<form action="javascript:void(0)">
    <div class="row">
        {% if getB2CIdioma() != 'en_US' %}
            {% if documentosPagantePermitidoCheckout() == null %}
                <div class="col-md-3">
                    <label for="">
                        {{ __('cpf') }}
                        <span>*</span>
                    </label>
                    <input placeholder="000.000.000-00" name="nrDocumento" maxlength="14" data-b2c-input="nrDocumento"
                           data-b2c-input-tipo="cpf" />
                </div>
            {% else %}
                <div class="col-md-3" style="padding-right: 0;" data-b2c-doc-pagador-group>
                    <label for="">
                        {{ __('documento') }}
                        <span>*</span>
                    </label>
                    <div class="form-group">
                        <select class="select-doc" name="tpDocumento" data-text-passaporte="{{ __('passaporte') }}" data-text-cpf="CPF" data-b2c-doc-switch-pagador>
                            {% for value in documentosPagantePermitidoCheckout()  %}
                                <option value="{{ value }}" {% if value == 'CPF' %}selected="selected"{% endif %}>{{ __(value|lower) }}</option>
                            {% endfor %}
                        </select>
                        <input type="text" name="nrDocumento" data-b2c-input="nrDocumento" data-b2c-input-tipo="cpf"
                               placeholder="" />
                    </div>
                </div>
            {% endif %}
        {% endif %}
        <div class="col-md-3">
            <label for="">
                {{ __('sexo') }}
                <span>*</span>
            </label>
            <select name="tpSexo" data-placeholder="Sexo" data-b2c-input="sexo">
                <option value="MASCULINO">{{ __('masculino') }}</option>
                <option value="FEMININO">{{ __('feminino') }}</option>
            </select>
        </div>
        <div class="col-md-3">
            <label for="">
                {{ __('telefone') }}
                <span>*</span>
            </label>
            <select name="tpTelefone" data-placeholder="{{ __('telefone') }}" required="" data-b2c-input="telefoneTipo">
                <option value="CELULAR">{{ __('celular') }}</option>
                <option value="RESIDENCIAL">{{ __('residencial') }}</option>
            </select>
        </div>
        <div class="col-md-3">

            <label for="">
                {{ __('numero') }}
                <span>*</span>
            </label>
            <input name="nrTelefone" placeholder="{% if getB2CIdioma() != 'en_US' %}(00) 00000-0000{% endif %}"
                   data-b2c-input="nrTelefone">
        </div>
        <div class="col-md-4">
            <label for="">
                {{ __('nascimento') }}
                <span>*</span>
            </label>
            <input placeholder="{% if getB2CIdioma() != 'en_US' %}DD/MM/YYYY{% else %}MM/DD/YYYY{% endif %}"
                   name="dtNascimento" value="" data-b2c-input="dtNascimento">
        </div>
    </div>
    <div class="row" b2c-data-form-endereco>
        <div class="col-md-4 hidden" data-b2c-form-pag-el-pais>
            <label for="">
                {{ __('pais') }}
                <span>*</span>
            </label>
            <select name="sgPais" required data-b2c-input="sgPais">
                <option value="ZA">África do Sul</option>
                <option value="AL">Albânia</option>
                <option value="DE">Alemanha</option>
                <option value="AD">Andorra</option>
                <option value="AO">Angola</option>
                <option value="AI">Anguilla</option>
                <option value="AG">Antígua e Barbuda</option>
                <option value="SA">Arábia Saudita</option>
                <option value="DZ">Argélia</option>
                <option value="AR">Argentina</option>
                <option value="AM">Armênia</option>
                <option value="AW">Aruba</option>
                <option value="AU">Austrália</option>
                <option value="AT">Áustria</option>
                <option value="AZ">Azerbaijão</option>
                <option value="BS">Bahamas</option>
                <option value="BD">Bangladesh</option>
                <option value="BB">Barbados</option>
                <option value="BH">Barein</option>
                <option value="BE">Bélgica</option>
                <option value="BZ">Belize</option>
                <option value="BJ">Benin</option>
                <option value="BM">Bermudas</option>
                <option value="BY">Bielorrússia</option>
                <option value="BO">Bolívia</option>
                <option value="BQ">Bonaire</option>
                <option value="BA">Bósnia-Herzegovina</option>
                <option value="BW">Botsuana</option>
                <option value="BR" selected>Brasil</option>
                <option value="BN">Brunei</option>
                <option value="BG">Bulgária</option>
                <option value="BF">Burkina Fasso</option>
                <option value="MM">Burma</option>
                <option value="BI">Burundi</option>
                <option value="BT">Butão</option>
                <option value="CV">Cabo Verde</option>
                <option value="CM">Camarões</option>
                <option value="KH">Camboja</option>
                <option value="CA">Canadá</option>
                <option value="QA">Catar</option>
                <option value="KZ">Cazaquistão</option>
                <option value="TD">Chade</option>
                <option value="CL">Chile</option>
                <option value="CN">China</option>
                <option value="CY">Chipre</option>
                <option value="VA">Cidade do Vaticano</option>
                <option value="SG">Cingapura</option>
                <option value="CO">Colômbia</option>
                <option value="KR">Coreia do Sul</option>
                <option value="CI">Costa do Marfim</option>
                <option value="CR">Costa Rica</option>
                <option value="HR">Croácia</option>
                <option value="CU">Cuba</option>
                <option value="CW">Curaçao</option>
                <option value="DK">Dinamarca</option>
                <option value="DJ">Djibuti</option>
                <option value="DM">Dominica</option>
                <option value="EG">Egito</option>
                <option value="SV">El Salvador</option>
                <option value="AE">Emirados Árabes Unidos</option>
                <option value="EC">Equador</option>
                <option value="ER">Eritréia</option>
                <option value="SK">Eslováquia</option>
                <option value="SI">Eslovênia</option>
                <option value="ES">Espanha</option>
                <option value="PS">Estado da Palestina</option>
                <option value="FM">Estados Federados da Micronésia</option>
                <option value="US">Estados Unidos</option>
                <option value="EE">Estônia</option>
                <option value="ET">Etiópia</option>
                <option value="MK">F.Y.R.O. Macedônia</option>
                <option value="FK">Falkland Islands</option>
                <option value="FJ">Fiji</option>
                <option value="PH">Filipinas</option>
                <option value="FI">Finlândia</option>
                <option value="FR">França</option>
                <option value="GA">Gabão</option>
                <option value="GM">Gâmbia</option>
                <option value="GH">Gana</option>
                <option value="GE">Geórgia</option>
                <option value="GI">Gibraltar</option>
                <option value="GD">Granada (país)</option>
                <option value="GR">Grécia</option>
                <option value="GL">Groenlândia</option>
                <option value="GP">Guadalupe</option>
                <option value="GU">Guam</option>
                <option value="GT">Guatemala</option>
                <option value="GY">Guiana</option>
                <option value="GF">Guiana Francesa</option>
                <option value="GN">Guiné</option>
                <option value="GQ">Guiné Equatorial</option>
                <option value="GW">Guiné-Bissau</option>
                <option value="HT">Haiti</option>
                <option value="NL">Holanda</option>
                <option value="HN">Honduras</option>
                <option value="HK">Hong Kong</option>
                <option value="HU">Hungria</option>
                <option value="BV">Ilha Bouvet</option>
                <option value="CX">Ilha Christmas</option>
                <option value="RE">Ilha da Reunião</option>
                <option value="YT">Ilha Mayotte</option>
                <option value="NF">Ilha Norfolk</option>
                <option value="PN">Ilha Pitcairn</option>
                <option value="KY">Ilhas Cayman</option>
                <option value="CC">Ilhas Cocos</option>
                <option value="KM">Ilhas Comores</option>
                <option value="CK">Ilhas Cook</option>
                <option value="FO">Ilhas Faroé</option>
                <option value="HM">Ilhas Heard e McDonald</option>
                <option value="MP">Ilhas Marianas do Norte</option>
                <option value="MH">Ilhas Marshall</option>
                <option value="MU">Ilhas Maurício</option>
                <option value="UM">Ilhas Menores Distantes dos EUA</option>
                <option value="SB">Ilhas Salomão</option>
                <option value="SC">Ilhas Seychelles</option>
                <option value="VG">Ilhas Virgens Britânicas</option>
                <option value="VI">Ilhas Virgens E.U.A.</option>
                <option value="IN">Índia</option>
                <option value="ID">Indonésia</option>
                <option value="IR">Irã</option>
                <option value="IE">Irlanda</option>
                <option value="IS">Islândia</option>
                <option value="IL">Israel</option>
                <option value="IT">Itália</option>
                <option value="JM">Jamaica</option>
                <option value="JP">Japão</option>
                <option value="JO">Jordânia</option>
                <option value="KI">Kiribati</option>
                <option value="KW">Kuwait</option>
                <option value="LA">Laos</option>
                <option value="LS">Lesoto</option>
                <option value="LV">Letônia</option>
                <option value="LB">Líbano</option>
                <option value="LR">Libéria</option>
                <option value="LY">Líbia</option>
                <option value="LI">Liechtenstein</option>
                <option value="LT">Lituânia</option>
                <option value="LU">Luxemburgo</option>
                <option value="MO">Macau</option>
                <option value="MG">Madagascar</option>
                <option value="MY">Malásia</option>
                <option value="MW">Malauí</option>
                <option value="MV">Maldivas</option>
                <option value="ML">Mali</option>
                <option value="MT">Malta</option>
                <option value="MA">Marrocos</option>
                <option value="MQ">Martinica</option>
                <option value="MR">Mauritânia</option>
                <option value="MX">México</option>
                <option value="MZ">Moçambique</option>
                <option value="MD">Moldávia</option>
                <option value="MC">Mônaco</option>
                <option value="MN">Mongólia</option>
                <option value="ME">Montenegro</option>
                <option value="MS">Montserrat</option>
                <option value="NA">Namíbia</option>
                <option value="NR">Nauru</option>
                <option value="NP">Nepal</option>
                <option value="NI">Nicarágua</option>
                <option value="NE">Níger</option>
                <option value="NG">Nigéria</option>
                <option value="NU">Niue</option>
                <option value="NO">Noruega</option>
                <option value="NC">Nova Caledônia</option>
                <option value="NZ">Nova Zelândia</option>
                <option value="OM">Omã</option>
                <option value="PW">Palau</option>
                <option value="PA">Panamá</option>
                <option value="PG">Papua Nova Guiné</option>
                <option value="PK">Paquistão</option>
                <option value="PY">Paraguai</option>
                <option value="PE">Peru</option>
                <option value="PF">Polinésia Francesa</option>
                <option value="PL">Polônia</option>
                <option value="PR">Porto Rico</option>
                <option value="PT">Portugal</option>
                <option value="KE">Quênia</option>
                <option value="KG">Quirguistão</option>
                <option value="GB">Reino Unido</option>
                <option value="CD">República Democrática do Congo</option>
                <option value="CG">República do Congo</option>
                <option value="DO">República Dominicana</option>
                <option value="CZ">República Tcheca</option>
                <option value="RO">Romênia</option>
                <option value="RW">Ruanda</option>
                <option value="RU">Rússia</option>
                <option value="SH">Saint Helena</option>
                <option value="PM">Saint-Pierre e Miquelon</option>
                <option value="WS">Samoa</option>
                <option value="AS">Samoa Americana</option>
                <option value="SM">San Marino</option>
                <option value="LC">Santa Lúcia</option>
                <option value="KN">São Cristóvão e Névis</option>
                <option value="ST">São Tomé e Príncipe</option>
                <option value="VC">São Vicente e Granadinas</option>
                <option value="SN">Senegal</option>
                <option value="SL">Serra Leoa</option>
                <option value="RS">Sérvia</option>
                <option value="SX">Sint Maarten</option>
                <option value="LK">Sri Lanka</option>
                <option value="BL">St. Barthelemy</option>
                <option value="MF">St. Martin</option>
                <option value="SZ">Suazilândia</option>
                <option value="SD">Sudão</option>
                <option value="SE">Suécia</option>
                <option value="CH">Suíça</option>
                <option value="SR">Suriname</option>
                <option value="SJ">Svalbard</option>
                <option value="TH">Tailândia</option>
                <option value="TW">Taiwan</option>
                <option value="TJ">Tajiquistão</option>
                <option value="TZ">Tanzânia</option>
                <option value="TF">Terras Austrais e Antárticas Francesas</option>
                <option value="IO">Território Britânico do Oceano Índico</option>
                <option value="TG">Togo</option>
                <option value="TO">Tonga</option>
                <option value="TK">Toquelau</option>
                <option value="TT">Trinidad e Tobago</option>
                <option value="TN">Tunísia</option>
                <option value="TM">Turcomenistão</option>
                <option value="TC">Turcos e Caicos</option>
                <option value="TR">Turquia</option>
                <option value="TV">Tuvalu</option>
                <option value="UA">Ucrânia</option>
                <option value="UG">Uganda</option>
                <option value="UY">Uruguai</option>
                <option value="UZ">Uzbequistão</option>
                <option value="VU">Vanuatu</option>
                <option value="VE">Venezuela</option>
                <option value="VN">Vietnã</option>
                <option value="WF">Wallis e Futuna</option>
                <option value="ZM">Zâmbia</option>
                <option value="ZW">Zimbábue</option>
            </select>
        </div>
        <div  class="col-md-4">
            <label for="">
                {{ __('cep') }}
                <span>*</span>
            </label>
            <input placeholder="{% if getB2CIdioma() != 'en_US' %}00000-000{% endif %}" name="nrCep"
                   data-b2c-input="cep">
            <img width="20" src="assets/img/ajax-loader.gif"
                 style="height: 20px;margin-top: -28px;margin-left: 11px;position: absolute;right: 19px;display: none;top: 71px;">
        </div>
        <div class="col-md-8">
            <label for="">
                {{ __('endereco') }}
                <span>*</span>
            </label>
            <input placeholder="" data-b2c-input="endereco">
        </div>
        {% if getB2CIdioma() != 'en_US' %}
            <div class="col-md-4" data-b2c-form-pag-el-nrendereco>
                <label for="">
                    {{ __('numero') }}
                    <span>*</span>
                </label>
                <input placeholder="" data-b2c-input="nrEndereco" maxlength="20">
            </div>
        {% endif %}
        <div class="col-md-4">
            <label for="">
                {{ __('complemento') }}
            </label>
            <input placeholder="" data-b2c-input="complemento">
        </div>
        {% if getB2CIdioma() != 'en_US' %}
            <div class="col-md-4" data-b2c-form-pag-el-bairro="">
                <label for="">
                    {{ __('bairro') }}
                    <span>*</span>
                </label>
                <input placeholder="" data-b2c-input="bairro">
            </div>
        {% endif %}
        <div class="col-md-6 hidden" data-b2c-form-pag-el-provincia>
            <label for="">
                Estado / Província / Região
                <span>*</span>
            </label>
            <input type="text" name="nmProvincia" required="" autocomplete="off" data-b2c-input="provincia">
        </div>
        <div class="col-md-6">
            <label for="">
                {{ __('municipio') }}
                <span>*</span>
            </label>
            <input type="text" name="nmMunicipio" required="" autocomplete="off" data-b2c-input="municipio">
            <input type="hidden" name="idMunicipio" data-b2c-input="idMunicipio"/>
        </div>
    </div>
</form>
