checked";} ?>><label class="labelRadio" for="adminis2">Tidak Lengkap</label>
				</div>
			</div>
			<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-5 col-md-5 col-sm-12 col-xs-12" id='label-input'>Apakah sudah akad nikah di desa, sebelum ke KUA ?</label>
				<div class="col-lg-5 col-md-5 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="akadSebelum1" value='1' name="akad_sebelum_kua" required="required" <?php if($perPas->akad_sebelum_kua == '1'){echo "checked";} ?>><label class="labelRadio" for="akadSebelum1">Ya</label>
					<input type="radio" class="customCheck" id="akadSebelum2" value='2' name="akad_sebelum_kua" required="required" <?php if($perPas->akad_sebelum_kua == '2'){echo "checked";} ?>><label class="labelRadio" for="akadSebelum2">Tidak</label>
				</div>
				<div class='col-lg-12 p-0 m-0 m-b-5' id='tglAkadSebelum' <?php if($perPas->akad_sebelum_kua == '2'){echo "style='display:none'";} ?>>
					<label class="control-label col-lg-5 col-md-5 col-sm-12 col-xs-12" id='label-input'>Tanggal</label>
					<div class="col-lg-5 col-md-5 col-sm-12 col-xs-12 input-group p-t-0 p-b-0 p-l-15 p-r-15">
						<div class="input-group-addon">
							<i class="fa fa-calendar"></i>
						</div>
						<?php if($perPas->akad_sebelum_kua == '2'): ?>
							<input type="text" name='tgl_akad' autocomplete='off' placeholder='dd-mm-yyyy' class="form-control pull-right"  id='form_datetime_today_akad' data-date-format="dd-mm-yyyy">
						<?php else: ?>
							<input type="text" name='tgl_akad' value='<?php echo e(date("d-m-Y", strtotime($perPas->tgl_akad))); ?>' autocomplete='off' placeholder='dd-mm-yyyy' class="form-control pull-right"  id='form_datetime_today_akad' data-date-format="dd-mm-yyyy">
						<?php endif; ?>
					</div>
				</div>
			</div>
			<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-5 col-md-5 col-sm-12 col-xs-12" id='label-input'>Apakah sudah menerima Vitamin pengantin dari puskesmas ?</label>
				<div class="col-lg-5 col-md-5 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="vitamin1" value='1' name="menerima_vitamin" required="required" <?php if($perPas->menerima_vitamin == '1'){echo "checked";} ?>><label class="labelRadio" for="vitamin1">Ya</label>
					<input type="radio" class="customCheck" id="vitamin2" value='2' name="menerima_vitamin" required="required" <?php if($perPas->menerima_vitamin == '2'){echo "checked";} ?>><label class="labelRadio" for="vitamin2">Tidak</label>
				</div>
			</div>
			<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-5 col-md-5 col-sm-12 col-xs-12" id='label-input'>Mengikuti konseling/SUSCATIN ?</label>
				<div class="col-lg-5 col-md-5 col-sm-12 col-xs-12">
					<input type="radio" class="customCheck" id="konseling1" value='1' name="ikut_konseling" required="required" <?php if($perPas->ikut_konseling == '1'){echo "checked";} ?>><label class="labelRadio" for="konseling1">Ya</label>
					<input type="radio" class="customCheck" id="konseling2" value='2' name="ikut_konseling" required="required" <?php if($perPas->ikut_konseling == '2'){echo "checked";} ?>><label class="labelRadio" for="konseling2">Tidak</label>
				</div>
			</div>
			<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 form-group m-b-0 p-b-5">
				<label class="control-label col-lg-5 col-md-5 col-sm-12 col-xs-12" id='label-input'>Tanggal Pernikahan</label>
				<div class="col-lg-5 col-md-5 col-sm-12 col-xs-12 input-group p-t-0 p-b-0 p-l-15 p-r-15">
					<div class="input-group-addon">
						<i class="fa fa-calendar"></i>
					</div>
					<input type="text" name='tgl_pernikahan' value='<?php echo e(date("d-m-Y", strtotime($perPas->tgl_pernikahan))); ?>' autocomplete='off' placeholder='dd-mm-yyyy' class="form-control pull-right"  id='form_datetime_today_nikah' data-date-format="dd-mm-yyyy" required='required'>
				</div>
			</div>
			<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12 form-group m-b-0">
				<label class="control-label col-lg-5 col-md-5 col-sm-12 col-xs-12" id='label-input'>No. Registrasi Pernikahan</label>
				<div class="col-lg-5 col-md-5 col-sm-12 col-xs-12">
					<input type="text" name="no_reg_pernikahan" value="<?php echo e($perPas->no_reg_pernikahan); ?>" required='required' autocomplete='off' class="form-control input-sm customInput col-md-7 col-xs-12">
				</div>
			</div>
			<div class='clearfix p-b-5'></div>
		</div>
		<div class="box-footer">
			<span id='tombol'>
				<button type="submit" class="btn btn-primary pull-right m-l-15">Simpan <span class="fa fa-save"></span></button>
			</span>
			<button type="button" class="btn btn-warning btn-cancel pull-right"><span class="fa fa-chevron-left"></span> Kembali</button>
		</div>
	</form>
</div>
<script type="text/javascript">
	var onLoad = (function() {
		$('#panel-add').animateCss('bounceInUp');
	})();

	$('.btn-cancel').click(function(e){
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    	$('#panel-add').animateCss('bounceOutDown');
    	$('.other-page').fadeOut(function(){
    		$('.other-page').empty();
            $('.main-layer').fadeIn();
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    $('#form_datetime_today_husban').datetimepicker({
        weekStart: 2,
        todayBtn:  1,
        autoclose: 1,
        todayHighlight: 1,
        startView: 2,
        minView: 2,
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    $('#agamaSuami').chosen();
    $('#provinsiSuami').chosen();
    $('#kabupatenSuami').chosen();
    $('#kecamatanSuami').chosen();
    $('#desaSuami').chosen();

    $('#provinsiSuami').change(function(){
    	var id= $('#provinsiSuami').val();
    	$.post("<?php echo route('getKabupaten'); ?>", {id :id }).done(function(data){
    		var listKab = '<option value="" disabled selected> .:: Pilih Kabupaten ::. </option>';
    		if(data.length > 0){
    			$.each(data, function(k,v){
    				listKab += '<option value="'+v.id_kabupaten+'">'+v.nama_kabupaten+'</option>';
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    		$('#kabupatenSuami').html(listKab);
    		$('#kabupatenSuami').trigger('chosen:updated');
    	});
    });
    $('#kabupatenSuami').change(function(){
    	var id= $('#kabupatenSuami').val();
    	$.post("<?php echo route('getKecamatan'); ?>", {id :id }).done(function(data){
    		var listKec = '<option value="" disabled selected> .:: Pilih Kecamatan ::. </option>';
    		if(data.length > 0){
    			$.each(data, function(k,v){
    				listKec += '<option value="'+v.id_kecamatan+'">'+v.nama_kecamatan+'</option>';
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    		}
    		$('#kecamatanSuami').html(listKec);
    		$('#kecamatanSuami').trigger('chosen:updated');
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    });
    $('#kecamatanSuami').change(function(){
    	var id= $('#kecamatanSuami').val();
    	$.post("<?php echo route('getDesa'); ?>", {id :id }).done(function(data){
    		var listDes = '<option value="" disabled selected> .:: Pilih Desa ::. </option>';
    		if(data.length > 0){
    			$.each(data, function(k,v){
    				listDes += '<option value="'+v.id_desa+'">'+v.nama_desa+'</option>';
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    });

    $('#akadSebelum1 ').click(function(){
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		$('#form_datetime_today_akad').attr('required',true);
	});
	$('#akadSebelum2').click(function(){
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		$('#form_datetime_today_akad').attr('required',false);
	});

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        weekStart: 2,
        todayBtn:  1,
        autoclose: 1,
        todayHighlight: 1,
        startView: 2,
        minView: 2,
        forceParse: 0,
    });
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