@php($class = "rounded-md shadow-sm border-gray-300 focus:border-indigo-300 focus:ring focus:ring-indigo-200 focus:ring-opacity-50 block mt-1 w-full")
<div class="grid grid-cols-3 gap-4 mb-4 date-of-expire">
    <div>
        {!! Form::label('disbursement_date', 'Date', ['class' => 'required']) !!}
    </div>
    <div class="col-span-2">
        {!! Form::input('date', 'disbursement_date', $disbursement &&  $disbursement->disbursement_date ? $disbursement->disbursement_date->format('Y-m-d') : null, ['class' => $class, 'required' => 'required']); !!}
    </div>
</div>

<div class="grid grid-cols-3 gap-4 mb-4">
    <div>
        {!! Form::label('mode', 'Payment Mode', ['class' => 'required']) !!}
    </div>
    <div class="col-span-2">
        {!! Form::select('mode', array('' => '- Select-', 'Cash' => 'Cash', 'DD' => 'DD', 'Online' => 'Online', 'Cheque' => 'Cheque'), null, ['class' => $class])  !!}
    </div>
</div>

<div class="grid grid-cols-3 gap-4 mb-4">
    <div>
        {!! Form::label('reference', 'Reference No.', ['class' => 'required']) !!}
    </div>
    <div class="col-span-2">
        {!! Form::text('reference', null, ['class' => $class]) !!}
    </div>
</div>