/*
 * Copyright 2022 Adobe. All rights reserved.
 * This file is licensed to you under the Apache License, Version 2.0 (the "License");
 * you may not use this file except in compliance with the License. You may obtain a copy
 * of the License at http://www.apache.org/licenses/LICENSE-2.0
 *
 * Unless required by applicable law or agreed to in writing, software distributed under
 * the License is distributed on an "AS IS" BASIS, WITHOUT WARRANTIES OR REPRESENTATIONS
 * OF ANY KIND, either express or implied. See the License for the specific language
 * governing permissions and limitations under the License.
 */
const claim = [
  {
    name: 'Form_1_cached',
    stats: {
      name: 'Form_1',
      isMarketToForm: false,
      fields: 2,
      hiddenFields: 0,
      attachmentsUsed: false,
      recaptchaUsed: false,
      isPDF: false,
    },
    data: [
      {
        Name: 'searchQuery',
        Type: 'text',
        Placeholder: 'Search',
        Label: 'Search',
      },
      {
        Type: 'submit',
        Label: 'Search',
      },
    ],
  },
  {
    name: 'Form_2',
    stats: {
      name: 'Form_2',
      isMarketToForm: false,
      fields: 2,
      hiddenFields: 0,
      attachmentsUsed: false,
      recaptchaUsed: false,
      isPDF: false,
    },
    data: [
      {
        Name: 'searchQuery',
        Type: 'text',
        Placeholder: 'Search',
        Label: 'Search',
      },
      {
        Type: 'submit',
        Label: 'Search',
      },
    ],
  },
  {
    name: 'new_form',
    stats: {
      name: 'new_form',
      isMarketToForm: false,
      fields: 36,
      hiddenFields: 0,
      attachmentsUsed: false,
      recaptchaUsed: true,
      isPDF: false,
    },
    data: [
      {
        Name: 'panel-1',
        Type: 'fieldset',
        Label: 'Your Contact Information',
      },
      {
        Name: 'Your Name',
        Type: 'text',
        Label: 'Your Name',
        Mandatory: true,
        Fieldset: 'panel-1',
      },
      {
        Name: 'Your Address',
        Type: 'text',
        Label: 'Your Address',
        Mandatory: true,
        Fieldset: 'panel-1',
      },
      {
        Name: 'Your City',
        Type: 'text',
        Label: 'Your City',
        Mandatory: true,
        Fieldset: 'panel-1',
      },
      {
        Name: 'Your State',
        Type: 'select',
        Label: 'Your State',
        Options: ',AL,AK,AZ,AR,CA,CO,CT,DE,DC,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OK,OR,PA,PR,RI,MP,SC,SD,TN,TX,UT,VT,VI,VA,WA,WV,WI,WY',
        OptionNames: [
          'Select a State',
          'Alabama',
          'Alaska',
          'Arizona',
          'Arkansas',
          'California',
          'Colorado',
          'Connecticut',
          'Delaware',
          'District of Columbia',
          'Florida',
          'Georgia',
          'Guam',
          'Hawaii',
          'Idaho',
          'Illinois',
          'Indiana',
          'Iowa',
          'Kansas',
          'Kentucky',
          'Louisiana',
          'Maine',
          'Maryland',
          'Massachusetts',
          'Michigan',
          'Minnesota',
          'Mississippi',
          'Missouri',
          'Montana',
          'Nebraska',
          'Nevada',
          'New Hampshire',
          'New Jersey',
          'New Mexico',
          'New York',
          'North Carolina',
          'North Dakota',
          'Ohio',
          'Oklahoma',
          'Oregon',
          'Pennsylvania',
          'Puerto Rico',
          'Rhode Island',
          'Saipan',
          'South Carolina',
          'South Dakota',
          'Tennessee',
          'Texas',
          'Utah',
          'Vermont',
          'Virgin Islands',
          'Virginia',
          'Washington',
          'West Virginia',
          'Wisconsin',
          'Wyoming',
        ],
        Fieldset: 'panel-1',
      },
      {
        Name: 'Your Zip/Postal Code',
        Type: 'number',
        Label: 'Your Zip/Postal Code',
        Mandatory: true,
        Fieldset: 'panel-1',
      },
      {
        Name: 'Your Province/Region',
        Type: 'text',
        Label: 'Your Province/Region (Optional)',
        Fieldset: 'panel-1',
      },
      {
        Name: 'Your Country',
        Type: 'text',
        Label: 'Your Country',
        Mandatory: true,
        Fieldset: 'panel-1',
      },
      {
        Name: 'Your Phone Number',
        Type: 'tel',
        Label: 'Your Phone Number',
        Mandatory: true,
        Fieldset: 'panel-1',
      },
      {
        Name: 'Your Fax Number',
        Type: 'tel',
        Label: 'Your Fax Number (Optional)',
        Fieldset: 'panel-1',
      },
      {
        Name: 'Your E-mail Address',
        Type: 'email',
        Label: 'Your E-mail Address',
        Mandatory: true,
        Fieldset: 'panel-1',
      },
      {
        Name: 'panel-2',
        Type: 'fieldset',
        Label: 'Insured Property Information (if different from above)',
      },
      {
        Name: 'Insured Property Address',
        Type: 'text',
        Label: 'Insured Property Address (Optional)',
        Fieldset: 'panel-2',
      },
      {
        Name: 'Insured Property City',
        Type: 'text',
        Label: 'City (Optional)',
        Fieldset: 'panel-2',
      },
      {
        Name: 'Insured Property State',
        Type: 'select',
        Label: 'Your State',
        Options: ',AL,AK,AZ,AR,CA,CO,CT,DE,DC,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OK,OR,PA,PR,RI,MP,SC,SD,TN,TX,UT,VT,VI,VA,WA,WV,WI,WY',
        OptionNames: [
          'Select a State',
          'Alabama',
          'Alaska',
          'Arizona',
          'Arkansas',
          'California',
          'Colorado',
          'Connecticut',
          'Delaware',
          'District of Columbia',
          'Florida',
          'Georgia',
          'Guam',
          'Hawaii',
          'Idaho',
          'Illinois',
          'Indiana',
          'Iowa',
          'Kansas',
          'Kentucky',
          'Louisiana',
          'Maine',
          'Maryland',
          'Massachusetts',
          'Michigan',
          'Minnesota',
          'Mississippi',
          'Missouri',
          'Montana',
          'Nebraska',
          'Nevada',
          'New Hampshire',
          'New Jersey',
          'New Mexico',
          'New York',
          'North Carolina',
          'North Dakota',
          'Ohio',
          'Oklahoma',
          'Oregon',
          'Pennsylvania',
          'Puerto Rico',
          'Rhode Island',
          'Saipan',
          'South Carolina',
          'South Dakota',
          'Tennessee',
          'Texas',
          'Utah',
          'Vermont',
          'Virgin Islands',
          'Virginia',
          'Washington',
          'West Virginia',
          'Wisconsin',
          'Wyoming',
        ],
        Fieldset: 'panel-2',
      },
      {
        Name: 'Insured Property Zip/Postal Code',
        Type: 'number',
        Label: 'Zip/Postal Code (Optional)',
        Fieldset: 'panel-2',
      },
      {
        Name: 'Insured Property Province/Region',
        Type: 'text',
        Label: 'Province/Region (Optional)',
        Fieldset: 'panel-2',
      },
      {
        Name: 'Insured Property Country',
        Type: 'text',
        Label: 'Country (Optional)',
        Fieldset: 'panel-2',
      },
      {
        Name: 'panel-3',
        Type: 'fieldset',
        Label: 'Alt. Contact Information (person to respond to if different from above)',
      },
      {
        Name: 'Alt. Contact Name',
        Type: 'text',
        Label: 'Name (Optional)',
        Fieldset: 'panel-3',
      },
      {
        Name: 'Alt. Contact Address',
        Type: 'text',
        Label: 'Address (Optional)',
        Fieldset: 'panel-3',
      },
      {
        Name: 'Alt. Contact City',
        Type: 'text',
        Label: 'City (Optional)',
        Fieldset: 'panel-3',
      },
      {
        Name: 'Alt. Contact State',
        Type: 'select',
        Label: 'State',
        Options: ',AL,AK,AZ,AR,CA,CO,CT,DE,DC,FL,GA,GU,HI,ID,IL,IN,IA,KS,KY,LA,ME,MD,MA,MI,MN,MS,MO,MT,NE,NV,NH,NJ,NM,NY,NC,ND,OH,OK,OR,PA,PR,RI,MP,SC,SD,TN,TX,UT,VT,VI,VA,WA,WV,WI,WY',
        OptionNames: [
          'Select a State',
          'Alabama',
          'Alaska',
          'Arizona',
          'Arkansas',
          'California',
          'Colorado',
          'Connecticut',
          'Delaware',
          'District of Columbia',
          'Florida',
          'Georgia',
          'Guam',
          'Hawaii',
          'Idaho',
          'Illinois',
          'Indiana',
          'Iowa',
          'Kansas',
          'Kentucky',
          'Louisiana',
          'Maine',
          'Maryland',
          'Massachusetts',
          'Michigan',
          'Minnesota',
          'Mississippi',
          'Missouri',
          'Montana',
          'Nebraska',
          'Nevada',
          'New Hampshire',
          'New Jersey',
          'New Mexico',
          'New York',
          'North Carolina',
          'North Dakota',
          'Ohio',
          'Oklahoma',
          'Oregon',
          'Pennsylvania',
          'Puerto Rico',
          'Rhode Island',
          'Saipan',
          'South Carolina',
          'South Dakota',
          'Tennessee',
          'Texas',
          'Utah',
          'Vermont',
          'Virgin Islands',
          'Virginia',
          'Washington',
          'West Virginia',
          'Wisconsin',
          'Wyoming',
        ],
        Fieldset: 'panel-3',
      },
      {
        Name: 'Alt. Contact Zip/Postal Code',
        Type: 'number',
        Label: 'Zip/Postal Code (Optional)',
        Fieldset: 'panel-3',
      },
      {
        Name: 'Alt. Contact Province/Region',
        Type: 'text',
        Label: 'Province/Region (Optional)',
        Fieldset: 'panel-3',
      },
      {
        Name: 'Alt. Contact Country',
        Type: 'text',
        Label: 'Country (Optional)',
        Fieldset: 'panel-3',
      },
      {
        Name: 'Alt. Contact Phone Number',
        Type: 'tel',
        Label: 'Phone Number (Optional)',
        Fieldset: 'panel-3',
      },
      {
        Name: 'panel-4',
        Type: 'fieldset',
        Label: 'Policy Information',
      },
      {
        Name: 'Policy Date',
        Type: 'date',
        Label: 'Policy Date (Optional)',
        Fieldset: 'panel-4',
      },
      {
        Name: 'Policy Number',
        Type: 'text',
        Label: 'Policy Number (Optional)',
        Fieldset: 'panel-4',
      },
      {
        Name: 'Name of Issuing Agent',
        Type: 'text',
        Label: 'Name of Issuing Agent (Optional)',
        Fieldset: 'panel-4',
      },
      {
        Name: "Agent's File Number/GF #",
        Type: 'text',
        Label: "Agent's File Number/GF # (Optional)",
        Fieldset: 'panel-4',
      },
      {
        Name: 'Name of Insured or Borrower',
        Type: 'text',
        Label: 'Name of Insured or Borrower (Optional)',
        Fieldset: 'panel-4',
      },
      {
        Name: 'Briefly Describe Your Concern',
        Type: 'textarea',
        Label: 'Briefly Describe Your Concern (Optional)',
        Fieldset: 'panel-4',
      },
      {
        Name: 'form-button-498615320',
        Type: 'submit',
        Label: 'Review',
      },
      {
        Name: 'panel-5',
        Type: 'fieldset',
      },
    ],
  },
];
export default claim;
