0xV3NOMx
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 : 3.149.28.7

Current Path : /var/www/html/cnv/kus/html_modules/
Upload File :
Current File : /var/www/html/cnv/kus/html_modules/system_general_master_setup.html

<div class="portlet box green">
	<div class="portlet-title">
		<div class="caption">
			<i class="fa fa-reorder"></i>Registration Form
		</div>	 
	</div>
</div>	
	<div class="portlet-body form" style='margin-top:20px;margin-left:100px;'>
		<div class="row">
			<!-- BEGIN FORM-->
			<form  class="form-horizontal" id='form_module_details_upload' enctype='multipart/form-data' method='POST'> 
				<div class="col-md-7">
					<input type='hidden' name= 'MAX_FILE_SIZE' value='10000000000' /> 
					<div class="form-body">
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Registration number</label>
							<div class="col-md-3">
								<input type="text"  name="candidate_name" id="candidate_name" class="form-control" title='University Registration no.'  maxlength=10>											
							</div>
						</div>	
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Candidate name</label>
							<div class="col-md-7">
								<input type="text"  name="candidate_name" id="candidate_name" class="form-control" disabled  maxlength=100 >											
							</div>
						</div>	
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >College</label>
							<div class="col-md-7">
								<input type="text"  name="candidate_name" id="candidate_name" class="form-control" disabled  maxlength=100 >											
							</div>
						</div>
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Degree</label>
							<div class="col-md-7">
								<input type="text"  name="candidate_name" id="candidate_name" class="form-control"  disabled maxlength=100 >											
							</div>
						</div>
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Mobile No.</label>
							<div class="col-md-3">
								<input type="text"  name="candidate_name" id="candidate_name" class="form-control"   maxlength=10>											
							</div>
						</div>	
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >confirm Mobile No.</label>
							<div class="col-md-3">
								<input type="text"  name="candidate_name" id="candidate_name" class="form-control"   maxlength=10>											
							</div>
						</div>	
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Email Id.</label>
							<div class="col-md-7">
								<input type="text"  name="candidate_name" id="candidate_name" class="form-control"   maxlength=10>											
							</div>
						</div>	
						<div class="form-group">
							<label class="col-md-3 control-label" style="text-align:left" >Postal Address</label>
							<div class="col-md-7">
								<input type="text"  name="candidate_name" id="candidate_name" class="form-control"   maxlength=50><br>											
								<input type="text"  name="candidate_name" id="candidate_name" class="form-control" style='margin-top:-18px;'  maxlength=50><br>											
								<input type="text"  name="candidate_name" id="candidate_name" class="form-control" style='margin-top:-18px;'  maxlength=50><br>
								<input type="text"  name="candidate_name" id="candidate_name" class="form-control" style='margin-top:-18px;'  maxlength=50><br>								
							</div>
						</div>	
						
				

						
					</div>
				</div>	
				
			</form> 
		</div>
	 
		

					
		<div class="form-body">
			<h3 class="form-section">Declaration</h3>
			<div class="row">
				<div class="col-md-2">
					<div class="form-group">
					<?php
					session_start();
					$_SESSION = array();
					include("captcha/simple-php-captcha.php");
					$_SESSION['captcha'] = simple_php_captcha();
					?>
					<?php
					echo '<img src="' . $_SESSION['captcha']['image_src'] . '" alt="CAPTCHA code">';
					?>					</div>
				</div>
				<div class="col-md-3">
					<div class="form-group">
						<label>Board name</label>
						<input type="text"  id='board_name' placeholder="Board Name" maxlength=50  class="form-control">
					</div>
				</div>
				<div class="col-md-2">
					<div class="form-group">
						<label>Exam Reg. no. / Roll no.</label>
						<input type="text"  id='qreg_no' placeholder="Qualifying Exam Reg. No." maxlength=20  class="form-control">
					</div>
				</div>
							<!--/span-->
			</div>
						
			<div class="row">
				<div class="col-md-2">
					<div class="form-group">
						<label>Passing year</label>
						<input type="text"  id='passing_year' placeholder="Passing Year" maxlength=4  class="form-control">
					</div>
				</div>
							<!--/span-->
				<div class="col-md-5">
					<div class="form-group">
						<label>Board address</label>
						<input type="text" id='board_address' placeholder="Board Address" maxlength=110 class="form-control">
					</div>
				</div>
							<!--/span-->
			</div>
		</div>
						 
										
					
	
	</div>				
	<div class="form-actions fluid">
		<div class="row">
			<div class="col-md-12">
				<div class="col-md-offset-10 col-md-9">
					<button class="btn purple" onclick='CMS.SendMailOtPToUser();' type="button"><i class="fa fa-check"></i> Submit</button>
					<button class="btn red" type="button" ><i class="fa fa-times">Cancel</i></button>
				</div>
			</div>
		</div>
	</div>
			 
<!-- END Row-->