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| <!DOCTYPE html>
<html>
<head>
<meta charset="utf-8" />
<link rel="stylesheet" href="stylesss.css" />
<title>Titre</title>
</head>
<body>
<?php
if(isset($_POST['submit']))
{
$nomass = htmlentities (trim ($_POST['nomass']));
$preass = htmlentities (trim ($_POST['preass']));
$nomconj = htmlentities (trim ($_POST['nomconj']));
$preconj = htmlentities (trim ($_POST['preconj']));
$nbreenft = htmlentities (trim ($_POST['nbreenft']));
if (($nomass<>'') AND ($preass<>'') AND ($nomass<>'') AND ($preconj<>'') AND ($nbreenft<>''))
{
$connect = mysql_connect('localhost', 'root', '') or die ('Impossible de se connnecter à la Base de Données');
$mabd = mysql_select_db ('assurance');
$gra = mysql_query ("SELECT * FROM assure WHERE nomass='$nomass' ");
$tra = mysql_num_rows($gra);
if($tra==0)
{
mysql_query ("INSERT INTO assure (idass, nomass, preass, nomconj, preconj, nbreenft) VALUES ('', '$nomass', '$preass', '$nomconj', '$preconj', '$nbreenft') ");
die (" <br/>Les données saisies ont été bien enregistrées. <a href='assurance.php'> <strong> Retour </strong> </a>");
} else "Cet assuré existe déjà dans la BD.";
}else echo "Veuillez renseigner tous les champs SVP.";
}
?>
<form method="post" action="assurance.php">
<p>
<table border="1" align="center">
<tr> <th>NOM ASSURE(E) </th>
<td><input type="text" name="nomass" id="nomass" size="32" maxlength="255" /> </td>
</tr>
<tr> <th>PRENOMS ASSURE(E) </th>
<td><input type="text" name="preass" id="preass" size="32" maxlength="255" /> </td>
</tr>
<tr> <th>NOM CONJOINT(E) </th>
<td><input type="text" name="nomconj" id="nomconj" size="32" maxlength="255" /> </td>
</tr>
<tr> <th>PRENOMS CONJOINT(E) </th>
<td><input type="text" name="preconj" id="preconj" size="32" maxlength="255" /> </td>
</tr>
<tr> <th>NOMBRE D'ENFANTS</th>
<td> <select name="nbreenft" id="nbreenft" >
<option value="1" selected="selected" >1</option>
<option value="2" >2</option>
<option value="3" >3</option>
<option value="4" >4</option>
<option value="5" >5</option>
<option value="6" >6</option>
<option value="7">7</option>
<option value="8" >8</option>
<option value="9" >9</option>
<option value="10" >10</option>
<option value="11" >11</option>
<option value="12" >12</option>
</select>
</td>
</tr>
<tr>
<th colspan="2"><input type="submit" value="VALIDER" name="submit" id="boutonvalider" /> </th>
</tr>
</table>
</p>
</form>
?>
<table border="1" align="center">
<?php
for ($i=1; $i<=$nbreenft; $i++)
{
<tr>
<td colspan="2"></td>
<?php echo'<td colspan="">ENFANT N° ......</td>'; ?>
</tr>
<form>
<tr> <td colspan="2">TYPE ASSURANCE </td>
<?php echo'<td>
<select name="typassur" id="typassur" >
<option value="toutrisk">Tout Risque</option>
<option value="maladie">Maladie</option>
<option value="accident">Accident</option>
</select>
</td>'; ?>
</tr>
<tr>
<td colspan="2">NOM </td>
<?php echo'<td><input type="text" name="nom" id="nom" size="32" maxlength="255" /> </td>'; ?>
</tr>
<tr> <td colspan="2">PRENOMS </td>
<?php echo'<td><input type="text" name="prenom" id="prenom" size="32" maxlength="255" /> </td>'; ?>
</tr>
<tr> <td colspan="2">DATE DE NAISSANCE</td>
<?php echo'<td><input type="date" name="datnaiss" id="datnaiss" size="32" maxlength="255" /> </td>'; ?>
</tr>
<tr> <td colspan="2">LIEU DE NAISSANCE</td>
<?php echo'<td><input type="text" name="lieunaiss" id="lieunaiss" size="32" maxlength="255" /> </td>'; ?>
</tr>
<tr> <td colspan="2">SEXE </td>
<?php echo'<td>
<select name="sexe" id="sexe" >
<option value="Masculin">Masculin</option>
<option value="Feminin">Feminin</option>
</select>
</td>'; ?>
</tr>
<tr>
<td colspan="3"><input type="submit" value="ENREGISTRER" name="submit" id="enregistrer" /> </td>
</tr>
}
?>
</table>
</form>
</body>
</html> |
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