Supplementary Information

Ticket No.	{!! Form::text('tkt_no', "", ['class'=>'form-control input-sm', 'placeholder'=>'']) !!}	Passport No.	{!! Form::text('passp_no', "", ['class'=>'form-control input-sm', 'placeholder'=>'']) !!}	Weight of Received Pc(s)	{!! Form::text('recv_wt', "", ['class'=>'form-control input-sm', 'placeholder'=>'']) !!}	Total Weight of Checked Bag(s)	{!! Form::text('chkd_wt', "", ['class'=>'form-control input-sm', 'placeholder'=>'']) !!}
Permanent Address {!! Form::textarea('perm_addr', \request("perm_addr"), ['class'=>'form-control input-sm', 'rows' => 4, 'placeholder'=>'']) !!}					Temporary Address; Dates From/To {!! Form::textarea('temp_addr', \request("temp_addr"), ['class'=>'form-control input-sm', 'rows' => 4, 'placeholder'=>'']) !!}
Permanent Phone No(s). {!! Form::text('perm_phone', \request("perm_phone"), ['class'=>'form-control input-sm', 'placeholder'=>'']) !!}					Temporary Phone No(s). {!! Form::text('temp_phone', \request("temp_phone"), ['class'=>'form-control input-sm', 'placeholder'=>'']) !!}
Local Delivery Instructions	{!! Form::textarea('deliv_instr', \request("deliv_instr"), ['class'=>'form-control input-sm', 'rows' => 2, 'placeholder'=>'']) !!}
Code of Combination Lock	{!! Form::text('lock_code', \request("lock_code"), ['class'=>'form-control input-sm', 'placeholder'=>'']) !!}				Keys Attached To PIR	Yes {!! Form::radio('keys_attached', 1, \request("keys_attached") == 1 ? true : false, ['class' => 'big-checkbox'] ) !!}		No {!! Form::radio('keys_attached', 0, \request("keys_attached") == 0 ? true : false, ['class' => 'big-checkbox']) !!}
Forwarding Instructions	{!! Form::textarea('local_forw_instr', \request("local_forw_instr"), ['class'=>'form-control input-sm', 'rows' => 2, 'placeholder'=>'']) !!}
Language	English {!! Form::radio('lang', 1, \request("lang") == 1 ? true : false, ['class' => 'big-checkbox']) !!}	@lang("content.other") {!! Form::radio('lang', 0, \request("lang") != 0 ? true : false, ['class' => 'big-checkbox']) !!}	{!! Form::text('lang_other', \request("lang_other"), ['class'=>'form-control input-sm', 'placeholder'=>'']) !!}		Reason For Loss	{!! Form::text('rsn_loss', \request("rsn_loss"), ['class'=>'form-control input-sm', 'placeholder'=>'']) !!}
					This Report Does Not Involve Any Acknowledgment of Liability
Agents Signature	{!! Form::checkbox('agent_signed', "1", \request("agent_signed") == "1" ? true : false, ['class' => 'big-checkbox', 'data-type' => '']) !!}	@lang("content.date")	{!! Form::text('report_date', \request("report_date"), ['class'=>'form-control dateTo input-sm margin_right float-left', 'placeholder'=>'Date']) !!}		Passenger's signature	{!! Form::checkbox('psng_signed', "1", \request("psng_signed") == "1" ? true : false, ['class' => 'big-checkbox', 'data-type' => '']) !!}