<%@ page contentType="text/html;charset=UTF-8" %>
<%@ taglib uri="/tags/struts-logic" prefix="logic" %>
<%@ taglib uri="/tags/displaytag" prefix="display" %>
<%@ taglib uri="/tags/esr-core" prefix="esrcore" %>
<%@ taglib uri="/tags/struts-bean-el" prefix="bean-el" %>
<%@ taglib uri="http://struts.apache.org/tags-html" prefix="html-el" %>
<%@ taglib uri="http://java.sun.com/jsp/jstl/core" prefix="c" %>

<script>
// Perform all page initialization
function onLoadInit()
{
    updateCountryFields();
}
</script>

<TABLE id=tblFinancials cellSpacing=0 cellPadding=0 width=100% border=0 class="moduleShell">
<html-el:form action="/editInsurance" method="post">
  <%@ include file="/admin/csrfgentoken.jsp" %>
 <tr>
   <td>
   <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellTable">
    <tr>
    <td>
      <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellTableHead">
        <tr>
          <td width="5%" class="moduleBlueBox">&nbsp;</td>
          <td class="moduleHeadline">Update Insurance Carrier - <c:out value="${insuranceInfoForm.insCompanyName}" /></TD>
        </tr>
       </table>
    </td>
     </TR>
     <tr>
    <td>

    <table width="100%" border="0" cellspacing="0" cellpadding="0" class="moduleShellTableBody">
      <tr><td><br><html-el:hidden property="insuranceId" /><%@ include file="insuranceData.jsp" %></td></tr>
      <tr>
        <td>
          <table width="100%" border="0" align="center" cellspacing="0" cellpadding="0">
              <tr>
                <td width="45%"><img alt=""  src="../images/spacer.gif"/></td>
                <td><img alt=""  src="../images/buttonEndLeft.gif" /></td>
                <td><html-el:submit property="methodName" style="width:50; vertical-align: top;" styleClass="buttonText"><bean-el:message key="button.update"/></html-el:submit></td>
                <td><img alt=""  src="../images/buttonEndRight.gif"/></td>
                <td width="1%"><img alt=""  src="../images/spacer.gif"/></td>
                <td><img alt=""  src="../images/buttonEndLeft.gif" /></td>
                <td><html-el:submit property="methodName" style="width:50; vertical-align: top;" styleClass="buttonText"><bean-el:message key="button.delete"/></html-el:submit></td>
                <td><img alt=""  src="../images/buttonEndRight.gif"/></td>
                <td width="1%"><img alt=""  src="../images/spacer.gif"/></td>
                <td><img alt=""  src="../images/buttonEndLeft.gif"/></td>
                <td><html-el:submit property="methodName" style="width:50; vertical-align: top;" styleClass="buttonText"><bean-el:message key="button.cancel"/></html-el:submit></td>
                <td><img alt=""  src="../images/buttonEndRight.gif"/></td>
                <td width="45%"><img alt=""  src="../images/spacer.gif"/></td>
              </tr>
          </table>
          <br>
        </td>
      </tr>
    </table>


    <!-- module shell table body -->
  </td>
 </tr>
</TABLE>
<!-- module shell table -->
</td>
</tr>
</html-el:form>
</TABLE>
<!-- module shell -->
