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Your IP : 3.145.37.211
<div class="card" id="personal_det">
<div class="card-header"><h2>Personal Details</h2></div>
<div class="card-body">
<div class="row">
<div class="col-sm-6">
<label
><b
>1. Name Of The Candidate(As per 10th Class)<span style="color: red"
>*</span
>
</b></label
>
<input
type="text"
id="fullname"
class="form-control"
placeholder="Candidate Name"
name="Student Name"
maxlength="60"
onkeypress="return charKeydown(event);"
autocomplete="off"
required
/>
</div>
<div class="col-sm-6">
<label
><b>2. Date of Birth<span style="color: red">*</span> </b></label
>
<input
type="date"
id="dob"
class="form-control date"
name="Date of Birth"
placeholder="dd/mm/yyyy"
autocomplete="off"
required
/>
</div>
</div>
<div class="row mt-2">
<div class="col-sm-6">
<label>
<b>3. Nationality<span style="color: red">*</span> </b></label
><select
id="nationality"
class="form-control"
placeholder="Nationality"
name="nationality"
autocomplete="off"
required
>
<option value="">--Select--</option>
<option value="Indian">Indian</option>
<option value="Foreigner">Foreigner</option>
</select>
</div>
<div class="col-sm-6">
<label>
<b>4. Religion<span style="color: red">*</span> </b></label
><input
type="text"
id="txtreligion"
class="form-control"
placeholder="Religion"
name="religion"
maxlength="60"
onkeypress="return charKeydown(event);"
autocomplete="off"
required
/>
</div>
</div>
<div class="row mt-2">
<div class="col-sm-6">
<label
><b>5. Gender<span style="color: red">*</span></b></label
>
<div class="form-group">
<div class="demo-radio-button" id="fgender" name="gender">
<input
name="fgender"
type="radio"
value="M"
id="radio_1"
autocomplete="off"
/>
<label for="radio_1">Male</label>
<input
name="fgender"
type="radio"
id="radio_2"
value="F"
autocomplete="off"
/>
<label for="radio_2">Female</label>
<input
name="fgender"
type="radio"
id="radio_3"
value="T"
autocomplete="off"
/>
<label for="radio_3">Other</label>
</div>
</div>
</div>
<div class="col-sm-6">
<label
><b>6. Aadhar Number <span style="color: red">*</span></b></label
>
<input
required
type="text"
id="faadhar"
class="form-control date"
name="faadhar"
placeholder="Aadhar Number"
autocomplete="off"
minlength="16"
maxlength="16"
/>
</div>
</div>
<div class="row mt-2">
<div class="col-sm-6">
<label>
<b>7. Blood Group<span style="color: red">*</span></b></label
>
<select id="blood_grp" class="form-control" name="blood_grp" value="">
<option value="">--Select--</option>
<option value="A+">A+</option>
<option value="A-">A-</option>
<option value="B+">B+</option>
<option value="B-">B-</option>
<option value="O+">O+</option>
<option value="O-">O-</option>
<option value="AB+">AB+</option>
<option value="AB-">AB-</option>
</select>
</div>
<div class="col-sm-6">
<label
><b>8. Category<span style="color: red">*</span> </b></label
>
<select
id="category"
class="form-control"
name="category"
value=""
aria-placeholder="select"
>
<option value="CAT-I">CAT-I</option>
<option value="GM">GM</option>
<option value="IIA">IIA</option>
<option value="IIB">IIB</option>
<option value="IIIA">IIIA</option>
<option value="IIIB">IIIB</option>
<option value="SC">SC</option>
<option value="ST">ST</option>
<option value="OTHER">OTHER</option>
</select>
</div>
</div>
<div class="row mt-2">
<div class="col-sm-4">
<label
><b>9. Father's name <span style="color: red">*</span></b></label
>
<input
type="text"
id="fname"
class="form-control"
name="fatname"
placeholder="Father Name"
autocomplete="off"
/>
</div>
<div class="col-sm-4">
<label>
<b>10. Father's Mobile No <span style="color: red">*</span></b></label
><input
type="text"
id="txtfatmobno"
class="form-control"
name="fatmobno"
placeholder="Father Mobile No."
autocomplete="off"
minlength="10"
maxlength="10"
/>
</div>
<div class="col-sm-4">
<label
><b
>11. Father's Occupation <span style="color: red">*</span></b
></label
>
<input
type="text"
id="txtfatocc"
class="form-control"
name="fatocc"
placeholder="Father Occupation"
autocomplete="off"
/>
</div>
</div>
<div class="row mt-2">
<div class="col-sm-4">
<label
><b>12. Mother's name <span style="color: red">*</span></b></label
>
<input
type="text"
id="mname"
class="form-control"
name="motname"
placeholder="Mother Name"
autocomplete="off"
/>
</div>
<div class="col-sm-4">
<label
><b
>13. Mother's Mobile No <span style="color: red">*</span></b
></label
>
<input
type="text"
id="txtmotmobno"
class="form-control"
name="motmobno"
placeholder="Mother Mobile No."
autocomplete="off"
minlength="10"
maxlength="10"
/>
</div>
<div class="col-sm-4">
<label
><b
>14. Mother's Occupation <span style="color: red">*</span></b
></label
>
<input
type="text"
id="txtmotocc"
class="form-control"
name="motocc"
placeholder="Mother Occupation"
autocomplete="off"
/>
</div>
</div>
<div class="row mt-2">
<div class="col-sm-4">
<label><b>15. Guardian name </b></label
><input
type="text"
id="txtgaurdname"
class="form-control"
name="gaurdname"
placeholder="Guardian Name"
autocomplete="off"
/>
</div>
<div class="col-sm-4">
<label><b>16. Guardian Mobile No </b></label
><input
type="text"
id="txtgaurdmobno"
class="form-control"
name="gaurdmobno"
placeholder="Guardian Mobile No."
autocomplete="off"
minlength="10"
maxlength="10"
/>
</div>
<div class="col-sm-4">
<label> <b>17. Guardian Occupation </b></label>
<input
type="text"
id="txtgaurdocc"
class="form-control"
name="gaurdocc"
placeholder="Guardian Occupation"
autocomplete="off"
/>
</div>
</div>
<div class="row mt-2">
<div class="col-sm-6">
<label
><b>18. Mother Tongue <span style="color: red">*</span></b></label
>
<input
type="text"
id="txtmottongue"
class="form-control"
name="mother_tongue"
placeholder="Mother Tongue"
autocomplete="off"
required
/>
</div>
<div class="col-sm-6">
<label
><b>19. Email <span style="color: red">*</span></b></label
>
<input
type="text"
id="email"
class="form-control"
name="email"
placeholder="Email"
autocomplete="off"
required
/>
</div>
</div>
<div class="row mt-2">
<div class="col-sm-6">
<label> <b>20. Passport No.</b></label>
<span>For Foreign Candidates</span>
<span class="fieldError"> Passport No. is Required </span>
<input
type="text"
id="passport"
class="form-control date"
placeholder="Passport No."
name="Passport No."
maxlength="60"
autocomplete="off"
/>
</div>
<div class="col-sm-6">
<label
><b>21. State of Domicile <span style="color: red">*</span></b></label
>
<input
type="text"
id="domicile"
class="form-control"
name="Domicile"
placeholder="State of Domicile"
autocomplete="off"
required
/>
</div>
</div>
<div class="row mt-2">
<div class="col-sm-6">
<label
><b>22. Permanent Address <span style="color: red">*</span></b></label
>
<span class="fieldError" id="padd1_err">
All fields in Address are required
</span>
<input
type="text"
id="fpermadd1"
name="Permanent Address Line - 1"
class="form-control"
placeholder="Address Line - 1"
maxlength="40"
autocomplete="off"
pattern="[^&'@$%]*"
title="No special characters allowed"
/>
</div>
<div class="col-sm-6">
<label>
<b
>23. Communication Address
<span style="color: red">*   </span> </b
><input
type="checkbox"
id="basic_checkbox_1"
onclick="autoFillAddr()"
autocomplete="off"
/><span style="font-size: 10px !important"
>Same as Perm. Add.?</span
></label
>
<span class="fieldError" id="cadd1_err">
All fields in Address are required
</span>
<input
type="text"
id="fcurradd1"
class="form-control"
name="Communication Address Line - 1"
placeholder="Address Line - 1"
maxlength="40"
autocomplete="off"
/>
</div>
</div>
<div class="row mt-2">
<div class="col-sm-6">
<input
type="text"
id="fpermadd2"
name="Permanent Address Line - 2"
class="form-control"
placeholder="Address Line - 2"
maxlength="40"
autocomplete="off"
/>
</div>
<div class="col-sm-6">
<input
type="text"
id="fcurradd2"
name="Communication Address Line - 2"
class="form-control"
placeholder="Address Line - 2"
maxlength="40"
autocomplete="off"
/>
</div>
</div>
<div class="row mt-2">
<div class="col-sm-6">
<input
type="text"
name="Permanent Address Line - 3"
id="fpermadd3"
class="form-control"
placeholder="Address Line - 3"
maxlength="40"
autocomplete="off"
/>
</div>
<div class="col-sm-6">
<input
type="text"
id="fcurradd3"
name="Communication Address Line - 3"
class="form-control"
placeholder="Address Line - 3"
maxlength="40"
autocomplete="off"
/>
</div>
</div>
<div class="row mt-2">
<div class="col-sm-3">
<input
type="text"
name="Permanent District"
id="fpermdist"
class="form-control"
placeholder="District"
maxlength="30"
onkeypress="return charKeydown(event);"
autocomplete="off"
/>
</div>
<div class="col-sm-3">
<input
type="text"
id="fpermpin"
name="Permanent Pincode"
class="form-control"
placeholder="Pincode"
onkeypress="return acceptNumbersOnlyForModule(event);"
maxlength="6"
autocomplete="off"
/>
</div>
<div class="col-sm-3">
<input
type="text"
id="fcurrdist"
name="Communication District"
class="form-control"
placeholder="District"
maxlength="30"
onkeypress="return charKeydown(event);"
autocomplete="off"
/>
</div>
<div class="col-sm-3">
<input
type="text"
id="fcurrpin"
name="Communication Pincode"
class="form-control"
placeholder="Pincode"
onkeypress="return acceptNumbersOnlyForModule(event);"
maxlength="6"
autocomplete="off"
/>
</div>
</div>
<div class="row mt-2">
<div class="col-sm-6">
<input
type="text"
id="fpermstate"
class="form-control"
placeholder="State"
maxlength="30"
onkeypress="return charKeydown(event);"
autocomplete="off"
/>
</div>
<div class="col-sm-6">
<input
type="text"
id="fcurrstate"
name="Communication State"
class="form-control"
placeholder="State"
maxlength="30"
onkeypress="return charKeydown(event);"
autocomplete="off"
value="Karnataka"
/>
</div>
</div>
<div class="row mt-2">
<div class="col-sm-12">
<button
type="button"
class="btn btn-primary"
onclick="personaldetails_acu()"
>
Save
</button>
</div>
</div>
</div>
</div>
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