insure/application/admin/view/insurance_info/add.html

<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Name')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-name" data-rule="required" class="form-control" name="row[name]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Category_id')}:</label>
        <div class="col-xs-12 col-sm-8">


            <select id="c-pid" data-rule="required" class="form-control selectpicker" name="row[category_id]">
                {foreach name="parentList" item="vo"}
                <option data-type="{$vo.type}" value="{$key}" {in name="key" value=""}selected{/in}>{$vo.name}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('I_image')}:</label>
        <div class="col-xs-12 col-sm-8">
            <div class="input-group">
                <input id="c-i_image" class="form-control" size="50" name="row[i_image]" type="text">
                <div class="input-group-addon no-border no-padding">
                    <span><button type="button" id="faupload-i_image" class="btn btn-danger faupload" data-input-id="c-i_image" data-mimetype="image/gif,image/jpeg,image/png,image/jpg,image/bmp" data-multiple="false" data-preview-id="p-i_image"><i class="fa fa-upload"></i> {:__('Upload')}</button></span>
                    <span><button type="button" id="fachoose-i_image" class="btn btn-primary fachoose" data-input-id="c-i_image" data-mimetype="image/*" data-multiple="false"><i class="fa fa-list"></i> {:__('Choose')}</button></span>
                </div>
                <span class="msg-box n-right" for="c-i_image"></span>
            </div>
            <ul class="row list-inline faupload-preview" id="p-i_image"></ul>
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Explain')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-explain" class="form-control" name="row[explain]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Sort')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-sort" class="form-control" name="row[sort]" type="number" value="0">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Age_limit')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-age_limit" class="form-control" name="row[age_limit]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Maximum_coverage')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-maximum_coverage" class="form-control" name="row[maximum_coverage]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Female_price')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-female_price" class="form-control" name="row[female_price]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Buy')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-buy" class="form-control" name="row[buy]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Remarks')}:</label>
        <div class="col-xs-12 col-sm-8">
            <textarea id="c-remarks" class="form-control " rows="5" name="row[remarks]" cols="50"></textarea>
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>