<%@ 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="http://java.sun.com/jsp/jstl/core" prefix="c" %>
<%@ taglib uri="/tags/struts-bean-el" prefix="bean-el" %>
<%@ taglib uri="http://struts.apache.org/tags-html" prefix="html-el" %>

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


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

      <tr>
        <td>
          <table width="100%" border="0" cellpadding="0" cellspacing="0" class="moduleShellTableBody" role="presentation">
              <tr>
                  <td colspan="2">
                    <%@ include file="/tiles/common/instructionalText.jsp" %>
                  </td>
              </tr>
            <tr><td><%@ include file="insuranceData.jsp" %></td></tr>
            <tr>
              <td>
                <table width="100%" border="0" align="center" cellspacing="0" cellpadding="0" role="presentation">
                    <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.add"/></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>
      </td>
       </tr>
    </table>
    </td>
  </tr>
</html-el:form>
</table>
