<form id="claimReviewForm" method="post" action="{{ $claimStoreUri }}">
    <input type="hidden" id="code" name="code" value="{{ $code }}" />
    <input type="hidden" id="mode" name="mode" value="{{ $mode }}" />
    <input type="hidden" id="offer_promotion_id" name="offer_promotion_id" value="{{ $formData['offer_promotion_id'] }}" />
    <input type="hidden" id="claim_id" name="claim_id" value="{{ $formData['claim_id'] }}" />
    {{ csrf_field() }}
    <hr />
    <div class="form-actions text-center clearfix">
        <input type="submit" class="btn btn-default" name="backButton" value="{{ __('Core::core.buttons.back') }}">
        <input type="submit" class="btn btn-primary" name="submitButton" value="{{ __('Core::core.buttons.submit') }}">
    </div>
</form>
