Linux ip-172-26-7-228 5.4.0-1103-aws #111~18.04.1-Ubuntu SMP Tue May 23 20:04:10 UTC 2023 x86_64
Your IP : 18.221.161.43
<div class="row" id="appForm">
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<div class="card">
<div class="header">
<h2>
Application Form
</h2>
</div>
<div class="body">
<div class="form-horizontal">
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="Application Number">Register Number</label>
</div>
<div class="col-sm-4 col-md-2">
<div class="form-group">
<div class="form-line">
<input type="text" title="Reg. No." class="form-control" id="regno" maxlength= "10" placeholder="Register no." onblur="Getstudentdetails(event,this.value)">
</div>
</div>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="Register Number">Candidate Name</label>
</div>
<div class="col-sm-4 col-md-4">
<div class="form-group">
<div class="form-line">
<input type="text" title="Candidate Name" class="form-control" id="formcandname" value="" disabled>
</div>
</div>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="college">College </label>
</div>
<div class="col-sm-4 col-md-4">
<div class="form-group">
<div class="form-line">
<input type="text" title="College" class="form-control" id="formcollege" disabled>
</div>
</div>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" title="Degree" for="Degree">Degree </label>
</div>
<div class="col-sm-4 col-md-4">
<div class="form-group">
<div class="form-line">
<input type="text" class="form-control" id="formdegree" disabled>
</div>
</div>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="Category">Category </label>
</div>
<div class="col-sm-4 col-md-2">
<select id="formcategory" title="Category" class="form-control show-tick" style="margin-left: -15px">
</select>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="Application For">Application For</label>
</div>
<div class="col-sm-2 col-md-4">
<select id="S2" title="service" class="form-control show-tick" style="margin-left: -15px" onchange="loadserviceslist(this.value)">
</select>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-8 col-md-8 col-sm-4 col-xs-5">
<fieldset class="scheduler-border">
<legend class="scheduler-border">Documents to be Submitted</legend>
<div class="control-group">
<span id='T27'></span>
</div>
</fieldset>
</div>
</div>
<div class="row clearfix" id = 'agencies' style = 'display:none;'>
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="Application For">Select Agencies</label>
</div>
<div class="col-sm-2 col-md-4">
<select class="form-control show-tick" onchange = 'getserviceagenciesfee($("#S2").val())' id="S8" title = "Select Agencies" style="margin-left: -15px">
<option value = ''>Select Agencies</option>
<option>Government department / Agencies</option>
<option>Foreign Agencies</option>
</select>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-8 col-md-8 col-sm-4 col-xs-5">
<div id="cont_serviceslist"></div>
</div>
</div>
<div class="row clearfix" id = 'transcript'>
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="amount">Additional No. of transcript</label>
</div>
<div class="col-sm-4 col-md-2">
<div class="form-group">
<div class="form-line">
<input type="text" title="amount" class="form-control" id = 'tranno' value = '0' onchange = 'updatetotalservfee()'>
</div>
</div>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="amount">Total amount </label>
</div>
<div class="col-sm-4 col-md-2">
<div class="form-group">
<div class="form-line">
<input type="text" title="amount" class="form-control" id="amount" disabled>
</div>
</div>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="Date of Birth "> Date of Birth</label>
</div>
<div class="col-sm-4 col-md-2 daterange">
<div class="form-group">
<div class="form-line">
<input type="text" title="Date of Birth" class="form-control date" id="formmdob" placeholder="dd/mm/yyyy">
</div>
</div>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="Postal Address">Postal Address </label>
</div>
<div class="col-sm-4 col-md-4">
<div class="form-group p-b-5">
<div class="form-line">
<input type="text" title="Address1" class="form-control" id="postal1">
</div>
</div>
<div class="form-group p-b-5">
<div class="form-line">
<input type="text" title="Address2" class="form-control" id="postal2">
</div>
</div>
<div class="form-group p-b-5">
<div class="form-line">
<input type="text" class="form-control" id="postal3">
</div>
</div>
<div class="form-group p-b-5">
<div class="form-line">
<input type="text" class="form-control" id="postal4">
</div>
</div>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="Mobile No."> Mobile No.<span style='color:red;'>*</span></label>
</div>
<div class="col-sm-4 col-md-2">
<div class="form-group">
<div class="form-line">
<input type="text" title="Mobile No." maxlength="10" class="form-control" id="mobile" onkeypress="return acceptNumbersOnlyForModule(event);" placeholder="Mobile No.">
</div>
</div>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="Email Id"> Email Id<span style='color:red;'>*</span></label>
</div>
<div class="col-sm-4 col-md-4">
<div class="form-group">
<div class="form-line">
<input type="email" title="email" class="form-control" id="email" placeholder="example@company.com">
</div>
</div>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="City"> City<span style='color:red;'>*</span></label>
</div>
<div class="col-sm-4 col-md-4">
<div class="form-group">
<div class="form-line">
<input type="text" title="City" class="form-control" id="city" placeholder="City">
</div>
</div>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="State"> State<span style='color:red;'>*</span></label>
</div>
<div class="col-sm-4 col-md-4">
<div class="form-group">
<div class="form-line">
<input type="text" title="State" class="form-control" id="state" placeholder="State">
</div>
</div>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="Country"> Country<span style='color:red;'>*</span></label>
</div>
<div class="col-sm-4 col-md-4">
<div class="form-group">
<div class="form-line">
<input type="text" title="Country" class="form-control" id="country" placeholder="Country">
</div>
</div>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="Pincode"> Pincode<span style='color:red;'>*</span></label>
</div>
<div class="col-sm-4 col-md-4">
<div class="form-group">
<div class="form-line">
<input type="text" title="Pincode" maxlength="6" class="form-control" id="pincode" onkeypress="return acceptNumbersOnlyForModule(event);" placeholder="Pincode">
</div>
</div>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<label class="pull-left" for="Application For">Payment Mode <span style='color:red;'>*</span></label>
</div>
<div class="col-sm-2 col-md-4">
<select id="S3" title="Payment Mode" class="form-control show-tick" style="margin-left: -15px">
</select>
</div>
</div>
<div class="row clearfix p-t-20">
<div class="col-lg-offset-7 col-md-offset-7 col-sm-offset-4 col-xs-offset-5">
<button type="button" class="btn btn-primary waves-effect m-l--5" onclick = "SaveApplicationDetails()">Submit</button>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="row" id="appConfirm">
<div class="col-lg-12 col-md-12 col-sm-12 col-xs-12">
<div class="card">
<div class="header">
<h2>
Application confirm
</h2>
</div>
<div class="body">
<div class="form-horizontal">
<div class="row clearfix">
<div class="col-md-offset-2 col-lg-6 col-md-6 col-sm-9 col-xs-9 form-control-label">
<h3> Application Registration completed successfully.</h3>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-3 col-lg-4 col-md-4 col-sm-4 col-xs-5 form-control-label">
<h3> Application No. : <span id="APT1"></span></h3>
</div>
</div>
<div class="row clearfix">
<div class="col-md-offset-4 col-lg-2 col-md-2 col-sm-4 col-xs-5 form-control-label">
<div id="payment_link"></div>
</div>
</div>
</div>
</div>
</div>
</div>
</div>
<script type="text/javascript">
$('#transcript').hide();
$('#appConfirm').addClass("hidden");
var $demoMaskedInput = $('.daterange');
//Date
$demoMaskedInput.find('.date').inputmask('dd/mm/yyyy', { placeholder: '__/__/____' });
</script>
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