/*
 * 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 claimAf = [
  {
    cached: true,
    adaptiveform: '0.10.0',
    metadata: {
      grammar: 'json-formula-1.0.0',
      version: '1.0.0',
    },
    properties: {},
    items: [
      {
        constraintMessages: {
          required: 'Please fill in this field.',
        },
        placeholder: 'Search',
        name: 'searchQuery',
        fieldType: 'text-input',
        label: {
          value: 'Search',
        },
        required: false,
      },
    ],
  },
  {
    adaptiveform: '0.10.0',
    metadata: {
      grammar: 'json-formula-1.0.0',
      version: '1.0.0',
    },
    properties: {},
    items: [
      {
        constraintMessages: {
          required: 'Please fill in this field.',
        },
        placeholder: 'Search',
        name: 'searchQuery',
        fieldType: 'text-input',
        label: {
          value: 'Search',
        },
        required: false,
      },
    ],
  },
  {
    adaptiveform: '0.10.0',
    metadata: {
      grammar: 'json-formula-1.0.0',
      version: '1.0.0',
    },
    properties: {},
    items: [
      {
        name: 'panel-1',
        fieldType: 'panel',
        label: {
          value: 'Your Contact Information',
        },
        required: false,
        items: [
          {
            Fieldset: 'panel-1',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Your Name',
            fieldType: 'text-input',
            required: true,
            label: {
              value: 'Your Name',
            },
          },
          {
            Fieldset: 'panel-1',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Your Address',
            fieldType: 'text-input',
            required: true,
            label: {
              value: 'Your Address',
            },
          },
          {
            Fieldset: 'panel-1',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Your City',
            fieldType: 'text-input',
            required: true,
            label: {
              value: 'Your City',
            },
          },
          {
            Fieldset: 'panel-1',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Your State',
            fieldType: 'drop-down',
            enum: [
              '',
              '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',
            ],
            enumNames: [
              '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',
            ],
            label: {
              value: 'Your State',
            },
            required: false,
          },
          {
            Fieldset: 'panel-1',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Your Zip/Postal Code',
            fieldType: 'number-input',
            required: true,
            label: {
              value: 'Your Zip/Postal Code',
            },
          },
          {
            Fieldset: 'panel-1',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Your Province/Region',
            fieldType: 'text-input',
            label: {
              value: 'Your Province/Region (Optional)',
            },
            required: false,
          },
          {
            Fieldset: 'panel-1',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Your Country',
            fieldType: 'text-input',
            required: true,
            label: {
              value: 'Your Country',
            },
          },
          {
            Fieldset: 'panel-1',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Your Phone Number',
            fieldType: 'tel',
            required: true,
            label: {
              value: 'Your Phone Number',
            },
          },
          {
            Fieldset: 'panel-1',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Your Fax Number',
            fieldType: 'tel',
            label: {
              value: 'Your Fax Number (Optional)',
            },
            required: false,
          },
          {
            Fieldset: 'panel-1',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Your E-mail Address',
            fieldType: 'email',
            required: true,
            label: {
              value: 'Your E-mail Address',
            },
          },
        ],
      },
      {
        name: 'panel-2',
        fieldType: 'panel',
        label: {
          value: 'Insured Property Information (if different from above)',
        },
        required: false,
        items: [
          {
            Fieldset: 'panel-2',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Insured Property Address',
            fieldType: 'text-input',
            label: {
              value: 'Insured Property Address (Optional)',
            },
            required: false,
          },
          {
            Fieldset: 'panel-2',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Insured Property City',
            fieldType: 'text-input',
            label: {
              value: 'City (Optional)',
            },
            required: false,
          },
          {
            Fieldset: 'panel-2',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Insured Property State',
            fieldType: 'drop-down',
            enum: [
              '',
              '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',
            ],
            enumNames: [
              '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',
            ],
            label: {
              value: 'Your State',
            },
            required: false,
          },
          {
            Fieldset: 'panel-2',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Insured Property Zip/Postal Code',
            fieldType: 'number-input',
            label: {
              value: 'Zip/Postal Code (Optional)',
            },
            required: false,
          },
          {
            Fieldset: 'panel-2',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Insured Property Province/Region',
            fieldType: 'text-input',
            label: {
              value: 'Province/Region (Optional)',
            },
            required: false,
          },
          {
            Fieldset: 'panel-2',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Insured Property Country',
            fieldType: 'text-input',
            label: {
              value: 'Country (Optional)',
            },
            required: false,
          },
        ],
      },
      {
        name: 'panel-3',
        fieldType: 'panel',
        label: {
          value: 'Alt. Contact Information (person to respond to if different from above)',
        },
        required: false,
        items: [
          {
            Fieldset: 'panel-3',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Alt. Contact Name',
            fieldType: 'text-input',
            label: {
              value: 'Name (Optional)',
            },
            required: false,
          },
          {
            Fieldset: 'panel-3',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Alt. Contact Address',
            fieldType: 'text-input',
            label: {
              value: 'Address (Optional)',
            },
            required: false,
          },
          {
            Fieldset: 'panel-3',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Alt. Contact City',
            fieldType: 'text-input',
            label: {
              value: 'City (Optional)',
            },
            required: false,
          },
          {
            Fieldset: 'panel-3',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Alt. Contact State',
            fieldType: 'drop-down',
            enum: [
              '',
              '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',
            ],
            enumNames: [
              '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',
            ],
            label: {
              value: 'State',
            },
            required: false,
          },
          {
            Fieldset: 'panel-3',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Alt. Contact Zip/Postal Code',
            fieldType: 'number-input',
            label: {
              value: 'Zip/Postal Code (Optional)',
            },
            required: false,
          },
          {
            Fieldset: 'panel-3',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Alt. Contact Province/Region',
            fieldType: 'text-input',
            label: {
              value: 'Province/Region (Optional)',
            },
            required: false,
          },
          {
            Fieldset: 'panel-3',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Alt. Contact Country',
            fieldType: 'text-input',
            label: {
              value: 'Country (Optional)',
            },
            required: false,
          },
          {
            Fieldset: 'panel-3',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Alt. Contact Phone Number',
            fieldType: 'tel',
            label: {
              value: 'Phone Number (Optional)',
            },
            required: false,
          },
        ],
      },
      {
        name: 'panel-4',
        fieldType: 'panel',
        label: {
          value: 'Policy Information',
        },
        required: false,
        items: [
          {
            Fieldset: 'panel-4',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Policy Date',
            fieldType: 'date',
            label: {
              value: 'Policy Date (Optional)',
            },
            required: false,
          },
          {
            Fieldset: 'panel-4',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Policy Number',
            fieldType: 'text-input',
            label: {
              value: 'Policy Number (Optional)',
            },
            required: false,
          },
          {
            Fieldset: 'panel-4',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Name of Issuing Agent',
            fieldType: 'text-input',
            label: {
              value: 'Name of Issuing Agent (Optional)',
            },
            required: false,
          },
          {
            Fieldset: 'panel-4',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: "Agent's File Number/GF #",
            fieldType: 'text-input',
            label: {
              value: "Agent's File Number/GF # (Optional)",
            },
            required: false,
          },
          {
            Fieldset: 'panel-4',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Name of Insured or Borrower',
            fieldType: 'text-input',
            label: {
              value: 'Name of Insured or Borrower (Optional)',
            },
            required: false,
          },
          {
            Fieldset: 'panel-4',
            constraintMessages: {
              required: 'Please fill in this field.',
            },
            name: 'Briefly Describe Your Concern',
            fieldType: 'multiline-input',
            label: {
              value: 'Briefly Describe Your Concern (Optional)',
            },
            required: false,
          },
        ],
      },
      {
        constraintMessages: {
          required: 'Please fill in this field.',
        },
        name: 'form-button-498615320',
        fieldType: 'button',
        label: {
          value: 'Review',
        },
        required: false,
        buttonType: 'submit',
        properties: {
          'fd:buttonType': 'submit',
        },
      },
      {
        name: 'panel-5',
        fieldType: 'panel',
        required: false,
      },
    ],
  },
];

export default claimAf;
