JSFiddle - React, Tailwind, and code Playground

by techrevolt

HTML

<div>
  <form action="" name="claimform">
    <div>
      <label>Claim number</label>
      <input type="text" name="claimnumber" id="claimnumber" />
    </div>
    <div>
      <label> Line of business</label>
      <select name="lineofbusiness" id="lineofbusiness">
      <option value="Motor">Motor</option>
      <option value="Casualty">Casualty</option>
      <option value="Property">Property</option>
      <option value="Life">Life</option>
      <option value="Pet">Pet</option>
    </select>
    </div>
    <div>
      <label> Accident circumstance </label>
      <input type="text" name="accidentcircumstance" id="accidentcircumstance" />
    </div>

    <div>
      <label> Any fraud concerns </label>
      <input type="radio" name="anyfraudconcerns" value="yes" checked> Yes
      <input type="radio" name="anyfraudconcerns" value="no"> No<br>
    </div>

    <div>
      <label> Handlers quantum estimate </label>
      <input type="text" name="handlersquantumestimate" id="handlersquantumestimate" />
    </div>

    <div>
      <label> Indemnity issues? </label>
      <input type="radio" name="indemnityissues" value="yes" checked> Yes
      <input type="radio" name="indemnityissues" value="no"> No<br>
    </div>
    <div>
      <label> Dealing on delegated authority? </label>
      <input type="radio" name="delegatedauth" value="yes" checked> Yes
      <input type="radio" name="delegatedauth" value="no"> No<br>
    </div>
    <div>
      <label> Investigation required? </label>
      <input type="radio" name="investigationreq" value="yes" checked> Yes
      <input type="radio" name="investigationreq" value="no"> No<br>
    </div>


    <div>
      <label> Formal claim received? </label>
      <input type="radio" name="formalclaimreceived" value="yes" checked> Yes
      <input type="radio" name="formalclaimreceived" value="no"> No<br>
    </div>


   <div>
      <label>HSE/Police involvement? </label>
      <input type="radio" name="policeinvolvement" value="yes"...