@extends('layouts.admin')

@section('content')

<style type="text/css">
	.text-heading {
		color: #2991d0;
	}
	.heading {
		font-weight: 800!important;
	}
	.total_div {
		background-color: #f7f7f7; 
		height:40px;
	}
	.total_val {
	    background-color: #f7f7f7;
		height: 40px;
	}
	.input-group-text {
	    background: #f7f7f7;
		border: none;
	}
</style>

<form method="post" action="{{ route('quebecs.update', $quebecReport->id) }}">
	@csrf
	@method('PUT')
	<div class="page-wrapper">
	<div class="content">
		<div class="page-title mt-5">
			<p class="text-mute text-center">{{ __('messages.NOT AN OFFICIAL INVOICE OR TAX DOCUMENT') }}</p>
			<h3 class="text-center mb-1">UBER</h3>
			<p class="text-center text-center" style="width: 20%;margin-left: auto;margin-right: auto;">
				{{ __('messages.Tax summary for the period') }} 
				<select name="year" class="form-control" required> 
	                <option value="">{!! __('messages.Select year (2024, 2025 etc.)') !!}</option>
	                @for ($year = now()->year; $year >= now()->year - 6; $year--)
	                    <option value="{{ $year }}" {{ $quebecReport->year == $year ? 'selected' : '' }}>{{ $year }}</option>
	                @endfor
	            </select>
			</p>

			<h4 class="text-mute text-center" style="width: 40%;margin-left: auto;margin-right: auto;">
				<input type="text" name="name" id="name" class="form-control" value="{{ $quebecReport->name }}" placeholder="{{ __('messages.Enter your name') }}" required>
			</h4>

			<p class="text-mute text-center">{{ __('messages.Many of the items listed below may be tax dedectible. For more information, we recommend that you seek guidance from a qualified tax site or service.') }}</p>
		</div>
		@include('layouts.errors')
		<div class="container mt-5">
			<!-- 1st Section -->
			<div class="row justify-content-center">
				<div class="row mb-5">
					<div class="col-md-12">
						<h4 class="text-heading">{{ __('messages.UBER RIDES - GROSS FARES BREAKDOWN') }}</h4>
						<p class="mt-3">{{ __('messages.This section indicates the fees you have charged to Riders.') }}</p>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="gross_uber_rides_fares">{{ __('messages.Gross Uber rides fares') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="gross_uber_rides_fares" id="gross_uber_rides_fares" value="{{ $quebecReport->gross_uber_rides_fares }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="booking_fee">{{ __('messages.Booking fee') }}</label>
					</div>
					<div class="col-md-6 form-group">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="booking_fee" id="booking_fee" value="{{ $quebecReport->booking_fee }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="mtq_dues">{{ __('messages.MTQ Dues') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="mtq_dues" id="mtq_dues" value="{{ $quebecReport->mtq_dues }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="airport_fee">{{ __('messages.Airport fee') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="airport_fee" id="airport_fee" value="{{ $quebecReport->airport_fee }}" required>
					    </div>
					</div>
				</div>
				
				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="split_fare">{{ __('messages.Split fare') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="split_fare" id="split_fare" value="{{ $quebecReport->split_fare }}" required>
					    </div>
					</div>
				</div>
				
				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="miscellaneous">{{ __('messages.Miscellaneous') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="miscellaneous" id="miscellaneous" value="{{ $quebecReport->miscellaneous }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="tolls">{{ __('messages.Tolls') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="tolls" id="tolls" value="{{ $quebecReport->tolls }}" required>
					    </div>
					</div>
				</div>
				
				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="tips">{{ __('messages.Tips') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="tips" id="tips" value="{{ $quebecReport->tips }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="gst_collected_from_riders">{{ __('messages.GST you collected from Riders') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="gst_collected_from_riders" id="gst_collected_from_riders" value="{{ $quebecReport->gst_collected_from_riders }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="qst_collected_from_riders">{{ __('messages.QST you collected from Riders') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="qst_collected_from_riders" id="qst_collected_from_riders" value="{{ $quebecReport->qst_collected_from_riders }}" required>
					    </div>
					</div>
				</div>

				<div class="row">
					<div class="col-md-6 d-flex align-items-center total_div">
					    <label class="form-label heading m-0" for="section_1_total">{{ __('messages.Total') }}</label>
					</div>

					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text heading total_label">CA$</span>
					        <input type="number" step="0.01" readonly class="form-control heading total_val" name="section_1_total" id="section_1_total" value="{{ $quebecReport->section_1_total }}" required>
					    </div>
					</div>
				</div>
			</div>

			<!-- 2nd Section -->
			<div class="row justify-content-center mt-5">
				<div class="row mb-5">
					<div class="col-md-12">
						<h4 class="text-heading">{{ __('messages.UBER RIDES - FEES BREAKDOWN') }}</h4>
						<p class="mt-3">{{ __('messages.This section indicates the fees you have paid to Uber. These include the service fees, as well as passthrough fees such as the booking fee, regulatory fees or airport fees.') }}</p>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="service_fee">{{ __('messages.Service Fee') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group"> 
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control calc-total" name="service_fee" id="service_fee" value="{{ $quebecReport->service_fee }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="other_amounts">{{ __('messages.Other Amounts (Booking, Airport, Split Fare, Green Future Fees)') }}</label>
					</div>
					<div class="col-md-6 form-group">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control calc-total" name="other_amounts" id="other_amounts" value="{{ $quebecReport->other_amounts }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="fee_discount">{{ __('messages.Fee Discount') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">-CA$</span>
					        <input type="number" step="0.01" class="form-control calc-total" name="fee_discount" id="fee_discount" value="{{ $quebecReport->fee_discount }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="gst_paid_to_uber">{{ __('messages.GST you paid to Uber') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control calc-total" name="gst_paid_to_uber" id="gst_paid_to_uber" value="{{ $quebecReport->gst_paid_to_uber }}" required>
					    </div>
					</div>
				</div>
				
				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="qst_paid_to_uber">{{ __('messages.QST you paid to Uber') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control calc-total" name="qst_paid_to_uber" id="qst_paid_to_uber" value="{{ $quebecReport->qst_paid_to_uber }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center total_div">
					    <label class="form-label heading m-0" for="section_2_total">{{ __('messages.Total') }}</label>
					</div>

					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text heading total_label">CA$</span>
					        <input type="number" step="0.01" readonly class="form-control heading total_val" name="section_2_total" id="section_2_total" value="{{ $quebecReport->section_2_total }}" required>
					    </div>
					</div>
				</div>


				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="uber_gst_registration_number">{{ __('messages.Uber GST registration number') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <input type="text" class="form-control" name="uber_gst_registration_number" id="uber_gst_registration_number" value="{{ $quebecReport->uber_gst_registration_number }}" required>
					    </div>
					</div>
				</div>
				
				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="uber_qst_registration_number">{{ __('messages.Uber QST registration number') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <input type="text" class="form-control" name="uber_qst_registration_number" id="uber_qst_registration_number" value="{{ $quebecReport->uber_qst_registration_number }}" required>
					    </div>
					</div>
				</div>
			</div>


			<!-- 3rd Section -->
			<div class="row justify-content-center mt-5">
				<div class="row mb-5">
					<div class="col-md-12">
						<h4 class="text-heading">{{ __('messages.FOR YOUR GST/QST RETURN') }}</h4>
						<p class="mt-3">{{ __('messages.This section includes relevant information to prepare your GST/QST return. Please note that, consistent with the tax agreement required by Revenu Québec, the amounts shown as remitted by Uber on your behalf for GST and QST are considered instalment payments remitted by you to Revenu Québec. Additional adjustments to the tax payable by you may be required depending on your circumstances (see instructions on this Revenu Québec') }} 
						<a href="https://www.revenuquebec.ca/en/businesses/consumption-taxes/gsthst-and-qst/special-cases-gsthst-and-qst/drivers-related-to-a-transportation-system-operator-under-agreement/" target="_blank">webpage</a>).</p>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="supplies_excluding_gst_qst">{{ __('messages.Supplies excluding GST and QST') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="supplies_excluding_gst_qst" id="supplies_excluding_gst_qst" value="{{ $quebecReport->supplies_excluding_gst_qst }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="gst_remitted_by_uber">{{ __('messages.GST remitted by Uber on your behalf') }}</label>
					</div>
					<div class="col-md-6 form-group">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="gst_remitted_by_uber" id="gst_remitted_by_uber" value="{{ $quebecReport->gst_remitted_by_uber }}" required>
					    </div>
					</div>
				</div>



				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="qst_remitted_by_uber">{{ __('messages.QST remitted by Uber on your behalf') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="qst_remitted_by_uber" id="qst_remitted_by_uber" value="{{ $quebecReport->qst_remitted_by_uber }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="gst_collected_from_riders_sec3">{{ __('messages.GST you collected from Riders') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="gst_collected_from_riders_sec3" id="gst_collected_from_riders_sec3" value="{{ $quebecReport->gst_collected_from_riders_sec3 }}" required>
					    </div>
					</div>
				</div>
				
				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="qst_collected_from_riders_sec3">{{ __('messages.QST you collected from Riders') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="qst_collected_from_riders_sec3" id="qst_collected_from_riders_sec3" value="{{ $quebecReport->qst_collected_from_riders_sec3 }}" required>
					    </div>
					</div>
				</div>
				
				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="your_gst_number_sec3">{{ __('messages.Your GST number') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <input type="text" class="form-control" name="your_gst_number_sec3" id="your_gst_number_sec3" value="{{ $quebecReport->your_gst_number_sec3 }}" required>
					    </div>
					</div> 
				</div>
				
				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="your_qst_number_sec3">{{ __('messages.Your QST number') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <input type="text" class="form-control" name="your_qst_number_sec3" id="your_qst_number_sec3" value="{{ $quebecReport->your_qst_number_sec3 }}" required>
					    </div>
					</div>
				</div>
			</div>

			<!-- 4th Section -->
			<div class="row justify-content-center mt-5">
				<div class="row mb-5">
					<div class="col-md-12">
						<h4 class="text-heading">{{ __('messages.UBER EATS - GROSS FARES BREAKDOWN') }}</h4>
						<p class="mt-3">{{ __('messages.Tolls and tips not subject to GST/HST. You have collected GST/HST from Uber on your Uber Eats Fares if you are registered for GST/HST and have entered all the relevant information in your tax profile. If you are not registered for GST/HST because you are a small supplier (e.g., you have less than $30,000 in sales over the past 12 months), you do not need to fill your tax profile.') }}</p>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="gross_uber_eats_fare">{{ __('messages.Gross Uber Eats fare') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="gross_uber_eats_fare" id="gross_uber_eats_fare" value="{{ $quebecReport->gross_uber_eats_fare }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="eats_tips">{{ __('messages.Tips') }}</label>
					</div>
					<div class="col-md-6 form-group">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="eats_tips" id="eats_tips" value="{{ $quebecReport->eats_tips }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="gst_collected_from_uber">{{ __('messages.GST you collected from Uber') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="gst_collected_from_uber" id="gst_collected_from_uber" value="{{ $quebecReport->gst_collected_from_uber }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="qst_collected_from_uber">{{ __('messages.QST you collected from Uber') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="qst_collected_from_uber" id="qst_collected_from_uber" value="{{ $quebecReport->qst_collected_from_uber }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center total_div">
					    <label class="form-label heading m-0" for="section_4_total">{{ __('messages.Total') }}</label>
					</div>

					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text heading total_label">CA$</span>
					        <input type="number" step="0.01" readonly class="form-control heading total_val" name="section_4_total" id="section_4_total" value="{{ $quebecReport->section_4_total }}" required>
					    </div>
					</div>
				</div>

				
				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="your_gst_number_sec4">{{ __('messages.Your GST number') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <input type="text" class="form-control" name="your_gst_number_sec4" id="your_gst_number_sec4" value="{{ $quebecReport->your_gst_number_sec4 }}" required>
					    </div>
					</div>
				</div>
				
				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="your_qst_number_sec4">{{ __('messages.Your QST number') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <input type="text" class="form-control" name="your_qst_number_sec4" id="your_qst_number_sec4" value="{{ $quebecReport->your_qst_number_sec4  }}" required>
					    </div>
					</div>
				</div>
			</div>

			<!-- 5th Section -->
			<div class="row justify-content-center mt-5">
				<div class="row mb-5">
					<div class="col-md-12">
						<h4 class="text-heading">{{ __('messages.OTHER INCOME BREAKDOWN') }}</h4>
						<p class="mt-3">{{ __('messages.This section indicates other amounts paid to you by Uber. Referrals and Promotions are subject to GST/HST') }}</p>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="quick_accounting_method_6085">{{ __('messages.6.085% with the Quick Accounting Method') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="quick_accounting_method_6085" id="quick_accounting_method_6085" value="{{ $quebecReport->quick_accounting_method_6085 }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="gst_collected_from_uber_sec5">{{ __('messages.GST you collected from Uber') }}</label>
					</div>
					<div class="col-md-6 form-group">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="gst_collected_from_uber_sec5" id="gst_collected_from_uber_sec5" value="{{ $quebecReport->gst_collected_from_uber_sec5 }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="qst_collected_from_uber_sec5">{{ __('messages.QST you collected from Uber') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text">CA$</span>
					        <input type="number" step="0.01" class="form-control" name="qst_collected_from_uber_sec5" id="qst_collected_from_uber_sec5" value="{{ $quebecReport->qst_collected_from_uber_sec5 }}" required>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center total_div">
					    <label class="form-label heading m-0" for="section_5_total">{{ __('messages.Total') }}</label>
					</div>

					<div class="col-md-6">
						<div class="input-group">
					        <span class="input-group-text heading total_label">CA$</span>
					        <input type="number" step="0.01" readonly class="form-control heading total_val" name="section_5_total" id="section_5_total" value="{{ $quebecReport->section_5_total }}" required>
					    </div>
					</div>
				</div>

				
				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="uber_gst_registration_number_sec5">{{ __('messages.Uber GST registration number') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <input type="text" class="form-control" name="uber_gst_registration_number_sec5" id="uber_gst_registration_number_sec5" value="{{ $quebecReport->uber_gst_registration_number_sec5 }}" required>
					    </div>
					</div>
				</div>
				
				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="uber_qst_registration_number_sec5">{{ __('messages.Uber QST registration number') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <input type="text" class="form-control" name="uber_qst_registration_number_sec5" id="uber_qst_registration_number_sec5" value="{{ $quebecReport->uber_qst_registration_number_sec5  }}" required>
					    </div>
					</div>
				</div>
			</div>
			
			<div class="row justify-content-center mt-5">
				<div class="col-md-6 d-flex align-items-center">
					<label class="form-label" for="other_taxable_income">{{ __('messages.Other Taxable Income') }}</label>
				</div> 
				<div class="col-md-6">
					<div class="input-group">
				        <span class="input-group-text">CA$</span>
				        <input type="number" step="0.01" class="form-control" name="other_taxable_income" id="other_taxable_income" value="{{ $quebecReport->other_taxable_income }}">
				    </div>
				</div>
			</div>

			<!-- 6th Section -->
			<div class="row justify-content-center mt-5">
				<div class="row mb-2">
					<div class="col-md-12">
						<h4 class="text-heading">{{ __('messages.OTHER POTENTIAL DEDUCTIONS') }}</h4>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="on_trip_mileage">{{ __('messages.On Trip Mileage') }}</label>
					</div>
					<div class="col-md-6">
						<div class="input-group">
					        <input type="number" step="0.01" class="form-control" name="on_trip_mileage" id="on_trip_mileage" value="{{ $quebecReport->on_trip_mileage }}" required>
					        <span class="input-group-text">Km</span>
					    </div>
					</div>
				</div>

				<div class="row mb-1">
					<div class="col-md-6 d-flex align-items-center">
						<label class="form-label" for="online_mileage">{{ __('messages.Online Mileage') }}</label>
					</div>
					<div class="col-md-6 form-group">
						<div class="input-group">
					        <input type="number" step="0.01" class="form-control" name="online_mileage" id="online_mileage" value="{{ $quebecReport->online_mileage }}" required>
					        <span class="input-group-text">Km</span>
					    </div>
					</div>
				</div>

				<div class="row mb-1 mt-5">
					<div class="col-md-4">
						<label class="form-label" for="period_from">{{ __('messages.Period From') }}</label>
						<input type="date" class="form-control" name="period_from" id="period_from" value="{{ $quebecReport->period_from }}" required>
					</div>
					<div class="col-md-4">
						<label class="form-label" for="period_to">{{ __('messages.Period To') }}</label>
						<input type="date" class="form-control" name="period_to" id="period_to" value="{{ $quebecReport->period_to }}" required>
					</div>
					<div class="col-md-4">
						<label class="form-label" for="due_date">{{ __('messages.Due Date') }}</label>
						<input type="date" class="form-control" name="due_date" id="due_date" value="{{ $quebecReport->due_date }}" required>
					</div>
				</div>

				
				<div class="row mb-1 mt-5">
					<div class="col-md-12 text-center d-flex align-items-center">
						<p>{{ __('messages.The information in this summary does not reflect your personal tax situation and is informative only. Nothing in this summary constitutes tax advice nor an employment relationship between Uber and you, neither express nor implied. Please consult your local tax adviser or tax administration for your personal tax obligations') }}</p>
					</div>
				</div>
			</div>

			<div class="row justify-content-center mt-5 mb-5">
				<div class="col-lg-12 text-center">
					<button type="submit" class="btn btn-submit">{{ __('messages.Save') }}</button>
					<a href="{{ route('quebecs.index') }}" class="btn btn-cancel me-2">{{ __('messages.Cancel') }}</a>
				</div>
			</div>
		</div>
	</div>
 </div>
</form>
@endsection