<div class="modal fade" id="requestacallback" tabindex="-1" role="dialog" aria-labelledby="exampleModalCenterTitle" aria-hidden="true">
      <div class="modal-dialog modal-dialog-centered modal-lg" role="document">
        <div class="modal-content">
          <div class="modal-header p-0 border-bottom-0">
            <div class="col-lg-12 col-12 text-right font-weight-bold pt-3"><i class="icon-close cb-close cursor-pointer" data-dismiss="modal" aria-label="Close"></i></div>
          </div>
          <div class="modal-body px-5">
              
                {form->start name="formReqCallBack" method="post" enctype="multipart/form-data"}    
            <div class="row request-callback-form-blk text-left">
              <div class="col-lg-12 col-12"><h4 class="text-secondary font-weight-bold mb-4">{$language.lblRequestCallBack}</h4></div>
              <div class="col-lg-6 col-12 mb-3">
                <label class="mb-1 text-secondary font-weight-bold">{$language.lblFirstName}<sup class="font-weight-normal font-xsmall text-danger">*</sup></label>
                <div class="row">
                  <div class="col-4 col-lg-3 pr-0">
                       {form->select 
                          id="cbsubtitle"
                          name="cbsubtitle"
                          class="form-control  primary text-secondary" 
                         options="{$language.lblMr}->{$language.lblMr}~*{$language.lblMrs}->{$language.lblMrs}~*{$language.lblMiss}->{$language.lblMiss}~*{$language.lblDr}->{$language.lblDr}"
                        }
                    
                  </div>
                  <div class="col-8 col-lg-9">
                  {form->textbox  name="cbUserFirstName" maxlength="50"  tabindex="1"  class="form-control " validate="required" error=$language.errFirstName}
                  </div>
                </div>
              </div>
              <div class="col-lg-6 col-12 mb-3">
                <label class="mb-1 text-secondary font-weight-bold">{$language.lblLastName}<sup class="font-weight-normal font-xsmall text-danger">*</sup></label>
                {form->textbox class="form-control " maxlength="50" tabindex="2" name="cbUserLastName" validate="required" error=$language.errLastName}
              </div>
              <div class="col-lg-6 col-12 mb-3">
                <label class="mb-1 text-secondary font-weight-bold">{$language.lblEmailAddress}<sup class="font-weight-normal font-xsmall text-danger">*</sup></label>
                {form->textbox name="cbUserEmail" class="form-control" tabindex="3" validate="required~*email" error=$language.errInvalidEmail} 
              </div>
              <div class="col-lg-6 col-12 mb-3">
                <label class="mb-1 text-secondary font-weight-bold">{$language.lblPhoneNumber}<sup class="font-weight-normal font-xsmall text-danger">*</sup></label>
				<div class="row">
                <div class="col-4 col-lg-3 pr-0">
                    {form->select 
                          id="cbCountrycode"
                          name="cbCountrycode"
                          class="form-control  primary text-secondary" 
                          options=$resOTPCountry
                        }
                {*<select class="form-control text-secondary" id="cbCountrycode">
                    <option value="971" selected="selected">+971</option>
                </select>*}
                </div>    
                <div class="col-8 col-lg-9">
                {form->textbox name="cbUserPhone" class="form-control text-secondary" maxlength="10" tabindex="5" validate="required~*isNumber" error=$language.errPhone|cat:"~*"|cat:$language.errValidPhone} 
                </div>
                <span class="sub-text col-12 font-small mt-2">{$language.lblPhoneSubText}</span>
              </div>
                </div>
              <div class="col-lg-12 col-12 mb-3">
                <label class="mb-1 text-secondary font-weight-bold">{$language.lblComments}</label>
                {form->textarea name="cbUserComment" class="form-control"  tabindex="5"  maxlength="150" error=$language.errComment} 
              </div>
              <div class="col-lg-12 col-12 mb-3">
               {form->checkbox class="pos-abs chkbx1"  name="cbagree" value="1"} 
               <label for="cbagree" class="mb-1 text-secondary  font-weight-bold">{$language.lblDataProtectionText}</label>
               <div> {form->validate name="cbvalidateAgree" validate="cbagree->required"  error=$language.errAgreement} </div>
              </div>
              <div class="col-lg-6 col-12 mb-4 mt-3">
                {form->button tabindex="10" value="{$language.lblSubmit}"  tabindex="6" name="submit" id="summaryReqCallBack" class="btn btn-primary font-small font-weight-bold w-50" form="formRequestCallback"} 
              </div> 
            </div>
                {form->close} 
             
            <div class="row request-callback-otp-blk hide">
             <div class="col-lg-12 col-12">
                <h4 class="font-weight-bold">{$language.lblEnterOTP}</h4>
                <p class="font-family-primary mb-4">{$language.lblPleaseTypeVerificationCode} {$language.lblPhone} <span class="phoneassign"></span> </p>
              </div>
              <div class="contact-information form-blk col-lg-5 col-12">
                <div class="row mb-4 otp-input-blk">
                  <div class="col">
                    {form->textbox name="callbackotp1" maxlength="1" class="form-control text-center cbotpfield"} 
                  </div>
                  <div class="col">
                    {form->textbox name="callbackotp2" maxlength="1" class="form-control text-center cbotpfield"} 
                  </div>
                  <div class="col">
                    {form->textbox name="callbackotp3" maxlength="1" class="form-control text-center cbotpfield"} 
                  </div>
                  <div class="col">
                    {form->textbox name="callbackotp4" maxlength="1" class="form-control text-center cbotpfield"} 
                  </div>
                  <div class="cb_validateion_error message_validation hide col-12 mt-2">{$language.InvalidOTP}</div>
                </div>
                <div class="col-12 p-0 mb-3">
                  <input type="submit" class="btn btn-primary font-small font-weight-bold w-100 py-3" id="callback-otp-submit" value="{$language.lblVerify}"/>
                </div>
                <div class="col-12 p-0 ">
                  <p class="text-muted resend">{$language.lblDidntGetOTP} 
                      <a href="javascript:void(0);" onclick="resendCBOTPData();" class="text-secondary hover-clr-primary text-underline">{$language.lblResendOTP}</a>
                  </p>
				  <p class="resending hide">
					<a href="javascript:void(0);" class="text-secondary disabled ">{$language.lblResendingOTP}</a>
				  </p>
                </div>
              </div>
            </div>
            <div class="row callback-thankyou-blk hide">
              <div class="col-lg-12 col-12 text-center py-5">
                <h2 class="mb-2 text-primary">{$language.lblThankYouForEnquiry}</h2>
                <p class="font-family-primary text-muted mb-4 h5">{$language.lblOurSupportTeamWillContact}</p>
              </div>
            </div>
          </div>
        </div>
      </div>
    </div>
              {form->validate_script form="formReqCallBack"}