{
  "@context": {
    "ixo": "https://w3id.org/ixo/ns/protocol/",
    "@id": "@type",
    "type": "@type",
    "@protected": true
  },
  "type": "ixo:entity#surveyTemplate",
  "question": {
    "title": "Payment Request",
    "description": "Claim Form to request a payment for Goods and/or Services provided",
    "pages": [
      {
        "name": "page1",
        "elements": [
          {
            "type": "text",
            "name": "name",
            "title": "Payee Name",
            "description": "Legal name of the Entity for which the payment request is being made",
            "isRequired": true
          },
          {
            "type": "text",
            "name": "identifier",
            "title": "Payee Identifier",
            "description": "A registered and valid Entity DID",
            "isRequired": true,
            "validators": [
              {
                "type": "regex",
                "text": "Check the DID format",
                "regex": "^did:ixo:entity:[0-9a-fA-F]{32}$"
              }
            ],
            "placeholder": "did:ixo:entity:"
          },
          {
            "type": "text",
            "name": "email",
            "title": "Email",
            "description": "Where correspondence relating to the claim may be sent",
            "inputType": "email",
            "placeholder": "Email Address"
          },
          {
            "type": "boolean",
            "name": "invoice",
            "title": "Submit an Invoice",
            "isRequired": true
          },
          {
            "type": "boolean",
            "name": "documentation",
            "title": "Submit Supporting Documentation",
            "isRequired": true
          }
        ],
        "title": "Claimant Details",
        "description": "About the Entity requesting payment"
      },
      {
        "name": "page2",
        "elements": [
          {
            "type": "text",
            "name": "reference",
            "title": "Reference",
            "description": "Such as Invoice number",
            "isRequired": true
          },
          {
            "type": "text",
            "name": "amount",
            "title": "Claimed Amount",
            "description": "Total in the Base Currency",
            "inputType": "number"
          },
          {
            "type": "tagbox",
            "name": "currency",
            "title": "Base Currency",
            "description": "In which the costs have been incurred ",
            "choices": [
              {
                "value": "Item 5",
                "text": "USDC"
              },
              {
                "value": "Item 1",
                "text": "USD"
              },
              {
                "value": "Item 2",
                "text": "CHF"
              },
              {
                "value": "Item 3",
                "text": "EUR"
              },
              {
                "value": "Item 4",
                "text": "IXO"
              },
              {
                "value": "Item 6",
                "text": "ETH"
              },
              {
                "value": "Item 7",
                "text": "BTC"
              }
            ],
            "maxSelectedChoices": 1,
            "minSelectedChoices": 1
          },
          {
            "type": "text",
            "name": "InvoiceDueDate",
            "title": "Payment Due Date",
            "inputType": "date"
          },
          {
            "type": "file",
            "name": "invoice_document",
            "visibleIf": "{invoice} = true",
            "title": "Invoice Upload",
            "isRequired": true,
            "waitForUpload": true,
            "needConfirmRemoveFile": true
          }
        ],
        "title": "Invoice Details",
        "description": "Document"
      },
      {
        "name": "page3",
        "elements": [
          {
            "type": "tagbox",
            "name": "currency_payment",
            "title": "Payment Currency",
            "description": "Cryptocurrencies Only",
            "showCommentArea": true,
            "commentPlaceholder": "Special Instructions",
            "choices": [
              {
                "value": "Item 8",
                "text": "USDC"
              },
              {
                "value": "Item 4",
                "text": "IXO"
              },
              {
                "value": "Item 6",
                "text": "ETH"
              },
              {
                "value": "Item 7",
                "text": "BTC"
              }
            ],
            "showOtherItem": true,
            "maxSelectedChoices": 1,
            "minSelectedChoices": 1,
            "closeOnSelect": true
          },
          {
            "type": "text",
            "name": "accountAddress",
            "title": "Account Address",
            "description": "Ensure this is a valid address for receiving the cryptocurrency payment on the network you select",
            "isRequired": true
          },
          {
            "type": "dropdown",
            "name": "network",
            "visible": false,
            "title": "Blockchain Network",
            "description": "Ensure the Account Address is valid on this network",
            "isRequired": true,
            "showCommentArea": true,
            "commentText": "Instructions (optional)",
            "commentPlaceholder": "Special Instructions",
            "choices": [
              {
                "value": "ethereum",
                "text": "Ethereum"
              },
              {
                "value": "impacts",
                "text": "Impacts Hub"
              },
              {
                "value": "noble",
                "text": "Noble"
              },
              "cosmos",
              {
                "value": "polygon",
                "text": "Polygon"
              }
            ],
            "showOtherItem": true,
            "otherPlaceholder": "Ensure this network is supported",
            "otherText": "Other (specify)",
            "placeholder": "Network...",
            "choicesMin": 1,
            "choicesMax": 1
          }
        ],
        "title": "Payment Details",
        "description": "Please ensure these are correct!"
      },
      {
        "name": "page4",
        "elements": [
          {
            "type": "file",
            "name": "documents",
            "visibleIf": "{documentation} = true",
            "title": "Supporting Documents",
            "description": "Max 1.2 MB",
            "isRequired": true,
            "showCommentArea": true,
            "commentText": "Comments (optional)",
            "allowMultiple": true,
            "waitForUpload": true,
            "maxSize": 1248588,
            "needConfirmRemoveFile": true,
            "sourceType": "file-camera"
          },
          {
            "type": "comment",
            "name": "notes",
            "title": "Notes",
            "description": "Any other information or requests you may wish to submit"
          }
        ],
        "title": "Additional Information",
        "description": "Supporting this Request"
      }
    ]
  }
}